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Young S, Abamyan A, Goldberg D, Hannallah J, Schaub D, Kalarn S, Fitzgerald Z, Woodhead G. Cryoablation in the liver: how accurately does the iceball predict the ablation zone? Abdom Radiol (NY) 2024; 49:625-630. [PMID: 38036773 DOI: 10.1007/s00261-023-04117-3] [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: 08/02/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To evaluate the accuracy with which the iceball predicts the realized ablation zone in patients undergoing cryoablation of the liver. MATERIALS AND METHODS Continuous patients who underwent cryoablation of primary or secondary malignancies of the liver were retrospectively reviewed. Iceball and ablation zone dimensions on 1 month follow up imaging were collected in three orientations, the long axis (LA), perpendicular transverse (PTR), and perpendicular craniocaudal (PCC). Factors which may predict differences in the measurements were evaluated with regression analysis. Oncologic outcomes were also collected. RESULTS The mean size of the iceball was 5.5 ± 1.1 cm, 3.9 ± 1.1 cm, and 4.4 ± 1.4 cm in the LA, PTR, and PCC orientations, respectively. The mean size of the one-month ablation cavity was 4.3 ± 1.3 cm, 3 ± 1.1 cm, and 3 ± 1.3 cm in the LA, PTR, and PCC orientations, respectively. The iceball was significantly larger than the ablation zone in all orientations (p < 0.001). When comparing HCC and non-HCC patients the Kaplan-Meier analysis of TTLP, the Kaplan Meier curves deviated significantly (p = 0.015, HR 2.26 (95%CI 1.17-4.37)). When a similar analysis was performed looking at TTP again the curves diverged significantly (p = 0.002, HR 2.4 (95%CI 1.37-4.19)). CONCLUSION The iceball seems to overestimate the realized ablation zone by about 1 cm in all orientations during hepatic cryoablation.
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Affiliation(s)
- Shamar Young
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA.
| | - Art Abamyan
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Dan Goldberg
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Jack Hannallah
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - David Schaub
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Salil Kalarn
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Zachary Fitzgerald
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Gregory Woodhead
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
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Lorton O, Guillemin PC, Peloso A, M’Rad Y, Crowe LA, Koessler T, Poletti PA, Boudabbous S, Ricoeur A, Salomir R. In Vivo Thermal Ablation of Deep Intrahepatic Targets Using a Super-Convergent MRgHIFU Applicator and a Pseudo-Tumor Model. Cancers (Basel) 2023; 15:3961. [PMID: 37568777 PMCID: PMC10417404 DOI: 10.3390/cancers15153961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND HIFU ablation of liver malignancies is particularly challenging due to respiratory motion, high tissue perfusion and the presence of the rib cage. Based on our previous development of a super-convergent phased-array transducer, we aimed to further investigate, in vivo, its applicability to deep intrahepatic targets. METHODS In a series of six pigs, a pseudo-tumor model was used as target, visible both on intra-operatory MRI and post-mortem gross pathology. The transcostal MRgHIFU ablation was prescribed coplanar with the pseudo-tumor, either axial or sagittal, but deliberately shifted 7 to 18 mm to the side. No specific means of protection of the ribs were implemented. Post-treatment MRI follow-up was performed at D7, followed by animal necropsy and gross pathology of the liver. RESULTS The pseudo-tumor was clearly identified on T1w MR imaging and subsequently allowed the MRgHIFU planning. The peak temperature at the focal point ranged from 58-87 °C. Gross pathology confirmed the presence of the pseudo-tumor and the well-delineated MRgHIFU ablation at the expected locations. CONCLUSIONS The specific design of the transducer enabled a reliable workflow. It demonstrated a good safety profile for in vivo transcostal MRgHIFU ablation of deep-liver targets, graded as challenging for standard surgery.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Pauline Coralie Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Andrea Peloso
- Visceral Surgery Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Yacine M’Rad
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | | | - Thibaud Koessler
- Oncology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | | | - Sana Boudabbous
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Alexis Ricoeur
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
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Wang L, Liu BX, Long HY. Ablative strategies for recurrent hepatocellular carcinoma. World J Hepatol 2023; 15:515-524. [PMID: 37206650 PMCID: PMC10190693 DOI: 10.4254/wjh.v15.i4.515] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the fifth leading cause of cancer death worldwide and the third leading cause of all diseases worldwide. Liver transplantation, surgical resection and ablation are the three main curative treatments for HCC. Liver transplantation is the optimal treatment option for HCC, but its usage is limited by the shortage of liver sources. Surgical resection is considered the first choice for early-stage HCC, but it does not apply to patients with poor liver function. Therefore, more and more doctors choose ablation for HCC. However, intrahepatic recurrence occurs in up to 70% patients within 5 years after initial treatment. For patients with oligo recurrence after primary treatment, repeated resection and local ablation are both alternative. Only 20% patients with recurrent HCC (rHCC) indicate repeated surgical resection because of limitations in liver function, tumor location and intraperitoneal adhesions. Local ablation has become an option for the waiting period when liver transplantation is unavailable. For patients with intrahepatic recurrence after liver transplantation, local ablation can reduce the tumor burden and prepare them for liver transplantation. This review systematically describes the various ablation treatments for rHCC, including radiofrequency ablation, microwave ablation, laser ablation, high-intensity focused ultrasound ablation, cryablation, irreversible electroporation, percutaneous ethanol injection, and the combination of ablation and other treatment modalities.
