1
|
Sparks H, Rink JS, Ramakrishnan A, Sung K, Ni J, Lu DSK, Raman SS, Lee EW, Chiang J. Characterization of Microwave Generator Energy and Ablation Volumes following Transarterial Embolization in an In Vivo Porcine Liver Model. J Vasc Interv Radiol 2024; 35:1227-1233. [PMID: 38754759 DOI: 10.1016/j.jvir.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/24/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To characterize the relationship between ablation zone volume (AZV) and microwave ablation (MWA) energy in an in vivo porcine liver model following arterial embolization. MATERIALS AND METHODS With Institutional Animal Care and Use Committee (IACUC) approval, 11 female swine underwent either right (n = 5) or left (n = 6) hepatic artery embolization under fluoroscopic guidance. Subsequently, ultrasound (US)-guided MWA was performed in each liver segment (left lateral, left medial, right medial, and right lateral) at either 30 W (n = 4 lobes), 60 W (n = 4), 65 W (n = 20), 90 W (n = 8), 120 W (n = 4), or 140 W (n = 4) continuously for 5 minutes. Postprocedural volumetric segmentation was performed on standardized multiphase T1 magnetic resonance (MR) imaging sequences. RESULTS Mean AZVs in embolized lobes (15.8 mL ± SD 10.6) were significantly larger than those in nonembolized lobes (11.2 mL ± SD 6.5, P < .01). MWA energy demonstrated significant positive linear correlation with both embolized (R2 = 0.66, P < .01) and nonembolized (R2 = 0.64, P < .01) lobes. The slope of the linear models corresponded to a 0.95 mL/kJ (SD ± 0.16) and 0.54 mL/kJ (SD ± 0.09) increase in ablation volume per applied kilojoule of energy (E) in embolized and nonembolized lobes, respectively. In the multivariate model, embolization status significantly modified the relationship between E and AZV as described by the following interaction term: 0.42∗E∗(embolization status) (P = .031). CONCLUSIONS Linear models demonstrated a near 1.8-fold increase in ratio of AZV per unit E, R(AZV:E), when applied to embolized lobes relative to nonembolized lobes. Absolute AZV differences between embolized and nonembolized lobes were greater at higher-power MWA.
Collapse
Affiliation(s)
- Hiro Sparks
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California.
| | - Johann S Rink
- Department for Radiology and Nuclear Medicine, Mannheim University Medical Centre, Mannheim, Germany
| | - Abinaya Ramakrishnan
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Kyunghun Sung
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Jason Ni
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - David S K Lu
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Steven S Raman
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Edward W Lee
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Jason Chiang
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| |
Collapse
|
2
|
Gallo P, De Vincentis A, Terracciani F, Falcomatà A, Pace Palitti V, Russello M, Vignone A, Alvaro D, Tortora R, Biolato M, Pompili M, Calvaruso V, Marzia V, Tizzani M, Caneglias A, Frigo F, Gesualdo M, Marzano A, Rosato V, Claar E, Villani R, Izzi A, Cozzolongo R, Cozzolino A, Airoldi A, Mazzarelli C, Distefano M, Iegri C, Fagiuoli S, Messina V, Ragone E, Sacco R, Cacciatore P, Masutti F, Crocé SL, Moretti A, Flagiello V, Di Pasquale G, Picardi A, Vespasiani-Gentilucci U. Final Results from the First European Real-World Experience on Lusutrombopag Treatment in Cirrhotic Patients with Severe Thrombocytopenia: Insights from the REAl-World Lusutrombopag Treatment in ITalY Study. J Clin Med 2024; 13:3965. [PMID: 38999529 PMCID: PMC11242055 DOI: 10.3390/jcm13133965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Background and aims: Management of severe thrombocytopenia poses significant challenges in patients with chronic liver disease. Here, we aimed to evaluate the first real-world European post-marketing cohort of cirrhotic patients treated with lusutrombopag, a thrombopoietin receptor agonist, verifying the efficacy and safety of the drug. Methods: In the REAl-world Lusutrombopag treatment in ITalY (REALITY) study, we collected data from consecutive cirrhotic patients treated with lusutrombopag in 19 Italian hepatology centers, mostly joined to the "Club Epatologi Ospedalieri" (CLEO). Primary and secondary efficacy endpoints were the ability of lusutrombopag to avoid platelet transfusions and to raise the platelet count to ≥50,000/μL, respectively. Treatment-associated adverse events were also collected. Results: A total of 66 patients and 73 cycles of treatment were included in the study, since 5 patients received multiple doses of lusutrombopag over time for different invasive procedures. Fourteen patients (19%) had a history of portal vein thrombosis (PVT). Lusutrombopag determined a significant increase in platelet count [from 37,000 (33,000-44,000/μL) to 58,000 (49,000-82,000), p < 0.001]. The primary endpoint was met in 84% of patients and the secondary endpoint in 74% of patients. Baseline platelet count was the only independent factor associated with response in multivariate logistic regression analysis (OR for any 1000 uL of 1.13, CI95% 1.04-1.26, p 0.01), with a good discrimination power (AUROC: 0.78). Notably, a baseline platelet count ≤ 29,000/μL was identified as the threshold for identifying patients unlikely to respond to the drug (sensitivity of 91%). Finally, de novo PVT was observed in four patients (5%), none of whom had undergone repeated treatment, and no other safety or hemorrhagic events were recorded in the entire population analyzed. Conclusions: In this first European real-world series, lusutrombopag demonstrated efficacy and safety consistent with the results of registrational studies. According to our results, patients with baseline platelet counts ≤29,000/μL are unlikely to respond to the drug.
Collapse
Affiliation(s)
- Paolo Gallo
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
| | - Antonio De Vincentis
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
- Research Unit of Internal Medicine, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 01128 Roma, Italy
| | | | - Andrea Falcomatà
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
| | | | | | - Anthony Vignone
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy
| | - Domenico Alvaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy
| | - Raffaella Tortora
- Liver Unit, Department of Medicine, Cardarelli Hospital, 80131 Napoli, Italy
| | - Marco Biolato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 01128 Roma, Italy
| | - Maurizio Pompili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 01128 Roma, Italy
| | - Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, University of Palermo, 90128 Palermo, Italy
| | - Veneziano Marzia
- Gastroenterology and Hepatology Unit, University of Palermo, 90128 Palermo, Italy
| | - Marco Tizzani
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Alessandro Caneglias
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Francesco Frigo
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Marcantonio Gesualdo
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Alfredo Marzano
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Valerio Rosato
- UOSD Epatologia, Ospedale Evangelico Betania, 80147 Naples, Italy
| | - Ernesto Claar
- UOSD Epatologia, Ospedale Evangelico Betania, 80147 Naples, Italy
| | - Rosanna Villani
- C.U.R.E. (University Center for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Antonio Izzi
- Department of Infectious Diseases, D. Cotugno Hospital, 80131 Napoli, Italy
| | - Raffaele Cozzolongo
- Gastroenterology Unit, National Institute of Gastroenterology, IRCCS "S de Bellis" Research Hospital, 70013 Castellana Grotte, Bari, Italy
| | | | - Aldo Airoldi
- Hepatology and Gastroenterology, ASST GOM Niguarda, 20162 Milan, Italy
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology, ASST GOM Niguarda, 20162 Milan, Italy
| | - Marco Distefano
- UOSD Epatologia-Ospedale Umberto I Siracusa-ASP 8, 96100 Siracusa, Italy
| | - Claudia Iegri
- Gastroenterology, Department of Medicine, University of Milan Bicocca, 20126 Milan, Italy
| | - Stefano Fagiuoli
- Gastroenterology, Department of Medicine, University of Milan Bicocca, 20126 Milan, Italy
| | - Vincenzo Messina
- Infectious Disease Unit, AORN Sant'Anna e San Sebastiano, 81100 Caserta, Italy
| | - Enrico Ragone
- UOC Medicina Infettivologica e dei Trapianti UOS Eco Interventistica, Clinica AORN Dei Colli-Ospedale Monaldi, 80131 Napoli, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, 71122 Foggia, Italy
| | | | - Flora Masutti
- Liver Clinic, University Hospital of Trieste (Azienda Sanitaria Giuliano-Isontina), 34149 Trieste, Italy
| | - Saveria Lory Crocé
- Liver Clinic, University Hospital of Trieste (Azienda Sanitaria Giuliano-Isontina), 34149 Trieste, Italy
| | | | | | - Giulia Di Pasquale
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
| | - Antonio Picardi
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 01128 Roma, Italy
| | - Umberto Vespasiani-Gentilucci
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
- Research Unit of Clinical Medicine and Hepatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 01128 Roma, Italy
| |
Collapse
|
3
|
Ümütlü MR, Öcal O, Puhr-Westerheide D, Fabritius MP, Wildgruber M, Deniz S, Corradini S, Rottler M, Walter F, Rogowski P, Seidensticker R, Philipp AB, Rössler D, Ricke J, Seidensticker M. Efficacy and Safety of Local Liver Radioablation in Hepatocellular Carcinoma Lesions within and beyond Limits of Thermal Ablation. Dig Dis 2024:1-12. [PMID: 38781948 DOI: 10.1159/000538788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION CT-guided interstitial brachytherapy (iBT) radiotherapy has been established in the treatment of liver tumors. With iBT, hepatocellular carcinoma (HCC) lesions can be treated beyond the limits of thermal ablation (i.e., size and location). However, a comprehensive analysis of the efficacy of iBT in patients within and beyond thermal ablation limits is lacking. MATERIALS AND METHODS A total of 146 patients with 216 HCC lesions have been analyzed retrospectively. Clinical and imaging follow-up data has been collected. Lesions were evaluated in terms of suitability for thermal ablation or not. The correlation between local tumor control (LTC), time to progression (TTP), overall survival (OS), and clinical and imaging parameters have been evaluated using univariable and multivariable Cox regression analyses. RESULTS LTC rates at 12 months, 24 months, and 36 months were 87%, 75%, and 73%, respectively. 65% of lesions (n = 141) were not suitable for radiofrequency ablation (RFA). The median TTP was 13 months, and the median OS was not reached (3-year OS rate: 70%). No significant difference in LTC, TTP, or OS regarding RFA suitability existed. However, in the overall multivariable analysis, lesion diameter >5 cm was significantly associated with lower LTC (HR: 3.65, CI [1.60-8.31], p = 0.002) and shorter TTP (HR: 2.08, CI [1.17-3.70], p = 0.013). Advanced BCLC stage, Child-Pugh Stage, and Hepatitis B were associated with shorter OS. CONCLUSION iBT offers excellent LTC rates and OS in local HCC treatment regardless of the limits of thermal ablation, suggesting further evidence of its alternative role to thermal ablation in patients with early-stage HCC.
Collapse
Affiliation(s)
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
4
|
Vogl TJ, Martin SS, Gruber-Rouh T, Booz C, Koch V, Nour-Eldin NEA, Hussainy Said MN. Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial. ROFO-FORTSCHR RONTG 2024; 196:482-490. [PMID: 38065541 DOI: 10.1055/a-2203-2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
PURPOSE To compare the therapeutic response and clinical outcome of CT-guided percutaneous microwave (MWA) and radiofrequency ablation (RFA) for the treatment of small- and medium-sized HCC. MATERIALS AND METHODS In this prospective trial, 50 patients with HCC were randomly assigned to MWA or RFA treatment. MRI was performed 24 h before and after ablation and subsequently in 3-month intervals. Ablation volumes, ablation durations, adverse events (AE), technique efficacy, technical success, local tumor progression (LTP), disease-free survival (DFS), intrahepatic distant recurrence (IDR), and overall survival (OS) rates were evaluated. RESULTS The mean ablation volume was 66.5 cm³ for MWA and 29.2 cm³ for RFA (p < 0.01). The mean ablation durations for MWA and RFA were 11.2 ± 4.0 min and 16.3 ± 4.7 min, respectively (p < 0.01). Six mild AEs were documented (p > 0.05). All treatments had a technical success rate and a technique efficacy rate of 100 % (50/50, p = 1.00). LTP within 2 years occurred in 1/25 (4 %) in the MWA group and in 4/25 (16 %) in the RFA group (p = 0.06). IDR within 2 years was 8/25 (32 %) for MWA and 14/25 (56 %) for RFA (p < 0.05). The median DFS was 24.5 months and 13.4 months for MWA and RFA, respectively (p = 0.02). The 1-, 2-, 3-year OS rates were 100 %, 80 %, 72 % in the MWA group and 72 %, 64 %, 60 % in the RFA group, respectively (p ≥ 0.14). CONCLUSION The clinical outcome after MWA or RFA for HCC treatment was very similar with no significant differences in LTP or OS. However, MWA shows a trend toward better DFS with fewer IDRs than RFA. KEY POINTS · MWA allows for larger ablation volumes and a shorter treatment duration compared to RFA in patients with HCC.. · MWA shows a trend toward better disease-free survival and fewer intrahepatic distant recurrences compared to RFA.. · The three-year survival rates show no significant difference between the two methods..
