Long-term results of surgery for small primary liver cancer in 514 adults

1.5T conventional MR-guided iodine-125 interstitial implants for hepatocellular carcinoma: feasibility and preliminary clinical experience

PURPOSE

To evaluate the feasibility and therapeutic efficacy of 1.5 T conventional MR-guided percutaneous interstitial implantation of I-125 radioactive seeds in patients with hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

The institutional ethics committee approved this study. After imformed consent was obtained, twenty-three patients suffering from a total of 65 HCC lesions were treated with I-125 seed permanent interstitial implantation under the guidance of a 1.5T conventional magnetic resonance imaging (MRI) system. The FSE T2WI, T1 FSPGR, FIESTA 2D, 3D Dyn T1WI sequences were used to guide an 18 G MR-compatible needle inserted into the lesions to introduce the I-125 seeds. The response evaluation criteria in solid tumors (RECIST) were used to evaluate the curative effect.

RESULTS

The needle and I-125 seed were seen clearly on MRI images. The final dose delivered to total decay was 173.46 ± 32.44 Gy (range, 110-270 Gy) as calculated by postoperative TPS. The complete response (CR) was seen in 22 lesions (33.8%), partial response (PR) in 24 lesions (36.9%), stable disease (SD) in 9 lesions (13.8%), and progressive disease (PD) in 10 lesions (15.4%). The post-operative alpha-fetoprotein (AFP) was decreased (t = 3.117, P = 0.005<0.05). Two patients were observed a small area of subcapsular bleeding that did not lead to any symptoms or clinical sequelae.

CONCLUSION

MR-guided I-125 implantation for HCC is technically feasible and effective.

Perioperative change in albumin messenger RNA levels in patients with hepatocellular carcinoma

A quantitative assay of albumin messenger RNA (mRNA) in blood samples was designed using the competitive reverse-transcription polymerase chain reaction, and the significance of measuring albumin mRNA levels in the blood of patients with hepatocellular carcinoma (HCC) in hepatic resection was evaluated. Albumin mRNA levels were measured in the following: (1) peripheral blood in 11 patients with HCC and 20 control subjects without liver disease, (2) blood in the portal and hepatic veins in five patients with HCC immediately after laparotomy, and (3) a perioperative series of peripheral blood in eight patients with HCC. Two patients with HCC whose albumin mRNA level in peripheral blood was markedly high were both at stage IVa. On the other hand, 20 control subjects showed negative or <5 x 10(3) transcripts/microgram RNA of albumin mRNA expression. Immediately after laparotomy, the albumin mRNA levels in the tumor-draining hepatic vein were greater than in the portal and non-tumor-draining hepatic veins in four of five patients with HCC. Albumin mRNA levels in peripheral blood showed a marked increase after mobilization and/or resection of the liver and, thereafter, gradually decreased at postoperative day 7 in all eight patients with HCC. A new method to measure the albumin mRNA levels in blood samples was developed, and high albumin mRNA levels in the peripheral blood of patients with advanced-stage HCC suggest the presence of HCC cells in the circulation. Increased levels in the tumor-draining hepatic vein could indicate the spontaneous release of tumor cells or nontumorous hepatocytes or an increased albumin transcription in activated blood mononuclear cells. An increase in the levels in peripheral blood during an operation is intermittent. Therefore, an increased albumin mRNA level in the tumor-draining vein suggests, but does not prove, that the increased albumin mRNA level reflects tumor cells entering the systemic circulation. This alone does not prove that the prognosis is worsened.

Cryotherapy for primary liver cancer

Between November 1973 and December 1996, the in situ freezing of tumor, i.e., cryotherapy, was performed with liquid nitrogen (-196 degrees C) on 235 patients with primary liver cancer (PLC). There were no operative mortalities or severe complications. The 5-year survival was 39.8% for the 235 PLC patients, and 55.4% for the 80 patients with small PLC (< or = 5 cm). When analyzed with respect to treatment modalities without considering the size of the tumor, the 5-year survival was 26.9% for 78 PLC patients treated by cryotherapy alone; 39.6% for 58 PLC patients treated by cryotherapy plus hepatic artery ligation and perfusion; 46.0% for 27 PLC patients treated by cryotherapy for residual tumor plus resection of the main tumor; and 60.4% for 72 PLC patients treated by cryotherapy followed by resection of the frozen tumor. These results indicate that cryotherapy is a safe and effective treatment for PLC.