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Lu YB, Huang YN, Weng YC, Chiang TY, Fang TK, Chen WT, Lee JC. Contrast-enhanced ultrasonography guidance avoids US-CT/MR fusion error for percutaneous radiofrequency ablation of hepatocellular carcinoma. BMC Med Imaging 2024; 24:323. [PMID: 39609743 PMCID: PMC11605966 DOI: 10.1186/s12880-024-01508-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 11/20/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND This study evaluated the impact of contrast-enhanced ultrasonography (CEUS) combined with CT or MRI fusion imaging on percutaneous radiofrequency ablation (RFA) outcomes for hepatocellular carcinoma (HCC) inconspicuous on conventional ultrasonography (US). METHODS Patients were categorized into US-inconspicuous (USI) and US-conspicuous (USC) groups based on US imaging. The parameters of viable HCCs ⎯ including diameter, location, and RFA efficacy ⎯ were compared between USI and USC groups. Moreover, the breathing fusion imaging errors were measured. The differences in technical success, technical efficacy, local tumor progression, new tumor occurrence, and overall survival rate between USI and USC groups were analyzed. RESULTS Sixty-five patients with 106 lesions were included. CEUS showed high consistency with CT/MRI but revealed larger diameters (p < 0.001) and more feeding arteries (p = 0.019) than CT/MRI. Breathing fusion imaging errors averaged 17 ± 4 mm, significantly affecting lesions in segments II, III, V, and VI (p < 0.001). The USI group had more lesions ablated per patient in a single RFA procedure (p = 0.001) than the USC group. No significant differences were observed in technical success rate, technical efficacy rate, local tumor progression rate, and overall survival rate between the two groups. CONCLUSIONS CEUS combined with fusion imaging provides detailed information on viable HCCs and their feeding arteries. CEUS-guided RFA avoids fusion imaging errors and achieves comparable efficacy in both US-conspicuous and US-inconspicuous HCCs.
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Affiliation(s)
- Yang-Bor Lu
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Yung-Ning Huang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Yu-Chieh Weng
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Tung-Ying Chiang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Ta-Kai Fang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Wei-Ting Chen
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung-Chieh Lee
- Department of Ultrasound, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China.
- Xiamen Chang Gung Hospital, No. 123 Xiafei Road, Haicang District, Xiamen, Fujian, 361028, China.
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Wu J, Zhou Z, Huang Y, Deng X, Zheng S, He S, Huang G, Hu B, Shi M, Liao W, Huang N. Radiofrequency ablation: mechanisms and clinical applications. MedComm (Beijing) 2024; 5:e746. [PMID: 39359691 PMCID: PMC11445673 DOI: 10.1002/mco2.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 10/04/2024] Open
Abstract
Radiofrequency ablation (RFA), a form of thermal ablation, employs localized heat to induce protein denaturation in tissue cells, resulting in cell death. It has emerged as a viable treatment option for patients who are ineligible for surgery in various diseases, particularly liver cancer and other tumor-related conditions. In addition to directly eliminating tumor cells, RFA also induces alterations in the infiltrating cells within the tumor microenvironment (TME), which can significantly impact treatment outcomes. Moreover, incomplete RFA (iRFA) may lead to tumor recurrence and metastasis. The current challenge is to enhance the efficacy of RFA by elucidating its underlying mechanisms. This review discusses the clinical applications of RFA in treating various diseases and the mechanisms that contribute to the survival and invasion of tumor cells following iRFA, including the roles of heat shock proteins, hypoxia, and autophagy. Additionally, we analyze‌ the changes occurring in infiltrating cells within the TME after iRFA. Finally, we provide a comprehensive summary of clinical trials involving RFA in conjunction with other treatment modalities in the field of cancer therapy, aiming to offer novel insights and references for improving the effectiveness of RFA.