Collapse
Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University, Faculty of Medicine, Cairo, Egypt
| | - M N Hussainy Said
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| |
Collapse
|
5
|
Alhasan AS, Daqqaq TS, Alhasan MS, Ghunaim HA, Aboualkheir M. Complication Rates and Risk of Recurrence After Percutaneous Radiofrequency Ablation and Microwave Ablation for the Treatment of Liver Tumors: a Meta-analysis. Acad Radiol 2024; 31:1288-1301. [PMID: 38087720 DOI: 10.1016/j.acra.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 04/14/2024]
Abstract
RATIONALE AND OBJECTIVES The rate of complications and risk of local recurrence following percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for liver tumors varies significantly between investigations. This meta-analysis aimed to assess complication rates and risk of local recurrence after percutaneous RFA and MWA. MATERIALS AND METHODS PubMed, Medline, Web of Science, the Cochrane Library, Embase, Google Scholar, and CINAHL were systematically searched from database inception until August 2022 to retrieve articles reporting the complication rates and risk of recurrence after percutaneous RFA and MWA for the treatment of liver tumors. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated and displayed by forest plots. To measure heterogeneity, Cochran Q and I2 statistics were also applied. Egger's test and funnel plots were also performed to assess any potential publication bias. Additionally, subgroup analysis was done to investigate the source of heterogeneity. RESULTS 26 studies including 2026 and 1974 patients for RFA and MWA, respectively, were included. The rate of minor complications was significantly higher after MWA compared to RFA, yielding an overall OR of 0.688 (95% CI: 0.549-0.862, P = 0.001). Similarly, the rate of major complications was significantly higher after MWA than RFA (P = 0.012), yielding an overall OR of 0.639 (95% CI: 0.450-0.907). No significant difference was found between RFA and MWA in terms of local recurrence after ablation (P > 0.05). In addition, there was no statistical evidence of publication bias. CONCLUSION When most factors are considered equally, percutaneous RFA and MWA can be considered safe modalities for the treatment of liver tumors, with RFA superior in terms of the incidence of minor and major complications.
Collapse
Affiliation(s)
- Ayman S Alhasan
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.); Department of Radiology, King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia (A.S.A.).
| | - Tareef S Daqqaq
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Mustafa S Alhasan
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Hadeel A Ghunaim
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.); Department of Clinical Science /College of Medicine/Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia (M.A.)
| |
Collapse
|
6
|
Ishigami A, Inaka S, Ishida Y, Nosaka M, Kuninaka Y, Yamamoto H, Shimada E, Kimura A, Furukawa F, Kondo T. A case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma. Forensic Sci Med Pathol 2024; 20:189-193. [PMID: 36943648 DOI: 10.1007/s12024-023-00601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/23/2023]
Abstract
We report a case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma. A 60-year-old female was hospitalized for the treatment of thrombasthenia and cirrhosis caused by chronic Hepatitis C, and computed tomography revealed hepatocellular carcinoma, which was treated by percutaneous radiofrequency ablation. After the ablation, hemoperitoneum was suspected because of the low hemoglobin level with abdominal pain. Approximately 6 h after the ablation treatment, the patient suddenly fell into a shock state and died. In this case, medical treatment-related death including malpractice was suspected, and forensic autopsy was performed. The abdominal cavity contained 910 mL of dark red fluid blood and 210 g of soft hemocoagula. Moreover, several puncture marks were observed on the liver surface and diaphragm, and there was no clear damage to the main arteries and veins. Considering the macroscopic and microscopic findings, the cause of death was assumed as hemorrhagic shock due to the hemoperitoneum caused by the damage to the liver by radiofrequency ablation. It is important to consider all the indications and adverse effects of radiofrequency ablation.
Collapse
Affiliation(s)
- Akiko Ishigami
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Shogo Inaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Yuko Ishida
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Mizuho Nosaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Yumi Kuninaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Hiroki Yamamoto
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Emi Shimada
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Akihiko Kimura
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Fukumi Furukawa
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Toshikazu Kondo
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan.
| |
Collapse
|
7
|
Peng X, Xing J, Zou H, Pang M, Huang Q, Zhou S, Li K, Ge M. Postoperative SIRS after thermal ablation of HCC: Risk factors and short-term prognosis. Heliyon 2024; 10:e25443. [PMID: 38327471 PMCID: PMC10847922 DOI: 10.1016/j.heliyon.2024.e25443] [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: 09/23/2023] [Revised: 01/15/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
Background We aimed to explore the potential risk factors and short-term prognosis for SIRS after thermal ablation of hepatocellular carcinoma (HCC). Methods Data from patients with HCC who underwent thermal ablation in the Third Affiliated Hospital of Sun Yat-sen University between January 2015 and August 2021 were retrieved from the perioperative database. Pre-, intra- and postoperative data between SIRS group and non-SIRS group were compared and multivariate logistic regression analysis was performed to identify the risk factors for SIRS after thermal ablation. Results A total of 1491 patients were enrolled and 234 (15.7 %) patients developed SIRS after thermal ablation. Compared with those without SIRS, patients with SIRS had a longer hospital stay, higher hospitalization costs and higher risk of more severe postoperative complications. In the multivariate logistic regression analysis, current smoking (OR 1.58, 95 %CI 1.09-2.29), decreased HCT (OR 1.51,95 %CI 1.11-2.04), NEUT < 1.5 × 109/L(OR 1.74, 95 %CI 1.14-2.65), NEUT% < 0.5 or > 0.7 (OR 1.36, 95 %CI 1.01-1.83) and PT > 16.3s (OR 2.42, 95 %CI 1.57-3.74) were significantly associated with postoperative SIRS. Conclusions Current smoking, decreased HCT, neutropenia, abnormal percentage of neutrophils and prolonged PT are the independent risk factors for SIRS after thermal ablation of HCC, which worsens outcomes of patients. This study can help identify high-risk population and guide appropriate care so as to reduce the incidence of postoperative SIRS.
Collapse
Affiliation(s)
- Xiaorong Peng
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jibin Xing
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hao Zou
- Department of Anesthesiology, Foshan Women and Children Hospital, Foshan, China
| | - Mengya Pang
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Qiannan Huang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaoli Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mian Ge
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
8
|
Matevish L, Patel MS, Vagefi PA. Downstaging Techniques for Hepatocellular Carcinoma in Candidates Awaiting Liver Transplantation. Surg Clin North Am 2024; 104:145-162. [PMID: 37953033 DOI: 10.1016/j.suc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
During the last decade, downstaging for hepatocellular carcinoma has expanded the pool of patients eligible for liver transplantation. The literature is rife with attempts to elucidate best treatment strategies with novel locoregional and systemic therapies continuing to emerge. Several trials have confirmed the large-scale success of downstaging protocols, with equitable long-term survival and recurrence rates after liver transplant. We review the currently available techniques used for downstaging, including their indications, complications, and efficacies. New frontiers have focused on the potential role of immunotherapy in the neoadjuvant setting, although more research is needed to delineate its role in current treatment paradigms.
Collapse
Affiliation(s)
- Lauren Matevish
- Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar S Patel
- Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Parsia A Vagefi
- Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
9
|
Orsi F. Interventional oncology in breast cancer. J Med Imaging Radiat Oncol 2023; 67:876-885. [PMID: 37964687 DOI: 10.1111/1754-9485.13600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Breast cancer (BC) is the most common cancer and one of the most important causes of death in women. Surgery is the standard therapy for breast cancer and in the last decades evolved towards a more conservative approach, with lumpectomy, followed by radiation therapy, the most common option. Unfortunately, up to 40% of women affected by BC will develop metastases and will receive systemic therapy, which improves survival and quality of life. Interventional oncology (IO), thanks to the improvement in technology and clinical experience, is gaining an important role in the field of breast cancer, both in treating the primary tumour and also in metastasis in well-selected cases. Percutaneous thermal ablation and more recently cryoablation are reported to achieve promising results in the radical treatment of small breast cancer, with optimal cosmetic outcome and a very high safety profile. Percutaneous ablation as well as intra-arterial therapies, such as chemoembolization and radioembolization, might also be indicated in metastatic BC patients. In advanced stage disease, breast cancer liver metastases (BCLM) represent the main factor affecting the overall survival. Metastatic breast disease is a systemic disease, with tumour deposits potentially spread into different organs and tissues for which systemic therapy is the standard approach. Local therapies for liver metastases might have an important role in improving survival and quality of life in well-selected patients. Clinical and technical indications with their limitations, results and potential complications in local IO treatment for BCLM, will be also described.
Collapse
Affiliation(s)
- Franco Orsi
- IRCCS Istituto Europeo di Oncologia, Milan, Italy
| |
Collapse
|
10
|
Minami Y, Aoki T, Hagiwara S, Kudo M. Tips for Preparing and Practicing Thermal Ablation Therapy of Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:4763. [PMID: 37835456 PMCID: PMC10571938 DOI: 10.3390/cancers15194763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Thermal ablation therapy, including radiofrequency ablation (RFA) and microwave ablation (MWA), is considered the optimal locoregional treatment for unresectable early-stage hepatocellular carcinomas (HCCs). Percutaneous image-guided ablation is a minimally invasive treatment that is being increasingly performed because it achieves good clinical outcomes with a lower risk of complications. However, the physics and principles of RFA and MWA markedly differ. Although percutaneous thermal ablation under image guidance may be challenging in HCC cases with limited access or a risk of thermal injury, a number of ablative techniques, each of which may be advantageous and disadvantageous for individual cases, are available. Furthermore, even when a HCC is eligible for ablation based on tumor selection and technical factors, additional patient factors may have an impact on whether it is the appropriate treatment choice. Therefore, a basic understanding of the advantages and limitations of each ablation device and imaging guidance technique, respectively, is important. We herein provide an overview of the basic principles of tissue heating in thermal ablation, clinical and laboratory parameters for ablation therapy, preprocedural management, imaging assessments of responses, and early adverse events. We also discuss associated challenges and how they may be overcome using optimized imaging techniques.