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Affiliation(s)
- Lin Wang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Bao-Xian Liu
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Hai-Yi Long
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
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Qiu JJ, Wei GF, Du JL, Guo J. Advances in the application of different anesthetic methods and drugs in interventional therapy for hepatocellular carcinoma. Clin Res Hepatol Gastroenterol 2022; 46:101982. [PMID: 35732267 DOI: 10.1016/j.clinre.2022.101982] [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: 05/15/2022] [Revised: 06/09/2022] [Accepted: 06/18/2022] [Indexed: 02/04/2023]
Abstract
Currently, interventional therapy has been widely used in clinical practice as a treatment method for hepatocellular carcinoma (HCC). The limitations of interventional therapy lie mainly in the intolerable pain felt by the patients during the treatment process. Hence, the selection of the anesthetic methods and drugs, as well as the precise control of the dosages, are particularly crucial before the initiation of the treatment. Moreover, different anesthetic methods and drugs may also affect the patient's recovery differently. To better comprehend the current status of various anesthetic methods and drugs used in interventional therapy for HCC, this study reviewed the advantages and disadvantages of different anesthetic methods and drugs.
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Affiliation(s)
- Jun-Jie Qiu
- Department of Anesthesiology, The First People's Hospital of Tongxiang, Tongxiang, Zhejiang 314500, China
| | - Gui-Fen Wei
- Department of Hepatobiliary Pancreatic Surgery, The First People's Hospital of Tongxiang, Tongxiang, Zhejiang 314500, China
| | - Jian-Long Du
- Department of Anesthesiology, The First People's Hospital of Tongxiang, Tongxiang, Zhejiang 314500, China
| | - Jing Guo
- Department of Anesthesiology, The First People's Hospital of Tongxiang, Tongxiang, Zhejiang 314500, China.
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Zhang W, Gao X, Sun J, Cheng J, Hu Y, Dong Z, Kong H, Zhang H, Wang C, Yang Y. Percutaneous Argon-Helium Cryoablation for Small Hepatocellular Carcinoma Located Adjacent to a Major Organ or Viscus: A Retrospective Study of 92 Patients at a Single Center. Med Sci Monit 2021; 27:e931473. [PMID: 34385410 PMCID: PMC8369936 DOI: 10.12659/msm.931473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/14/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cryoablation of hepatocellular carcinoma (HCC) close to major organs or viscus is challenging because it can cause complications. This retrospective study aimed to investigate the safety and efficacy of percutaneous argon-helium cryoablation of small HCC located adjacent to major organs or viscus. MATERIAL AND METHODS Ninety-two patients who underwent percutaneous argon-helium cryoablation between February 2012 and December 2018 at the Fifth Medical Center of the Chinese People's Liberation Army General Hospital were included. Treatment efficacy was evaluated by magnetic resonance imaging or triphasic computed tomography scan within 1 week after each cryoablation procedure. Local tumor progression, distant recurrence, and overall survival were analyzed using the Kaplan-Meier method and log-rank test. RESULTS A total of 92 patients with small HCC located adjacent to major organs or viscus who underwent cryoablation were retrospectively reviewed. The number of patients with tumors adjacent to the gallbladder, portal or hepatic vein, diaphragm, stomach, heart, and intestine was 22, 1, 39, 6, 8, and 16, respectively. Cumulative local tumor progression rates at 1 and 2 years were 2.8% and 7.3%, respectively. Cumulative distant recurrence rates at 1, 2, and 3 years were 11.1%, 17.6%, and 20.7%, respectively. The overall survival rates at 1, 2, and 4 years were 100%, 93.6%, and 74.9%, respectively. Major complications were observed in 5 (5.4%) patients. Minor complications were observed in 85 (92.4%) patients. CONCLUSIONS This experience from a single center showed that percutaneous argon-helium cryoablation was safe and effective in the management of small HCC that is located adjacent to major organs or viscus.
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Affiliation(s)
- Wei Zhang
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
| | - Xudong Gao
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
| | - Jie Sun
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
| | - Jiamin Cheng
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
| | - Yanli Hu
- Department of Emergency Medicine, Beidaihe Sanatorium of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Beidaihe, Hebei, PR China
| | - Zheng Dong
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
| | - Huifang Kong
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
| | - Huixin Zhang
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
| | - Chunping Wang
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
| | - Yongping Yang
- Department of Liver Disease of Chinese People’s Liberation Army (PLA) General Hospital, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, PR China
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Abstract
Cryotherapy or cryoablation involves the freezing of tissues to destroy unwanted tissue or to control bleeding. Endoscopic cryotherapy has been developed for gastrointestinal application by through-the-scope noncontact delivery of compressed carbon dioxide gas or liquid nitrogen (cryospray) or contact balloon cryoablation. The mechanism of cryotherapy ablative effects includes immediate injury as well as coagulation necrosis occurring over several hours and days, unlike heat-based thermal ablation. This article reviews the basis, technique, safety, efficacy, and durability for the use of endoscopic cryotherapy in Barrett's esophagus and esophageal adenocarcinoma.
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Abstract
Hepatocellular carcinoma (HCC) remains a significant malignancy and is the second leading cause of cancer death worldwide. Multiple therapeutic strategies exist for patients with HCC including locoregional therapy, liver resection, and liver transplantation. In many instances locoregional therapy is used to decrease tumor burden and "bridge" patients to liver transplant. Surgical technique during liver transplantation may need to be altered in light of these preoperative therapies used for treating HCC. In this review we discuss the technical aspects of liver transplantation and how they are impacted in patients with HCC.
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Ching-Ning Chong C, Lai-Hung Wong G. Treatments of Hepatocellular Carcinoma Patients with Hepatitis B Virus Infection: Treat HBV-related HCC. AIMS MEDICAL SCIENCE 2016. [DOI: 10.3934/medsci.2016.1.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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