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Affiliation(s)
- Jianhua Wu
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Zhiyuan Zhou
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Yuanwen Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Xinyue Deng
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Siting Zheng
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Shangwen He
- Department of Respiratory and Critical Care MedicineChronic Airways Diseases Laboratory, Nanfang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - Genjie Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Binghui Hu
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Min Shi
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Wangjun Liao
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Na Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
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Hsu WF, Hsu SC, Chen TH, Lin CH, Lin YC, Chang YW, Wang HW, Liao YM, Lai HC, Peng CY. Modified Albumin-Bilirubin Model for Stratifying Survival in Patients with Hepatocellular Carcinoma Receiving Anticancer Therapy. Cancers (Basel) 2022; 14:cancers14205083. [PMID: 36291867 PMCID: PMC9600636 DOI: 10.3390/cancers14205083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/09/2022] [Accepted: 10/15/2022] [Indexed: 11/20/2022] Open
Abstract
Albumin−bilirubin (ALBI) grade is an objective and reproducible model for evaluating overall survival (OS) in patients with hepatocellular carcinoma (HCC). However, the original ALBI grade was established for patients with Child−Pugh classes A−C. HCC patients with Child−Pugh class C or poor performance status (Barcelona Clinic Liver Cancer (BCLC) stage D) usually receive hospice care. Thus, optimized cutoffs for the ALBI grade for stratifying OS in HCC patients receiving anticancer therapy are pertinent for accurate prognostication. This study retrospectively enrolled 2116 patients with BCLC stages A−C HCC after the exclusion of those ineligible for receiving anticancer therapy. The modified ALBI (mALBI) grades were: an ALBI score ≤−3.02 for mALBI grade 1, an ALBI score >−3.02 to ≤−2.08 for mALBI grade 2, and an ALBI score >−2.08 for mALBI grade 3. The original ALBI and mALBI grades were independent predictors of OS in all the enrolled patients and those receiving transarterial chemoembolization. In patients receiving curative therapy (radiofrequency ablation and surgical resection), the mALBI grade (grade 2 vs. 1 and grade 3 vs. 2) was an independent predictor of OS. Original ALBI grade 2 vs. 1 was an independent predictor of OS but not ALBI grade 3 vs. 2. The mALBI model can differentiate between patients with early, intermediate, or advanced HCC who received anticancer therapy into three prognostic groups. External validation of the proposed mALBI grade is warranted.
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Affiliation(s)
- Wei-Fan Hsu
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404327, Taiwan
- School of Chinese Medicine, China Medical University, Taichung 404327, Taiwan
| | - Shih-Chao Hsu
- Department of Surgery, China Medical University Hospital, Taichung 404327, Taiwan
| | - Te-Hong Chen
- Department of Surgery, China Medical University Hospital, Taichung 404327, Taiwan
| | - Chien-Hung Lin
- Department of Radiology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Ying-Chun Lin
- Department of Radiation Oncology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Yu-Wei Chang
- Department of Pathology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Hung-Wei Wang
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 404327, Taiwan
| | - Yu-Min Liao
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung 404327, Taiwan
| | - Hsueh-Chou Lai
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404327, Taiwan
- School of Chinese Medicine, China Medical University, Taichung 404327, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 404327, Taiwan
- Correspondence:
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Chen PY, Tsai TJ, Yang HY, Chou CK, Chang LJ, Chen TH, Hsu MT, Fang CC, Su CC, Lin YL, Feng YM, Chen CY. The Incidence of Bacteremia and Risk Factors of Post-Radiofrequency Ablation Fever for Patients with Hepato-Cellular Carcinoma. Cancers (Basel) 2021; 13:cancers13215303. [PMID: 34771466 PMCID: PMC8582517 DOI: 10.3390/cancers13215303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Post-radiofrequency ablation (RFA) fever is a self-limited complication of RFA. The correlation between post-RFA fever and bacteremia and the risk factors associated with post-RFA fever have not been evaluated. Patients with newly diagnosed or recurrent hepatocellular carcinoma who underwent ultrasonography-guided RFA between April 2014 and February 2019 were retrospectively enrolled. Post-RFA fever was defined as any episode of body temperature >38.0 °C after RFA during hospitalization. A total of 272 patients were enrolled, and there were 452 applications of RFA. The frequency of post-RFA fever was 18.4% (83/452), and 65.1% (54/83) of post-RFA fevers occurred on the first day after ablation. Patients with post-RFA fever had a longer hospital stay than those without (9.06 days vs. 5.50 days, p < 0.001). Only four (4.8%) patients with post-RFA fever had bacteremia. The independent factors associated with post-RFA fever were younger age (adjusted odds ratio (OR) = 0.96, 95% CI, 0.94-0.99, p = 0.019), low serum albumin level (adjusted OR = 0.49, 95% CI, 0.25-0.95, p = 0.036), general anesthesia (adjusted OR = 2.06, 95% CI, 1.15-3.69, p = 0.015), tumor size (adjusted OR = 1.52, 95% CI, 1.04-2.02, p = 0.032), and tumor number (adjusted OR = 1.71, 95% CI, 1.20-2.45, p = 0.003).
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Affiliation(s)
- Po-Yueh Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Tsung-Jung Tsai
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Hsin-Yi Yang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan;
| | - Chu-Kuang Chou
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Li-Jen Chang
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
- Min-Hwei Junior College of Health Care Management, Tainan 73658, Taiwan
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Ming-Tse Hsu
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chien-Chung Fang
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chang-Chao Su
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Yu-Ling Lin
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Yu-Min Feng
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chi-Yi Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
- Correspondence: ; Tel.: +886-5-2765041 (ext. 62535)
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