Collapse
Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan (M.K.)
| | | | | | | |
Collapse
|
11
|
Ben-Arie G, Sosna J. Predicting Infectious Complications after US-guided Ablation of Liver Malignancies: Personalized Patient Care. Radiology 2023; 308:e231681. [PMID: 37552070 DOI: 10.1148/radiol.231681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Gal Ben-Arie
- From the Department of Medical Imaging, Soroka Medical Center, Rager Blvd, PO Box 151, Be'er Sheva, Israel 84101 (G.B.A.); Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel (G.B.A.); and Department of Radiology, Hebrew University School of Medicine, Hadassah Medical Center, Jerusalem, Israel (J.S.)
| | - Jacob Sosna
- From the Department of Medical Imaging, Soroka Medical Center, Rager Blvd, PO Box 151, Be'er Sheva, Israel 84101 (G.B.A.); Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel (G.B.A.); and Department of Radiology, Hebrew University School of Medicine, Hadassah Medical Center, Jerusalem, Israel (J.S.)
| |
Collapse
|
12
|
Li X, Zhang Y, Wang X, Zeng H, Zhou L, Huang G, Lin M, Zhuang B, Xie X, Xu M. Predicting Infectious Complications after Percutaneous Thermal Ablation of Liver Malignancies: A 12-year Single-Center Experience. Radiology 2023; 308:e223091. [PMID: 37552092 DOI: 10.1148/radiol.223091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background Infectious complications after percutaneous thermal ablation are seldom discussed, but better understanding of risk factors and early prediction is critical. Purpose To estimate the incidence of infectious complications after percutaneous thermal ablation of liver malignancies and to develop prediction models. Materials and Methods This single-center retrospective study reviewed the data of 3167 patients who underwent 7545 percutaneous US-guided thermal ablation procedures of liver malignancies between January 2010 and January 2022. All procedures with infectious complications were included as the case group. For each case, one treatment date-matched control subject without infection was randomly selected following a nested case-control design. Independent factors of overall and hepatobiliary infection were investigated with multivariable logistic regression. Results A total of 80 patients (median age, 59 years; IQR, 51-68 years; 64 men, 16 women) developed infectious complications after 80 ablation procedures; the incidence was 1.1% (80 of 7545 procedures). Of those with infection, 18% (14 of 80 patients) were severe, and 10% (eight of 80 patients) died as a result. Independent risk factors for overall infectious complication included prior biliary intervention (odds ratio [OR], 18.6; 95% CI: 4, 86; P < .001), prior transarterial chemoembolization (TACE) (OR, 2.4; 95% CI: 1.0, 5.8; P = .045), and the largest tumor size (OR, 1.9; 95% CI: 1.3, 2.8; P = .002); on this basis, subcapsular location was an additional risk factor of hepatobiliary infection. Prediction models for overall and hepatobiliary infection had an area under the receiver operating characteristics curve (AUC) of 0.77 and 0.82, respectively, both of which showed better AUC compared with the models, including prior biliary intervention alone (AUC = 0.63 and 0.65, respectively; P = .01 and P = .005, respectively). Conclusion Infectious complications after percutaneous thermal ablation of liver malignancies were uncommon but potentially fatal. Independent predictors were prior biliary intervention, prior transarterial chemoembolization, and the largest tumor size. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Ben-Arie and Sosna in this issue.
Collapse
Affiliation(s)
- Xiaoju Li
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Yutong Zhang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Xiaoli Wang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Hua Zeng
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Luyao Zhou
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Guangliang Huang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Manxia Lin
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Bowen Zhuang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Xiaoyan Xie
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| | - Ming Xu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.)
| |
Collapse
|
13
|
Jing R, Merritt T, Gemmete JJ. Diaphragmatic Injury with Empyema Development after Microwave Ablation of a Liver Dome Lesion. Semin Intervent Radiol 2023; 40:258-261. [PMID: 37484437 PMCID: PMC10359124 DOI: 10.1055/s-0043-1769774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Percutaneous microwave ablation (MWA) of the liver is a minimally invasive procedure that utilizes high frequency electromagnetic waves to generate heat and induce tumor necrosis. MWA has been proven to be a safe and effective treatment option for primary and metastatic liver tumors. The treatment of liver dome lesions can present a technical challenge due to the proximity of the hepatic dome to the diaphragm and lung parenchyma. In this report, we present a case of diaphragmatic injury and subsequent empyema following MWA of a liver dome lesion.
Collapse
Affiliation(s)
- Ran Jing
- Integrated IR/DR Residency, Michigan Medicine, Ann Arbor, Michigan
| | - Travis Merritt
- Integrated IR/DR Residency, Michigan Medicine, Ann Arbor, Michigan
| | - Joseph J. Gemmete
- Departments of Radiology, Neurosurgery, Neurology, and Otolaryngology, Michigan Medicine, Ann Arbor, Michigan
| |
Collapse
|
14
|
Domini J, Makary MS. Single-center analysis of percutaneous ablation in the treatment of hepatocellular carcinoma: long-term outcomes of a 7-year experience. Abdom Radiol (NY) 2023; 48:1173-1180. [PMID: 36717404 DOI: 10.1007/s00261-023-03819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE The objective of this study is to examine the safety and efficacy of ablative therapy for hepatocellular carcinoma (HCC). METHODS A retrospective review of 419 consecutive patients diagnosed with HCC, treated with percutaneous ablation at a tertiary academic medical center from June 2015 to June 2022, was conducted. Data evaluated included demographics, disease and tumor burden scores, and functional status. Procedural outcomes included procedural course, complication rates, biochemical and radiologic response, survival, and functional status. RESULTS A total of 419 patients, including 313 males (74.7%) and 106 females (25.3%) with a mean age of 63.8 ± 6.64 years, made up the study cohort. 120 patients (28.6%) presented with solitary lesions and 299 patients (71.4%) had multifocal involvement, with a mean tumor size of 2.3 ± 0.92 cm. A majority of the interventions performed were microwave ablations (n = 413, 98.3%), with 6 radiofrequency ablations (1.4%). Treatment response was radiographically assessed up to 6 months post-ablation and graded as complete response (96.2%), partial response (2.6%), stable disease (0%), and progressive disease (1.2%). 97 (23.2%) of the treated patients went on to receive liver transplant. The average progression-free survival in the study population was 24 months with a survival of 85.9% (n = 360), 67.8% (n = 284), and 63.2% (n = 265) at 1 year, 3 years, and 5 years respectively. Functional outcomes, as defined by ECOG scores, were maintained or improved in 383 patients (91.4%) and 349 patients (83.3%) at 6 months and 12 months respectively. CONCLUSIONS This large institutional experience demonstrated safety and efficacy of ablation therapies for treatment of HCC with promising tumor response rates and enduring clinical outcomes including prolonged survival and preserved functional status.
Collapse
Affiliation(s)
- John Domini
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12Th Ave, 4Th Floor Faculty Office Tower, Columbus, OH, 43210, USA
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12Th Ave, 4Th Floor Faculty Office Tower, Columbus, OH, 43210, USA.
| |
Collapse
|
15
|
Jo MG, Lee MW, Ahn S, Kang TW, Song KD, Cha DI, Min JH, Rhim H. Percutaneous radiofrequency ablation of hepatocellular carcinoma in a recent cohort at a tertiary cancer center: incidence and factors associated with major complications and unexpected hospitalization events. Ultrasonography 2023; 42:41-53. [PMID: 36353791 PMCID: PMC9816693 DOI: 10.14366/usg.22041] [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: 03/12/2022] [Accepted: 05/23/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE This study aimed to assess the incidence of and factors associated with major complications, delayed discharge, and emergency room (ER) visits or readmission after percutaneous radiofrequency ablation (RFA) for single hepatocellular carcinoma (HCC) <3 cm in a recent cohort at a tertiary cancer center. METHODS A total of 188 patients with treatment-naïve single HCCs <3 cm who underwent RFA between January 2018 and April 2021 were included in the analysis. Univariable and multivariable logistic regression analyses were performed to identify the factors associated with major complications, delayed discharge, and ER visits or readmission. Local tumor progression (LTP) and overall survival were estimated using the Kaplan-Meier method and Cox proportional-hazards regression analysis. RESULTS Major complications occurred in 3.2% (6/188) of the patients. The longest diameter of the ablation zone was significantly larger in patients with major complications (P=0.023). Delayed discharge occurred in 5.8% (9/188) of the patients, for which albumin-bilirubin grade 3 was identified as an important determinant. No variables other than major complications were significantly associated with ER visits or readmission, which occurred in 7.0% (13/188) of the patients. Major complications, delayed discharge, and ER visits or readmission were not substantially related to the post-treatment outcomes of LTP and overall survival. CONCLUSION This study confirmed RFA as a highly safe procedure for single HCCs <3 cm, despite the rapidly changing RFA techniques in the most recent cohort. A large ablation zone and poor liver function were predictors of major complications and delayed discharge, respectively.
Collapse
Affiliation(s)
- Min Geun Jo
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea,Correspondence to: Min Woo Lee, MD, PhD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel. +82-2-3410-2518 Fax. +82-2-3410-2559 E-mail:
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
16
|
Analysis of Infectious Complications after Thermal Ablation of Hepatocellular Carcinoma and the Impact on Long-Term Survival. Cancers (Basel) 2022; 14:cancers14215198. [PMID: 36358617 PMCID: PMC9657620 DOI: 10.3390/cancers14215198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Although thermal ablation has been widely used in treatments of HCC due to its unique advantages of less trauma, safety, postoperative complications still occur in clinical practice. Infectious complications are the third most common complication. The objective of our retrospective study was to summarize the clinical characteristics of infection after thermal ablation for HCC patients and to explore whether it affects tumor recurrence and overall survival. We enrolled 49 patients who developed postoperative infections and matched the same number of control patients, and we also summarized the clinical features and treatment of mild and severe infections. We found that postoperative infection among patients receiving ultrasound-guided thermal ablation adversely affected tumor progression. Empirical antibiotics and catheterization to reduce pressure inside the lesion should be utilized to minimize symptoms in patients with postoperative infection. Abstract Purpose: This study aims to complete a detailed record of the clinical characteristics and treatment of HCC patients with post-ablation infection and evaluate the infections on recurrence-free survival (RFS) and overall survival (OS) among patients receiving ultrasound-guided thermal ablation. Methods: 3117 patients with liver tumors receiving thermal ablation from January 2010 to December 2021 were analyzed. A total of 49 patients with infectious complications after thermal ablation were selected as the infection group. A total of 49 patients without postoperative infection were randomly selected among those who underwent ablation within three days before or after the treatment date of the infection group as the control group. The clinical characteristics of both groups were analyzed by an independent sample t-test and chi-square test. A log-rank test was performed to compare the RFS and OS data. A multivariate Cox regression model was employed to identify prognostic factors influencing RFS and OS. Subgroup analyses of mild and severe infections were conducted to explore the infection-related situation further. Results: Between mild and severe infection groups, there were statistically significant differences in the infection position (p = 0.043), positive rate of body fluid culture (p = 0.002), proportion of catheter drainage (p = 0.017), use of advanced antibiotics (p = 0.006), and outcome (p = 0.00). The Kaplan–Meier survival analysis revealed that postoperative infection was significantly correlated with tumor recurrence (p = 0.028), and severe infection was significantly associated with overall survival (p = 0.049). The cox model showed that postoperative infection was an independent variable for RFS deterioration (HR = 1.724, 95% CI: 1.038–2.862, p = 0.035). Conclusions: Postoperative infection among patients receiving ultrasound-guided thermal ablation adversely affected tumor progression. In addition, empirical antibiotics and catheterization to reduce pressure inside the lesion should be utilized to minimize symptoms in patients with postoperative infection.
Collapse
|
17
|
Huang Q, Pang M, Zeng Q, He X, Zheng R, Ge M, Li K. The frequency and risk factors of major complications after thermal ablation of liver tumours in 2,084 ablation sessions. Front Surg 2022; 9:1010043. [PMID: 36189384 PMCID: PMC9520062 DOI: 10.3389/fsurg.2022.1010043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background To assess the frequency of major complications after thermal ablation of liver tumours and to determine risk factors for adverse events. Methods A retrospective study was conducted between January 2015 and January 2021. A total of 2,084 thermal ablation sessions in 1,592 patients with primary and metastatic liver tumours were evaluated. The frequency of major complications was evaluated according to the Society of Interventional Radiology Standards, and putative predictors of adverse events were analysed using simple and multivariate logistic regression. Results Thermal ablation-related mortality was 0.1% (2/2,084), with an overall major complication rate of 5.6% (117/2,084). The most frequent major complication was symptomatic pleural effusion (2.9%, 60/2,084). Multivariate logistic regression analysis revealed that a total maximum diameter of lesions >3 cm, microwave ablation (MWA) and MWA combined with radiofrequency ablation, intrahepatic cholangiocarcinoma and postoperative systemic inflammatory response syndrome were independent prognostic factors for major complications. Conclusions Thermal ablation of liver tumours is a safe procedure with an acceptable incidence of major complications. The risk factors identified in this study will help to stratify high-risk patients.
Collapse
Affiliation(s)
- Qiannan Huang
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mengya Pang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuqi He
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mian Ge
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Correspondence: Kai Li Mian Ge
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Correspondence: Kai Li Mian Ge
| |
Collapse
|
18
|
Tsunoda J, Nishi T, Ito T, Inaguma G, Matsuzaki T, Seki H, Yasui N, Sakata M, Shimada A, Matsumoto H. Laparoscopic repair of diaphragmatic hernia associating with radiofrequency ablation for hepatocellular carcinoma: A case report. World J Clin Cases 2022; 10:7020-7028. [PMID: 36051126 PMCID: PMC9297430 DOI: 10.12998/wjcc.v10.i20.7020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/21/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is an effective treatment for early-stage hepatocellular carcinoma (HCC). Although RFA is a relatively safe technique compared with surgery, several complications have been reported to be following/accompanying this treatment. Delayed diaphragmatic hernia caused by RFA is rare; however, the best surgical approach for its treatment is uncertain. We present a case of laparoscopic repair of diaphragmatic hernia due to RFA.
CASE SUMMARY An 80-year-old woman with segment VIII HCC was treated twice in 5 years with RFA; 28 mo after the second RFA, the patient complained of right hypochondriac pain. Computed tomography revealed that the small intestine was incarcerated in the right thorax. The patient was diagnosed with diaphragmatic hernia and underwent laparoscopic repair by non-absorbable running sutures. The patient’s postoperative course was favorable, and the patient was discharged on postoperative day 12. The diaphragmatic hernia has not recurred 24 mo after surgery.
CONCLUSION Laparoscopic treatment of iatrogenic diaphragmatic hernia is effective and minimally invasive.
Collapse
Affiliation(s)
- Junya Tsunoda
- Department of Surgery, Keiyu Hospital, Yokohama 220-8521, Japan
| | - Tomohiko Nishi
- Department of Surgery, Keiyu Hospital, Yokohama 220-8521, Japan
| | - Takafumi Ito
- Department of Internal Medicine, Keiyu Hospital, Yokohama 220-8521, Japan
| | - Gaku Inaguma
- Department of Surgery, Keiyu Hospital, Yokohama 220-8521, Japan
| | | | - Hiroaki Seki
- Department of Surgery, Keiyu Hospital, Yokohama 220-8521, Japan
| | - Nobutaka Yasui
- Department of Surgery, Keiyu Hospital, Yokohama 220-8521, Japan
| | - Michio Sakata
- Department of Surgery, Keiyu Hospital, Yokohama 220-8521, Japan
| | - Akihiko Shimada
- Department of Surgery, Keiyu Hospital, Yokohama 220-8521, Japan
| | | |
Collapse
|
19
|
Zane KE, Nagib PB, Jalil S, Mumtaz K, Makary MS. Emerging curative-intent minimally-invasive therapies for hepatocellular carcinoma. World J Hepatol 2022; 14:885-895. [PMID: 35721283 PMCID: PMC9157708 DOI: 10.4254/wjh.v14.i5.885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/20/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common cause of liver malignancy and the fourth leading cause of cancer deaths universally. Cure can be achieved for early stage HCC, which is defined as 3 or fewer lesions less than or equal to 3 cm in the setting of Child-Pugh A or B and an ECOG of 0. Patients outside of these criteria who can be down-staged with loco-regional therapies to resection or liver transplantation (LT) also achieve curative outcomes. Traditionally, surgical resection, LT, and ablation are considered curative therapies for early HCC. However, results from recently conducted LEGACY study and DOSISPHERE trial demonstrate that transarterial radio-embolization has curative outcomes for early HCC, leading to its recent incorporation into the Barcelona clinic liver criteria guidelines for early HCC. This review is based on current evidence for curative-intent loco-regional therapies including radioembolization for early-stage HCC.
Collapse
Affiliation(s)
- Kylie E Zane
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Paul B Nagib
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Sajid Jalil
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| |
Collapse
|
20
|
Karagiannis E, Strouthos I, Leczynski A, Zamboglou N, Ferentinos K. Narrative Review of High-Dose-Rate Interstitial Brachytherapy in Primary or Secondary Liver Tumors. Front Oncol 2022; 12:800920. [PMID: 35299745 PMCID: PMC8920984 DOI: 10.3389/fonc.2022.800920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022] Open
Abstract
The optimal management of intrahepatic malignancies involves a multidisciplinary approach. Although surgical resection has been considered the only curative approach, the use of several minimally invasive ablative techniques has dramatically increased the last two decades, mainly due to the fact that they provide similar oncological results with significantly decreased morbidity. Among these modalities, interstitial liver brachytherapy, probably the most flexible liver ablative method, with excellent clinical data on its safety and effectiveness, is frequently not even mentioned as an option in the current peer reviewed literature and guidelines. Brachytherapy is a type of radiotherapy utilizing radionuclides that are directly inserted into the tumor. Compared to external beam radiation therapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time, with the advantage of a rapid dose fall-off, that allows for sparing of adjacent healthy tissue. For numerous malignancies such as skin, gynecological, breast, prostate, head and neck, bladder, liver and soft-tissue tumors, brachytherapy as a monotherapy or combined with external beam radiation therapy, has become a standard treatment for many decades. This review article aims to describe the high-dose-rate liver brachytherapy technique, its selection criteria, present its advantages and disadvantages, as well as the available clinical data, in order to help physicians to explore and hopefully introduce liver brachytherapy into their clinical routine.
Collapse
Affiliation(s)
- Efstratios Karagiannis
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Agnes Leczynski
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
| | - Nikolaos Zamboglou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| |
Collapse
|
21
|
Yang Y, Yu H, Qi L, Liu C, Feng Y, Qi J, Li J, Zhu Q. Combined radiofrequency ablation or microwave ablation with transarterial chemoembolization can increase efficiency in intermediate-stage hepatocellular carcinoma without more complication: a systematic review and meta-analysis. Int J Hyperthermia 2022; 39:455-465. [PMID: 35271786 DOI: 10.1080/02656736.2022.2048095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES Radiofrequency ablation (RFA) and microwave ablation (MWA) are widely used in combination with transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) in clinical practice. We aim to compare the efficacy and safety of TACE combined with RFA or MWA versus TACE monotherapy for intermediate-stage HCC. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant studies. The outcomes included overall survival (OS), progression-free survival (PFS), local tumor control (LTC) rate, and major complication. Subgroup analysis for different TACE combination therapies was performed. RESULTS Ten studies with 1799 patients with intermediate-stage HCC were included. The pooled hazard ratio (HR) for OS was in favor of TACE combination therapy (HR, 0.50, 95% confidence interval [CI], 0.40-0.62). Specifically, the TACE combination therapy was associated with higher 1-, 3-, and 5-year OS rates. Regarding tumor progression, the TACE combination therapy showed significantly better PFS (HR, 0.47, 95% CI, 0.37-0.61) and higher 1-, 2- and 3-year PFS rates than TACE monotherapy. The pooled odds ratio (OR) for the LTC was also in favor of TACE combination therapy (OR, 0.36, 95% CI, 0.24-0.53). No significant difference was found between the two groups regarding the major complication rate (OR, 1.26, 95% CI, 0.74-2.16). These results were consistent across subgroups of TACE + RFA versus TACE and TACE + MWA versus TACE. CONCLUSION TACE combined with RFA or MWA can provide significantly better OS, PFS and LTC than TACE monotherapy for patients with intermediate-stage HCC, without increasing the risk of major complications.
Collapse
Affiliation(s)
- Yao Yang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongli Yu
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lingyu Qi
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chenxi Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuemin Feng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jianni Qi
- Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jie Li
- Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| |
Collapse
|
22
|
El-Agawy W, El-Ganainy SA, Gad MAA, Abd-Elsalam S, Mostafa WAA, El-Shewi MES. Combined Transarterial Chemoembolization with Microwave Ablation versus Microwave Alone for Treatment of Medium Sized Hepatocellular Carcinoma. Curr Cancer Drug Targets 2022; 22:77-85. [PMID: 35078397 DOI: 10.2174/1568009622666220117094146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
Background & Aims:
Hepatocellular carcinoma (HCC) is the fifth most common cancer
and the second leading cause of cancer-related deaths. The only definitive treatment for both HCC
and cirrhosis is liver transplantation, but long wait times in some regions and a relatively fixed
number of donor organs negatively impact access to liver transplantation. The aim of the work was
to evaluate and compare the short outcome of patients with medium-sized HCC who will undergo
percutaneous microwave ablation (MWA) alone and in combination with TACE.
Methods:
This prospective study included 40 patients with medium-sized HCC lesions who were
classified into two groups; Group A that included twenty patients treated by TACE followed by percutaneous MWA after 2 weeks and group B that included twenty patients treated by 2 sessions of
percutaneous MWA with 2 weeks interval. Full history taking, clinical examination, laboratory investigation, abdominal ultrasonography and abdominal tri-phasic computed tomography (CT) with
contrast were obtained from the two groups. Laboratory and radiological follow up of the cases
were done at 1 and 3 months after the treatment.
Results:
There was no statistically significant difference in the sociodemographic criteria, laboratory measurement and clinical criteria between the cases in the two study groups before initiation of
treatment. The response was slightly better in the combined treatment group, but it did not show a
statistically significant difference. The incidence of complications was higher in the MWA group.
Conclusion::
Hepatocellular carcinoma is a common complication of HCV related cirrhosis. Association of TACE-MWA led to better response rates than MWA with fewer complications.
Collapse
Affiliation(s)
- Waleed El-Agawy
- Tropical Medicine Department, Faculty of Medicine, Port-Said University, Port Fouad, Egypt
| | | | - Magdy Abd Almawgoud Gad
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of
Medicine, Benha University, Benha, Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University,
Tanta, Egypt
| | | | - Mohammed El-Sayed El-Shewi
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of
Medicine, Benha University, Benha, Egypt
| |
Collapse
|
23
|
Huolin YMD, Qiannan HMD, Qingjing ZMD, Xuqi HMD, Erjiao XMD, Yinglin LMD, Kai LMD, Rongqin ZMD. Contrast-enhanced Ultrasound for Evaluation of Active Needle Tract Bleeding during Thermal Ablation of Liver Cancer. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2021.210019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
24
|
Takayama T, Hasegawa K, Izumi N, Kudo M, Shimada M, Yamanaka N, Inomata M, Kaneko S, Nakayama H, Kawaguchi Y, Kashiwabara K, Tateishi R, Shiina S, Koike K, Matsuyama Y, Omata M, Makuuchi M, Kokudo N. Surgery versus Radiofrequency Ablation for Small Hepatocellular Carcinoma: A Randomized Controlled Trial (SURF Trial). Liver Cancer 2021; 11:209-218. [PMID: 35949295 PMCID: PMC9218617 DOI: 10.1159/000521665] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION It remains unclear which surgery or radiofrequency ablation (RFA) is the more effective treatment for small hepatocellular carcinoma (HCC). We aimed to compare survival between patients undergoing surgery (surgery group) and patients undergoing RFA (RFA group). METHODS We conducted a randomized controlled trial involving 49 institutions in Japan. Patients with Child-Pugh scores ≤7, largest HCC diameter ≤3 cm, and ≤3 HCC nodules were considered eligible. The co-primary endpoints were recurrence-free survival (RFS) and overall survival (OS). The current study reports the final result of RFS, and the follow-up of OS is still ongoing. RESULTS During 2009-2015, 308 patients were registered. After excluding ineligible patients, the surgery and RFA groups included 150 and 151 patients, respectively. Baseline factors did not differ significantly between the groups. In both groups, 90% of patients had solitary HCC. The median largest HCC diameter was 1.8 cm (interquartile range [IQR], 1.5-2.2 cm) in the surgery group and 1.8 cm (IQR, 1.5-2.3 cm) in the RFA group. The median procedure duration (274 vs. 40 min, p < 0.01) and the median duration of hospital stay (17 days vs. 10 days, p < 0.01) were longer in the surgery group than in the RFA group. RFS did not differ significantly between the groups as the median RFS was 3.5 (95% confidence interval [CI], 2.6-5.1) years in the surgery group and 3.0 (95% CI, 2.4-5.6) years in the RFA group (hazard ratio, 0.92; 95% CI, 0.67-1.25; p = 0.58). DISCUSSION/CONCLUSION Our study did not show which surgery or RFA is the better treatment option for small HCC.
Collapse
Affiliation(s)
- Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan,*Kiyoshi Hasegawa,
| | - Namiki Izumi
- Department of Gastroenterology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University School of Medicine, Tokushima, Japan
| | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Ishikawa, Japan
| | - Hisashi Nakayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kosuke Kashiwabara
- Biostatistics Division, Central Coordinating Unit, Clinical Research Support Center, the University of Tokyo Hospital, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterological Imaging and Interventional Oncology, Juntendo University, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Masao Omata
- Internal Medicine, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | | | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
25
|
Image-guided locoregional non-intravascular interventional treatments for hepatocellular carcinoma: Current status. J Interv Med 2021; 4:1-7. [PMID: 34805939 PMCID: PMC8562266 DOI: 10.1016/j.jimed.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/26/2020] [Accepted: 10/10/2020] [Indexed: 01/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most deadly and frequent cancers worldwide, although great advancement in the treatment of this malignancy have been made within the past few decades. It continues to be a major health issue due to an increasing incidence and a poor prognosis. The majority of patients have their HCC diagnosed at an intermediate or advanced stage in theUSA or China. Curative therapy such as surgical resection or liver transplantation is not considered anoption of treatment at these stages. Transarterial chemoembolization (TACE), the most widely used locoregional therapeutic approach, used to be the mainstay of treatment for cases with unresectable cancer entities. However, for those patients with hypovascular tumors or impaired liver function reserve, TACE is a suboptimal treatment option. For example, embolization does not result in complete coverage of a hypovascular tumor, and may rather promotes postoperative tumor recurrence, or leave residual tumor, in these TACE-resistance patients. In addition, TACE carries a higher risk of hepatic decompensation in patients with poor liver function or reserve. Non-vascular interventional locoregional therapies for HCC include radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), laser-induced thermotherapy (LITT), cryosurgical ablation (CSA), irreversible Electroporation (IRE), percutaneous ethanol injection (PEI), and brachytherapy. Recent advancements in these techniques have significantly improved the treatment efficacy of HCC and expanded the population of patients who qualify for treatment. This review embraces the current status of imaging-guided locoregional non-intravascular interventional treatments for HCCs, with a primary focus on the clinical evaluation and assessment of the efficacy of combined therapies using these interventional techniques.
Collapse
|
26
|
Makary MS, Ramsell S, Miller E, Beal EW, Dowell JD. Hepatocellular carcinoma locoregional therapies: Outcomes and future horizons. World J Gastroenterol 2021; 27:7462-7479. [PMID: 34887643 PMCID: PMC8613749 DOI: 10.3748/wjg.v27.i43.7462] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/09/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and has an overall five-year survival rate of less than twenty percent. For patients with unresectable disease, evolving liver-directed locoregional therapies provide efficacious treatment across the spectrum of disease stages and via a variety of catheter-directed and percutaneous techniques. Goals of locoregional therapies in HCC may include curative intent in early-stage disease, bridging or downstaging to surgical resection or transplantation for early or intermediate-stage disease, and local disease control and palliation in advanced-stage disease. This review explores the outcomes of chemoembolization, bland embolization, radioembolization, and percutaneous ablative therapies. Attention is also given to prognostic factors related to each of the respective techniques, as well as future directions of locoregional therapies for HCC.
Collapse
Affiliation(s)
- Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Stuart Ramsell
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Eric Miller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Eliza W Beal
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Joshua D Dowell
- Department of Radiology, Northwest Radiology, St. Vincent Health, Indianapolis, IN 46260, United States
| |
Collapse
|
27
|
Nakagomi R, Tateishi R, Mikami S, Wake T, Kinoshita MN, Nakatsuka T, Minami T, Sato M, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Shiina S, Koike K. Infectious complications related to radiofrequency ablation of liver tumors: The role of antibiotics. PLoS One 2021; 16:e0259641. [PMID: 34797828 PMCID: PMC8604344 DOI: 10.1371/journal.pone.0259641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aim Prophylactic administration of antibiotics within 24 hours of surgery is recommended to reduce the risk of infection. We conducted a prospective study to compare the efficacy of single administration of antibiotics with a historical control of continuous administration of antibiotics for radiofrequency ablation (RFA) of malignant liver tumors. Methods Between February 1, 1999 and November 30, 2010, a total of 6,763 RFA treatments were performed in 2,355 patients, using a protocol with continuous administration of prophylactic antibiotics. On December 1, 2010, we began using a revised protocol with a single administration of prophylactic antibiotics, while continuing to use the old continuous administration protocol for patients who declined the new protocol. Interim analysis was performed to assess the safety of the single administration protocol. Thereafter, from April 1, 2012, all patients were treated using the new protocol. Risk factors for infectious complications of RFA were assessed using logistic regression. Results From December 2010 to March 2012, 766 RFA treatments were performed in 663 patients using the new antibiotic protocol. Infectious complications were observed following 4 of these treatments (0.52%). As the upper limit of the confidence interval (CI) resulting from a one-sided binomial test was exactly the prespecified limit of 1.0%, from April 2012 onwards, we treated all patients using the new protocol with single administration of prophylactic antibiotics. A total of 3,547 RFA treatments were performed using the single administration protocol. Univariable logistic regression indicated that prior transcatheter arterial chemoembolization (TACE) and maximal tumor diameter were significant risk factors for infectious complications (P = 0.04 and P < 0.001, respectively). Multivariable analysis indicated that the adjusted hazard ratio of single vs. continuous administration of antibiotics was 1.20 (95% CI: 0.53–2.75; P = 0.66). Conclusions The rate of infectious complications related to RFA was acceptably low. Single administration of prophylactic antibiotics did not significantly increase the rate of infectious complications related to RFA, compared with a more intensive antibiotic protocol.
Collapse
Affiliation(s)
- Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Shintaro Mikami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taijiro Wake
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takuma Nakatsuka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshinari Asaoka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University Hospital, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
28
|
Zane KE, Makary MS. Locoregional Therapies for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis. Cancers (Basel) 2021; 13:5430. [PMID: 34771593 PMCID: PMC8582519 DOI: 10.3390/cancers13215430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma is the fourth leading cause of cancer worldwide, and the fastest increasing cause of cancer mortality in the United States. Its propensity for vascular invasion leads to the presence of portal vein tumor thrombus in up to half of patients. PVTT results in a classification of advanced disease, given the risk recurrence secondary to intravascular spread, and formal guidelines recommend systemic therapy in these patients. However, recent advances in locoregional therapies including TACE, TARE, and ablation have demonstrated the potential to drastically improve overall survival in patients with HCC complicated by PVTT.
Collapse
Affiliation(s)
| | - Mina S. Makary
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| |
Collapse
|
29
|
Tsang SH, Ma KW, She WH, Chu F, Lau V, Lam SW, Cheung TT, Lo CM. High-intensity focused ultrasound ablation of liver tumors in difficult locations. Int J Hyperthermia 2021; 38:56-64. [PMID: 34420450 DOI: 10.1080/02656736.2021.1933217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
High-intensity focused ultrasound (HIFU) has been shown to be a valuable tool in the management of small liver tumors such as hepatocellular carcinoma (HCC). It has been shown to be a safe and effective means to ablate small HCC even in the presence of advanced cirrhosis. This review examines the challenges faced during HIFU ablation when the target tumors are located in difficult locations such as the liver dome, close to the rib cage, near large blood vessels or the heart, or adjacent to hollow viscera; and the special maneuvers employed to tackle such lesions.
Collapse
Affiliation(s)
- Simon H Tsang
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Ka Wing Ma
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Wong Hoi She
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Ferdinand Chu
- Department of Radiology, Queen Mary Hospital, Hong Kong, China
| | - Vince Lau
- Department of Radiology, Queen Mary Hospital, Hong Kong, China
| | - Shuk Wan Lam
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Chung Mau Lo
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
30
|
Suk FM, Wang YH, Chiu WC, Liu CF, Wu CY, Chen TL, Liao YJ. Secretory NPC2 Protein-Mediated Free Cholesterol Levels Were Correlated with the Sorafenib Response in Hepatocellular Carcinoma. Int J Mol Sci 2021; 22:ijms22168567. [PMID: 34445279 PMCID: PMC8395255 DOI: 10.3390/ijms22168567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 01/02/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor in the world. Sorafenib is the first-line drug for patients with advanced HCC. However, long-term treatment with sorafenib often results in reduced sensitivity of tumor cells to the drug, leading to acquired resistance. Identifying biomarkers which can predict the response to sorafenib treatment may represent a clinical challenge in the personalized treatment era. Niemann-Pick type C2 (NPC2), a secretory glycoprotein, plays an important role in regulating intracellular free cholesterol homeostasis. In HCC patients, downregulation of hepatic NPC2 is correlated with poor clinical pathological features through regulating mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) activation. This study aimed to investigate the roles of secretory NPC2-mediated free cholesterol levels as biomarkers when undergoing sorafenib treatment and evaluate its impact on acquired sorafenib resistance in HCC cells. Herein, we showed that NPC2 downregulation and free cholesterol accumulation weakened sorafenib’s efficacy through enhancing MAPK/AKT signaling in HCC cells. Meanwhile, NPC2 overexpression slightly enhanced the sorafenib-induced cytotoxic effect. Compared to normal diet feeding, mice fed a high-cholesterol diet had much higher tumor growth rates, whereas treatment with the free cholesterol-lowering agent, hydroxypropyl-β-cyclodextrin, enhanced sorafenib’s tumor-inhibiting ability. In addition, sorafenib treatment induced higher NPC2 secretion, which was mediated by inhibition of the Ras/Raf/MAPK kinase (MEK)/ERK signaling pathway in HCC cells. In both acquired sorafenib-resistant cell and xenograft models, NPC2 and free cholesterol secretion were increased in culture supernatant and serum samples. In conclusion, NPC2-mediated free cholesterol secretion may represent a candidate biomarker for the likelihood of HCC cells developing resistance to sorafenib.
Collapse
Affiliation(s)
- Fat-Moon Suk
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yuan-Hsi Wang
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (Y.-H.W.); (C.-F.L.); (C.-Y.W.)
| | - Wan-Chun Chiu
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110, Taiwan;
- Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan
| | - Chiao-Fan Liu
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (Y.-H.W.); (C.-F.L.); (C.-Y.W.)
| | - Chien-Ying Wu
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (Y.-H.W.); (C.-F.L.); (C.-Y.W.)
| | - Tzu-Lang Chen
- Department of Medical Education, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
| | - Yi-Jen Liao
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (Y.-H.W.); (C.-F.L.); (C.-Y.W.)
- Correspondence: ; Tel.: +886-2-27361661-3333
| |
Collapse
|
31
|
Suwa K, Seki T, Aoi K, Yamashina M, Murata M, Yamashiki N, Nishio A, Shimatani M, Naganuma M. Efficacy of microwave ablation versus radiofrequency ablation for hepatocellular carcinoma: a propensity score analysis. Abdom Radiol (NY) 2021; 46:3790-3797. [PMID: 33675382 PMCID: PMC8286931 DOI: 10.1007/s00261-021-03008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022]
Abstract
Purpose To evaluate the efficacy and safety of radiofrequency ablation (RFA) and new-generation microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC). Methods The propensity score matching method was applied to patients with HCC treated with MWA (93 patients) or RFA (156 patients) at a single institution from January 2014 to April 2020. The local tumor progression (LTP), intrahepatic distant recurrence (IDR), and recurrence-free survival (RFS) of the two matched therapies were analyzed using the Kaplan–Meier method. Cox proportional hazard models were used to identify risk factors for LTP and RFS. The therapeutic effects and complications of the two treatments were also compared. Results The LTP, IDR, and RFS of MWA and RFA were equivalent (LTP: hazard ratio [HR] = 0.87; 95% confidence interval [95% CI] 0.36- 2.07; P = 0.746, IDR: HR = 1.03; 95% CI 0.61–1.73; P = 0.890, RFS: HR = 1.15; 95% CI 0.69–1.91; P = 0.566). Para-vessel lesions was the only risk factor for LTP, whereas age, previous treatment, Albumin-Bilirubin score, and tumor diameter were risk factors for RFS. On the other hand, the ablation time per nodule (6.79 ± 2.73 and 9.21 ± 4.90 min; P = 0.008) and number of sessions per nodule required to achieve technical success (1.16 ± 0.39 and 1.34 ± 0.57; P = 0.009) were significantly lower in MWA than in RFA. The major complication rate of MWA and RFA was also equivalent. Conclusion MWA and RFA have similar therapeutic effects and safety, although MWA has advantages over RFA regarding efficacy, including shorter ablation time and fewer sessions required.
Collapse
|
32
|
Öcal O, Rössler D, Ricke J, Seidensticker M. Advances in Diagnostic and Interventional Radiology in Hepatocellular Carcinoma. Dig Dis 2021; 40:458-467. [PMID: 34348282 DOI: 10.1159/000518101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths, and radiological imaging and locoregional therapies are essential for the management of patients with HCC. SUMMARY In cirrhotic patients, a characteristic imaging pattern establishes the noninvasive diagnosis of HCC with acceptable sensitivity and high specificity. In addition to diagnosis, imaging is used in the staging of patients and treatment allocation. Multiparametric MRI with hepatospecific contrast agents improves lesion detection, characterization, and treatment allocation; recently described imaging criteria allow identification of precursor lesions. Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) have been established in the treatment of patients with HCC at the early and intermediate stages, respectively. Microwave ablation has been described as an alternative to RFA in selected cases. Imaging-guided brachytherapy, a catheter-based radiotherapy technique, offers advantages to overcome some limitations of the aforementioned therapies, including the tumor location and size. Currently, no adjuvant therapy is recommended after RFA or TACE, but several new drugs are under evaluation. Furthermore, although the exact role of selective internal radiation therapy (SIRT) in HCC still needs to be defined, it is an alternative to systemic agents in patients with intolerance, and additional benefit has been shown in selected subgroups. Additionally, SIRT offers an alternate to TACE with higher objective response rates in patients who needs bridging before transplantation. KEY MESSAGES New imaging criteria improved lesion detection in patients at a risk for HCC, and advances in interventional therapies expanded the range of patients eligible for locoregional treatments.
Collapse
Affiliation(s)
- Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
33
|
Llovet JM, De Baere T, Kulik L, Haber PK, Greten TF, Meyer T, Lencioni R. Locoregional therapies in the era of molecular and immune treatments for hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol 2021; 18:293-313. [PMID: 33510460 DOI: 10.1038/s41575-020-00395-0] [Citation(s) in RCA: 403] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related mortality and has an increasing incidence worldwide. Locoregional therapies, defined as imaging-guided liver tumour-directed procedures, play a leading part in the management of 50-60% of HCCs. Radiofrequency is the mainstay for local ablation at early stages and transarterial chemoembolization (TACE) remains the standard treatment for intermediate-stage HCC. Other local ablative techniques (microwave ablation, cryoablation and irreversible electroporation) or locoregional therapies (for example, radioembolization and sterotactic body radiation therapy) have been explored, but have not yet modified the standard therapies established decades ago. This understanding is currently changing, and several drugs have been approved for the management of advanced HCC. Molecular therapies dominate the adjuvant trials after curative therapies and combination strategies with TACE for intermediate stages. The rationale for these combinations is sound. Local therapies induce antigen and proinflammatory cytokine release, whereas VEGF inhibitors and tyrosine kinase inhibitors boost immunity and prime tumours for checkpoint inhibition. In this Review, we analyse data from randomized and uncontrolled studies reported with ablative and locoregional techniques and examine the expected effects of combinations with systemic treatments. We also discuss trial design and benchmarks to be used as a reference for future investigations in the dawn of a promising new era for HCC treatment.
Collapse
Affiliation(s)
- Josep M Llovet
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clinic, University of Barcelona, Catalonia, Spain. .,Institució Catalana d'Estudis Avançats (ICREA), Barcelona, Catalonia, Spain.
| | - Thierry De Baere
- Radiology Department Gustave Roussy Cancer Center, Vilejuif, France.,University Paris-Saclay, Saint-Aubin, France
| | - Laura Kulik
- Division of Gastroenterology and Hepatology, Surgery and Interventional Radiology in Northwestern University, Chicago, IL, USA
| | - Philipp K Haber
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tim F Greten
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tim Meyer
- Deptartment of Oncology, University College London Cancer Institute, London, UK.,Deptartment of Oncology, Royal Free Hospital, London, UK
| | - Riccardo Lencioni
- Department of Radiology, University of Pisa School of Medicine, Pisa, Italy.,Miami Cancer Institute, Miami, FL, USA
| |
Collapse
|
34
|
High-intensity focused ultrasound alone or combined with transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with unsuitable indications for hepatectomy and radiofrequency ablation: a phase II clinical trial. Surg Endosc 2021; 36:1857-1867. [PMID: 33788029 DOI: 10.1007/s00464-021-08465-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aims to evaluate the efficacy and safety of high-intensity focused ultrasound (HIFU) alone or combined with transcatheter arterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC) but were contraindicated for hepatectomy and radiofrequency ablation (RFA). METHODS Patients between 20 and 80 years of age with 1-3 foci of HCC were selected. Included patients have had primary or recurrent liver lesions with no evidence of extra-hepatic metastasis prior to the study. Patients were treated with ultrasound-guided HIFU alone or HIFU combined with TACE (treated with TACE once within 4 weeks prior to receiving HIFU). RESULTS Thirty-seven patients were enrolled, for a total of 45 lesions. The 2-year local control (LC) rate was 73.0% and the median LC time was 22 months. The 2-year progression-free survival (PFS) was 29.7% and the median PFS time was 9 months. Finally, the 2-year overall survival (OS) was 70.3%, and the median OS time was 24 months. The most common adverse events (AEs) were elevated liver enzymes, followed by fatigue, and pain, no grade 4 AEs or death occurred. Multivariate analysis showed that age, Child-Pugh class, and the number of tumors were independent prognostic factors for PFS and that the AFP levels and the number of tumors were significantly correlated with the OS. CONCLUSIONS This study indicates that the HIFU/HIFU combined with TACE treatment is safe, and is capable of achieving both a good LC rate and a considerably good prognosis. The procedure should be considered for patients who were deemed unsuitable for other local treatments.
Collapse
|
35
|
Radiofrequency Ablation of Liver Tumors in Patients on Antithrombotic Therapy: A Case-Control Analysis of over 10,000 Treatments. J Vasc Interv Radiol 2021; 32:869-877. [PMID: 33689831 DOI: 10.1016/j.jvir.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate the safety of radiofrequency ablation (RFA) for liver tumors in patients on antithrombotic therapy. MATERIALS AND METHODS A total of 10,653 consecutive RFA treatments in 3,485 patients with liver tumors were analyzed. The incidence of complications was analyzed on a treatment basis. The treatments for patients who had received antithrombotic medication up to 1 week prior to RFA comprised the antithrombotic therapy group (n = 806), and the others comprised the control group (n = 9,847). Antithrombotic agents were ceased prior to RFA (aspirin, ticlopidine, clopidogrel, and prasugrel ceased 7 days before RFA; cilostazol, 2 or 3 days before RFA; warfarin, 3 days before RFA; and direct oral anticoagulants, 1 day before RFA) and resumed as soon as possible after RFA. Logistic regression analysis was performed to assess whether the antithrombotic therapy increased the risk of hemorrhagic complications. RESULTS Hemorrhagic complications were diagnosed after 6 treatments (0.7%) in the antithrombotic group and 48 (0.5%) in the control group, and there was no significant difference between the groups (P = .30). In 3 treatments, hemorrhage was diagnosed on or after 8 days of RFA, all of which were in the antithrombotic group. Thrombotic complications were diagnosed after 2 treatments (0.2%) in the antithrombotic group and after 5 (0.1%) in the control group. In a multivariate analysis, receiving antithrombotic therapy was not an independent risk factor for hemorrhagic complications (adjusted odds ratio, 1.52; 95% confidence interval, 0.60-3.87; P = .38). CONCLUSIONS RFA of liver tumors in patients on antithrombotic therapy is generally safe with appropriate cessation and resumption. Late-onset hemorrhage should be noted in the patients on antithrombotic therapy.
Collapse
|
36
|
Ushijima H, Hida JI, Yane Y, Kato H, Ueda K, Kawamura J. Laparoscopic repair of diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma: Case report. Int J Surg Case Rep 2021; 81:105728. [PMID: 33820734 PMCID: PMC8073201 DOI: 10.1016/j.ijscr.2021.105728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 01/16/2023] Open
Abstract
Diaphragmatic hernia is a rare late-onset complication associated with RFA for HCC. The tumor location is closely related to the risk of diaphragmatic hernia caused by RFA. Patients with HCC often have severe liver dysfunction and cirrhosis. Laparoscopic approach is safe and minimally invasive for severe cirrhosis patient. The hernia gate was closed by suture, and vulnerable area was reinforced using mesh.
Introduction and importance We describe the case of a patients with a diaphragmatic hernia associated with radiofrequency ablation for hepatocellular carcinoma who was treated by laparoscopic repair. Case presentation An 82-years-old man with history of HCC with hepatitis C virus-related liver cirrhosis (Child-Pugh B). The patient was treated RFA to HCC for segment 4, 5, 6, 8. After 16 months from latest RFA for segment 8, the patient was admitted to our hospital because of mild dyspnea. Computed tomography revealed a diaphragmatic herniation of bowel loops into the right thoracic cavity. The patients electively underwent laparoscopic repair of the diaphragmatic hernia. The patient was discharged from hospital without any post-operative complications. Clinical discussion The only treatment to diaphragmatic hernia is surgery, but liver cirrhosis patients limits this possibility. For the surgical treatment of patients with severe cirrhosis, the operation should be carefully assessed. We believe that a laparoscopic approach should be used for repairing diaphragmatic hernia. In the present case, we considered that a laparoscopic approach was safer and more feasible than open laparotomy. Conclusion Diaphragmatic hernia is a rare late-onset complication associated with RFA for HCC. And patients with HCC often have severe liver dysfunction and cirrhosis. A laparoscopic approach is safe and minimally invasive for sever cirrhosis patients.
Collapse
Affiliation(s)
- Hokuto Ushijima
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan.
| | - Jin-Ichi Hida
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Yoshinori Yane
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Hiroaki Kato
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Kazuki Ueda
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Junichiro Kawamura
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| |
Collapse
|
37
|
Yan Z, Jianmin D, Fengmei W, Zhengyi Q, Yandong W, Hongyu Z, Xiang J. The Effects of Liver Function Damage after Thermal Ablation on the Prognosis of HCC Patients and Its Prediction. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
38
|
Zhang J, Lay RJ, Roberts SK, Chauhan S. Towards real-time finite-strain anisotropic thermo-visco-elastodynamic analysis of soft tissues for thermal ablative therapy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 198:105789. [PMID: 33069033 DOI: 10.1016/j.cmpb.2020.105789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Accurate and efficient prediction of soft tissue temperatures is essential to computer-assisted treatment systems for thermal ablation. It can be used to predict tissue temperatures and ablation volumes for personalised treatment planning and image-guided intervention. Numerically, it requires full nonlinear modelling of the coupled computational bioheat transfer and biomechanics, and efficient solution procedures; however, existing studies considered the bioheat analysis alone or the coupled linear analysis, without the fully coupled nonlinear analysis. METHODS We present a coupled thermo-visco-hyperelastic finite element algorithm, based on finite-strain thermoelasticity and total Lagrangian explicit dynamics. It considers the coupled nonlinear analysis of (i) bioheat transfer under soft tissue deformations and (ii) soft tissue deformations due to thermal expansion/shrinkage. The presented method accounts for anisotropic, finite-strain, temperature-dependent, thermal, and viscoelastic behaviours of soft tissues, and it is implemented using GPU acceleration for real-time computation. RESULTS The presented method can achieve thermo-visco-elastodynamic analysis of anisotropic soft tissues undergoing large deformations with high computational speeds in tetrahedral and hexahedral finite element meshes for surgical simulation of thermal ablation. We also demonstrate the translational benefits of the presented method for clinical applications using a simulation of thermal ablation in the liver. CONCLUSION The key advantage of the presented method is that it enables full nonlinear modelling of the anisotropic, finite-strain, temperature-dependent, thermal, and viscoelastic behaviours of soft tissues, instead of linear elastic, linear viscoelastic, and thermal-only modelling in the existing methods. It also provides high computational speeds for computer-assisted treatment systems towards enabling the operator to simulate thermal ablation accurately and visualise tissue temperatures and ablation zones immediately.
Collapse
Affiliation(s)
- Jinao Zhang
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, Victoria, Australia.
| | - Remi Jacob Lay
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Sunita Chauhan
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, Victoria, Australia.
| |
Collapse
|
39
|
Rim CH, Lee HY, Kim JS, Kim H. Radiofrequency ablation and stereotactic body radiotherapy for hepatocellular carcinoma: should they clash or reconcile? Int J Radiat Biol 2020; 97:111-119. [PMID: 33253598 DOI: 10.1080/09553002.2021.1857453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Until a few decades ago, surgical resection was the only valid option for treating hepatocellular carcinoma (HCC). However, various locoregional modalities including arterial-directed therapy, radiofrequency ablation (RFA), and radiotherapy have been recently shown to be effective. RFA is now established as a standard treatment for small localized HCCs, showing oncological results comparable to those of surgical resection in randomized studies. Stereotactic body radiotherapy (SBRT) is a modern radiotherapeutic modality that targets tumors with precision and delivers high radiation doses over a short period of time; it has particularly attracted clinical interest after its therapeutic efficacy was found to be similar to that of surgery in early-stage lung cancer. Given its potent disease control capability, SBRT has also been applied to early HCCs and demonstrated promising results in recent studies. It has also been noted for its suitability to treat tumors located in anatomical locations where RFA would be challenging. However, since its effectiveness has not been compared to that of RFA in randomized studies of patients eligible for RFA, the use of SBRT has been debated. This review was conducted to guide physicians from all fields involved in the treatment of early HCC. The therapeutic characteristics and indications of both SBRT and RFA are described, and recent comparative studies between the two modalities are discussed. In addition, we examined the factors that should be considered when selecting the appropriate treatments, and offer our recommendations.
Collapse
Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Gyeonggido, Korea
| | - Hye Yoon Lee
- Department of General Surgery, Korea University Ansan Hospital, Gyeonggido, Korea
| | - Jung Sun Kim
- Department of Medical Oncology, Korea University Ansan Hospital, Gyeonggido, Korea
| | - Hakyoung Kim
- Department of Radiation Oncology, Korea University Guro Hospital, Seoul, Korea
| |
Collapse
|
40
|
Rogger TM, Michielan A, Sferrazza S, Pravadelli C, Moser L, Agugiaro F, Vettori G, Seligmann S, Merola E, Maida M, Ciarleglio FA, Brolese A, de Pretis G. Gastrointestinal tract injuries after thermal ablative therapies for hepatocellular carcinoma: A case report and review of the literature. World J Gastroenterol 2020; 26:5375-5386. [PMID: 32994695 PMCID: PMC7504251 DOI: 10.3748/wjg.v26.i35.5375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) and microwave ablation (MWA) represent the standard of care for patients with early hepatocellular carcinoma (HCC) who are unfit for surgery. The incidence of reported adverse events is low, ranging from 2.4% to 13.1% for RFA and from 2.6% to 7.5% for MWA. Gastrointestinal tract (GIT) injury is even more infrequent (0.11%), but usually requires surgery with an unfavourable prognosis. Due to its low incidence and the retrospective nature of the studies, the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics, comorbidities and treatment approaches.
CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location. He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever. A subcutaneous abscess was diagnosed and treated by percutaneous drainage. A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall. The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulent abdominal collection. An over-the-scope clip (OTSC) was used to successfully close the defect
CONCLUSION This is the first reported case of RFA-related GIT injury to have been successfully treated with an OTSC, which highlights the role of this endoscopic treatment for the management of this complication.
Collapse
Affiliation(s)
- Teresa Marzia Rogger
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Andrea Michielan
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Sandro Sferrazza
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Cecilia Pravadelli
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Luisa Moser
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Flora Agugiaro
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Giovanni Vettori
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Sonia Seligmann
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Elettra Merola
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta, Caltanissetta 93100, Italy
| | | | - Alberto Brolese
- Department of Surgery, Hepato-biliary Surgery Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Giovanni de Pretis
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| |
Collapse
|
41
|
Morani AC, Hanafy AK, Marcal LP, Subbiah V, Le O, Bathala TK, Elsayes KM. Imaging of acute abdomen in cancer patients. Abdom Radiol (NY) 2020; 45:2287-2304. [PMID: 31758230 DOI: 10.1007/s00261-019-02332-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pattern of disease causing acute abdominal pain has changed over last few decades, some of this has been attributed to intraabdominal cancers. The most common acute abdominal complaints in cancer patients are related to the gastrointestinal system. Abdominal emergencies in cancer patients can result from the underlying malignancy itself, cancer therapy and/or result from the standard pathologies causing acute abdomen in otherwise healthy population. Therapy-related or disease-related immunosuppression or high dose analgesics often blunt many of the findings which are usually expected in non-cancer general population. This complicates the clinical picture rendering the clinical exam less reliable in many cancer patients, and resulting in different pathologies which clinicians and the radiologists should remain aware of. This article focuses on imaging illustrations with differential diagnosis for various emergency scenarios related to acute abdomen specifically in oncologic settings.
Collapse
Affiliation(s)
- Ajaykumar C Morani
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA.
| | - Abdelrahman K Hanafy
- Diagnostic Radiology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, 78229, USA
| | - Leonardo P Marcal
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Vivek Subbiah
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ott Le
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Tharakeshwara K Bathala
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| |
Collapse
|
42
|
Choi JW, Lee JM, Lee DH, Yoon JH, Kim YJ, Lee JH, Yu SJ, Cho EJ. Radiofrequency Ablation Using a Separable Clustered Electrode for the Treatment of Hepatocellular Carcinomas: A Randomized Controlled Trial of a Dual-Switching Monopolar Mode Versus a Single-Switching Monopolar Mode. Korean J Radiol 2020; 22:179-188. [PMID: 32729269 PMCID: PMC7817634 DOI: 10.3348/kjr.2020.0134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to prospectively compare the efficacy, safety, and mid-term outcomes of dual-switching monopolar (DSM) radiofrequency ablation (RFA) to those of conventional single-switching monopolar (SSM) RFA in the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS This single-center, two-arm, parallel-group, randomized controlled study was approved by the Institutional Review Board. Written informed consent was obtained from all patients upon enrollment. A total of 80 patients with 94 HCC nodules were randomized into either the DSM-RFA group or SSM-RFA group in a 1:1 ratio, using a blocked randomization method (block size 2). The primary endpoint was the minimum diameter of the ablation zone per unit time. The secondary endpoints included other technical parameters, complication rate, technique efficacy, and 2-year clinical outcomes. RESULTS Significantly higher ablation energy per unit time was delivered to the DSM-RFA group than to the SSM-RFA group (1.7 ± 0.2 kcal/min vs. 1.2 ± 0.3 kcal/min; p < 0.001). However, no significant differences were observed between the two groups for the analyzed variables, including primary endpoint, regarding size of the ablation zone and ablation time. Major complication rates were 4.9% in the DSM-RFA group and 2.6% in the SSM-RFA group (p = 1.000). The 2-year local tumor progression (LTP) rates of the HCC nodules treated using DSM-RFA and SSM-RFA were 8.5% and 4.7%, respectively (p = 0.316). The 2-year LTP-free survival rates of patients in the DSM-RFA and SSM-RFA groups were 90.0% and 94.4%, respectively (p = 0.331), and the 2-year recurrence-free survival rates were 54.9% and 75.7%, respectively (p = 0.265). CONCLUSION Although DSM-RFA using a separable clustered electrode delivers higher ablation energy than SSM-RFA, its effectiveness failed to show superiority over SSM-RFA in the treatment of HCC.
Collapse
Affiliation(s)
- Jae Won Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
43
|
Veltri A, Basile D, Calandri M, Bertaggia C, Volante M, Porpiglia F, Calabrese A, Puglisi S, Basile V, Terzolo M. Oligometastatic adrenocortical carcinoma: the role of image-guided thermal ablation. Eur Radiol 2020; 30:6958-6964. [PMID: 32621242 DOI: 10.1007/s00330-020-07019-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/26/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the impact of image-guided ablation of liver and lung metastases from adrenocortical carcinoma (ACC). METHODS Patients with oligometastatic ACC (liver and lung metastases) who underwent image-guided ablation were retrospectively included in the study. Complete ablation (CA) at the first contrast-enhanced CT control, local tumor progression (LTP), local tumor progression-free survival (LTPFS), liver disease-free survival (LDFS), and overall survival (OS) were evaluated. Correlation between outcomes and other prognostic factors (including Ki67, hormonal secretion, and progression-free survival after primary tumor resection (PR-PFS)) was also analyzed. Kaplan-Meier methods, log-rank tests, and Spearman correlation models were applied. RESULTS Thirty-two ACC metastases (4 lung and 28 liver) from 16 patients (10 females; mean age 41 years) were treated with RFA or MWA. A single major adverse event was observed (intrahepatic hematoma with subsequent right hemothorax). One patient (2 lesions) was lost to follow-up. CA was obtained in 97% (29/30). During follow-up, LTP was registered in 7/29 cases (24.1%), with a median LTPFS of 21 months (± 12.6). Metastasis size was significantly higher in case of LTP (20 mm vs. 34.5 mm; p = 0.009) and was an independent predictive factor of local tumor control with an AUC of 0.934 (p = 0.0009). Hepatic progression was observed in 66% of the cases, with a median LDFS of 25 months. Median OS was 48.6 months. PR-PFS and hormonal secretion were independent predictors of OS (p < 0.001 and p = 0.045, respectively). CONCLUSIONS Image-guided ablation achieves adequate local tumor control of ACC liver and lung metastases, providing a safe and effective treatment option in the multidisciplinary management of the oligometastatic ACC. KEY POINTS • Image-guided ablation allows adequate local tumor control in the oligometastatic adrenocortical carcinoma setting. • After percutaneous thermal ablation, complete ablation was achieved in 29 out of 30 lesions (97%). • Lesion size together with primary resection disease-free survival and hormonal secretion play a significant role in determining outcomes.
Collapse
Affiliation(s)
- Andrea Veltri
- Diagnostic and Interventional Radiology Unit, Oncology department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano, Turin, Italy.
| | - Domenico Basile
- Diagnostic and Interventional Radiology Unit, Oncology department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano, Turin, Italy
| | - Marco Calandri
- Diagnostic and Interventional Radiology Unit, Oncology department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano, Turin, Italy
| | - Chiara Bertaggia
- Diagnostic and Interventional Radiology Unit, Oncology department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano, Turin, Italy
| | - Marco Volante
- Pathology Unit, Oncology department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Urology Unit, Oncology department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Anna Calabrese
- Internal Medicine Unit, Clinical and Biological Sciences Department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Soraya Puglisi
- Internal Medicine Unit, Clinical and Biological Sciences Department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Vittoria Basile
- Internal Medicine Unit, Clinical and Biological Sciences Department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Massimo Terzolo
- Internal Medicine Unit, Clinical and Biological Sciences Department, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| |
Collapse
|
44
|
He ZH, Wu QL, Ye H, Wang KY, Li LQ, Peng NF. Microwave ablation of liver cancer: An updated review. Shijie Huaren Xiaohua Zazhi 2020; 28:371-377. [DOI: 10.11569/wcjd.v28.i10.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The treatment methods for early liver cancer include surgical resection, liver transplantation, and local ablation. Among them, microwave ablation (MWA) is widely used in clinical practice because of its outstanding advantages, such as minimal invasiveness, radical curative effect, short treatment time, few complications, and no heat-sink effect, especially for the treatment of tumors adjacent to major vessels and hepatic metastases. However, MWA also has limitations such as unpredictable size and shape of the ablation area. This review systematically illustrates the effectiveness and safety of MWA in the treatment of liver cancer. Meanwhile, the relative superiority of the new generation of MWA is discussed, with an aim to provide reference for MWA of liver cancer.
Collapse
Affiliation(s)
- Ze-Hua He
- Department of General Surgery, Langdong Hospital of Guangxi Medical University, Nanning 530022, Guangxi Zhuang Autonomous Region, China
| | - Qiu-Lin Wu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hang Ye
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Kai-Yuan Wang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ning-Fu Peng
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| |
Collapse
|
45
|
Yang T, Ng DM, Du N, He N, Dai X, Chen P, Wu F, Chen B, Fan X, Yan K, Zhou X, Dong M, Zheng Z, Gu L. HIFU for the treatment of difficult colorectal liver metastases with unsuitable indications for resection and radiofrequency ablation: a phase I clinical trial. Surg Endosc 2020; 35:2306-2315. [PMID: 32435962 DOI: 10.1007/s00464-020-07644-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The goal of this study is to evaluate the safety and efficacy of high intensity focused ultrasound (HIFU) for patients with colorectal liver metastases (CRLM) but were contraindicated for resection and radiofrequency ablation. METHODS Patients between 20 and 80 years of age with 1-3 liver metastases from colorectal cancer were selected. Included patients have had their primary lesions removed with no evidence of extrahepatic metastasis prior to the study. Ultrasound-guided HIFU was employed and target regions' ablation was achieved with repeated sonications from the deep to shallow regions of the tumors section by section. RESULTS Thirteen patients were enrolled. The most common adverse events (AEs) were pain (n = 8), followed by fatigue (n = 7), increased aspartate aminotransferase (AST) (n = 7), increased alanine aminotransferase (ALT) (n = 5), and skin edema (n = 4). No grade ≥ 3 AEs occurred and while most patients (76.9%) achieved a complete response, three patients achieved a partial response. The objective response rate was 100% after the first HIFU treatment. Nine patients relapsed but the tumors were mostly isolated to the liver (8/9). The median follow-up period was 25 months. The 2-year progression-free survival (PFS) was 16.7%, and the median PFS was 9 months. Notably, the 2-year overall survival (OS) was 77.8%, and the median OS was 25 months. CONCLUSION This study indicates that the HIFU treatment is safe, is able to achieve a good tumor response rate and long-term prognosis even when the foci were in high-risk locations, and should be considered for patients who were considered unsuitable for other local treatments.
Collapse
Affiliation(s)
- Tong Yang
- Department of Tumor HIFU Therapy, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China
| | | | - Nannan Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ning He
- Department of Tumor HIFU Therapy, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Xiaoyu Dai
- Department of Anus and Intestine Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China
| | - Feng Wu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China
| | - Bo Chen
- Department of Medical Image, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Xiaoxiang Fan
- Department of Interventional Therapy, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Kun Yan
- Department of Medical Image, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Xinfeng Zhou
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China
| | - Mingjun Dong
- Department of Anus and Intestine Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Zhi Zheng
- Department of Tumor HIFU Therapy, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Lihu Gu
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China.
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China.
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China.
| |
Collapse
|
46
|
Davidson B, Gurusamy K, Corrigan N, Croft J, Ruddock S, Pullan A, Brown J, Twiddy M, Birtwistle J, Morris S, Woodward N, Bandula S, Hochhauser D, Prasad R, Olde Damink S, Coolson M, Laarhoven KV, de Wilt JH. Liver resection surgery compared with thermal ablation in high surgical risk patients with colorectal liver metastases: the LAVA international RCT. Health Technol Assess 2020; 24:1-38. [PMID: 32370822 DOI: 10.3310/hta24210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although surgical resection has been considered the only curative option for colorectal liver metastases, thermal ablation has recently been suggested as an alternative curative treatment. There have been no adequately powered trials comparing surgery with thermal ablation. OBJECTIVES Main objective - to compare the clinical effectiveness and cost-effectiveness of thermal ablation versus liver resection surgery in high surgical risk patients who would be eligible for liver resection. Pilot study objectives - to assess the feasibility of recruitment (through qualitative study), to assess the quality of ablations and liver resection surgery to determine acceptable standards for the main trial and to centrally review the reporting of computed tomography scan findings relating to ablation and outcomes and recurrence rate in both arms. DESIGN A prospective, international (UK and the Netherlands), multicentre, open, pragmatic, parallel-group, randomised controlled non-inferiority trial with a 1-year internal pilot study. SETTING Tertiary liver, pancreatic and gallbladder (hepatopancreatobiliary) centres in the UK and the Netherlands. PARTICIPANTS Adults with a specialist multidisciplinary team diagnosis of colorectal liver metastases who are at high surgical risk because of their age, comorbidities or tumour burden and who would be suitable for liver resection or thermal ablation. INTERVENTIONS Thermal ablation conducted as per local policy (but centres were encouraged to recruit within Cardiovascular and Interventional Radiological Society of Europe guidelines) versus surgical liver resection performed as per centre protocol. MAIN OUTCOME MEASURES Pilot study - patients' and clinicians' acceptability of the trial to assist in optimisation of recruitment. Primary outcome - disease-free survival at 2 years post randomisation. Secondary outcomes - overall survival, timing and site of recurrence, additional therapy after treatment failure, quality of life, complications, length of hospital stay, costs, trial acceptability, and disease-free survival measured from end of intervention. It was planned that 5-year survival data would be documented through record linkage. Randomisation was performed by minimisation incorporating a random element, and this was a non-blinded study. RESULTS In the pilot study over 1 year, a total of 366 patients with colorectal liver metastases were screened and 59 were considered eligible. Only nine participants were randomised. The trial was stopped early and none of the planned statistical analyses was performed. The key issues inhibiting recruitment included fewer than anticipated patients eligible for both treatments, misconceptions about the eligibility criteria for the trial, surgeons' preference for one of the treatments ('lack of clinical equipoise' among some of the surgeons in the centre) with unconscious bias towards surgery, patients' preference for one of the treatments, and lack of dedicated research nurses for the trial. CONCLUSIONS Recruitment feasibility was not demonstrated during the pilot stage of the trial; therefore, the trial closed early. In future, comparisons involving two very different treatments may benefit from an initial feasibility study or a longer period of internal pilot study to resolve these difficulties. Sufficient time should be allowed to set up arrangements through National Institute for Health Research (NIHR) Research Networks. TRIAL REGISTRATION Current Controlled Trials ISRCTN52040363. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 21. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Brian Davidson
- Royal Free Campus, Division of Surgery and Interventional Science, University College London, London, UK
| | - Kurinchi Gurusamy
- Royal Free Campus, Division of Surgery and Interventional Science, University College London, London, UK
| | - Neil Corrigan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sharon Ruddock
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alison Pullan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,Institute of Clinical and Applied Health Research, Faculty of Health Science, University of Hull, Hull, UK
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | | | | | | | - Raj Prasad
- Surgery and Transplantation, Leeds Teaching Hospital, Leeds, UK
| | | | - Marielle Coolson
- General Surgery, Maastricht University, Maastricht, the Netherlands
| | - K van Laarhoven
- Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | |
Collapse
|
47
|
Santambrogio R, Barabino M, De Nicola E, Galfrascoli E, Giovenzana M, Zappa MA. Laparoscopic ablation therapies for hepatocellular carcinoma: could specific indications for the laparoscopic approach influence the effectiveness? Updates Surg 2020; 72:435-443. [DOI: 10.1007/s13304-020-00759-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/27/2020] [Indexed: 12/21/2022]
|
48
|
Chua JME, Lam YMP, Tan BS, Tay KH, Gogna A, Irani FG, Lo HGR, Too CW. Single-centre retrospective review of risk factors for local tumour progression and complications in radiofrequency ablation of 555 hepatic lesions. Singapore Med J 2020; 60:188-192. [PMID: 31069400 DOI: 10.11622/smedj.2019036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study aimed to assess safety, local tumour progression (LTP) and risk factors for LTP after radiofrequency ablation (RFA) of liver tumours in a single centre. METHODS All consecutive patients treated with RFA for liver tumours between January 2009 and October 2012 were included. Previously treated lesions that progressed were excluded. Using electronic medical records, the following data was captured: patient demographics, pre-procedural laboratory results, Child-Pugh status, tumour characteristics, development of tumoral seeding, RFA complications and LTP. Possible risk factors for LTP were identified using Cox regression. RESULTS In total, 555 liver tumours were treated in 337 patients. 483 (87.0%) hepatocellular carcinomas, 52 (9.4%) colorectal metastases and 20 (3.6%) other tumour types were treated. Mean tumour size was 2.1 ± 1.1 (range 0.4-6.8) cm. Mean follow-up duration was 387 days. 416 (75.0%) lesions had no LTP at the last imaging. 70 (12.6%) patients had minor complications requiring observation, while 7 (1.3%) patients had significant complications requiring prolonged hospitalisation or further interventions. Only one case of tumour seeding was detected. Using multivariate Cox regression, the following factors were statistically significant in predicting LTP: hilar location (relative ratio [RR] 3.988), colorectal metastases (RR 2.075), size (RR 1.290) and younger age (RR 0.982). CONCLUSION RFA of liver tumours is safe and effective, with a low significant complication rate of 1.3%. Hilar lesions are most prone to LTP, followed by lesions that were larger in size and colorectal metastases. 75.0% of patients showed no LTP at the last follow-up.
Collapse
Affiliation(s)
| | - Yu Ming Paul Lam
- Faculty of Medicine, Baringa Private Hospital, Coffs Harbour, Australia
| | - Bien Soo Tan
- Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Kiang Hiong Tay
- Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Apoorva Gogna
- Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Farah Gillan Irani
- Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | | | - Chow Wei Too
- Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| |
Collapse
|
49
|
Huang ZM, Zuo MX, Gu YK, Lai CX, Pan QX, Yi XC, Zhang TQ, Huang JH. Bronchobiliary fistula after ablation of hepatocellular carcinoma adjacent to the diaphragm: Case report and literature review. Thorac Cancer 2020; 11:1233-1238. [PMID: 32147969 PMCID: PMC7180580 DOI: 10.1111/1759-7714.13380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023] Open
Abstract
Background Bronchobiliary fistula is a rare, but life‐threatening complication after ablation of hepatocellular carcinoma. Few cases of bronchobiliary fistula have been reported and the treatment is controversial. Methods From 2006 to 2019, a total of 11 patients were diagnosed with bronchobiliary fistula after ablation and received nonsurgical treatment. Results All 11 patients presented with cough and bilioptysis. There were only two patients in which MRI revealed an obvious fistulous tract connecting the pleural effusion and biliary lesions. Pleural effusion, liver abscess and hepatic biloma were found in other patients. Three patients died of uncontrolled bronchobiliary fistula. Conclusions Bronchobiliary fistula is a rare post‐ablation complication but should be taken into consideration in clinical decisions. Minimally invasive interventional treatment is a relatively effective means of dealing with bronchobiliary fistula, but as for the more severe cases, greater clinical experience is required.
Collapse
Affiliation(s)
- Zhi-Mei Huang
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Meng-Xuan Zuo
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yang-Kui Gu
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chun-Xiao Lai
- Department of Gastroenterology, Huangpu People's Hospital, Zhongshan, China
| | - Qiu-Xiang Pan
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Cheng Yi
- Department of Medical Oncology, TCM Hospital of Ruichang, Ruichang, China
| | - Tian-Qi Zhang
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jin-Hua Huang
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
50
|
Darweesh SK, Gad AA. Percutaneous microwave ablation for HCV-related hepatocellular carcinoma: Efficacy, safety, and survival. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:445-453. [PMID: 31060999 DOI: 10.5152/tjg.2019.17191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma (HCC) has a poor prognosis if managed late. Percutaneous microwave ablation (MWA) emerged as one of the top therapeutic decisions for non-surgical patients. The aim of the present study aim was to evaluate the efficacy, side effects, and survival after MWA of hepatitis C virus (HCV)-related HCC tumors with spectrum sizes up to 5 cm. MATERIALS AND METHODS Fifty-nine patients with early HCC were treated in the Hepatology Department using percutaneous MWA. Patients were assessed for side effects and efficacy that includes the rate of complete ablation, primary or de novo recurrence, and survival. RESULTS Complete ablation was achieved in 57 (96.6%) patients treated by MWA, with a minor complication rate of 3.3% (n=2) including liver abscess formation and abdominal skin burn. The ablation rates in lesions <3 versus 3-5 cm were not different. Of the patients, 3 (5%) had primary recurrence in the treated HCC tumors, de novo lesions (secondary recurrence) developed in 8 (13.5%, 5 of them >3 cm), and 2 (3.3%) had malignant portal vein thrombosis. The survival rates were 95.4% and 69% at 1 and 2 years, respectively. CONCLUSION Percutaneous MWA had achieved a safe and effective treatment with good overall survival in patients with HCV-related HCC.
Collapse
Affiliation(s)
- Samar K Darweesh
- Department of Hepato-gastroenterology and Tropical Medicine, Cairo University School of Medicine, Egypt
| | - Amal A Gad
- Department of Internal Medicine, Suez Canal University School of Medicine, Ismailia, Egypt
| |
Collapse
|