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Robinson TP, Pebror T, Krosin ME, Koniaris LG. Ablative Therapy in Non-HCC Liver Malignancy. Cancers (Basel) 2023; 15:cancers15041200. [PMID: 36831543 PMCID: PMC9954041 DOI: 10.3390/cancers15041200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Surgical extirpation of liver tumors remains a proven approach in the management of metastatic tumors to the liver, particularly those of colorectal origin. Ablative, non-resective therapies are an increasingly attractive primary therapy for liver tumors as they are generally better tolerated and result in far less morbidity and mortality. Ablative therapies preserve greater normal liver parenchyma allowing better post-treatment liver function and are particularly appropriate for treating subsequent liver-specific tumor recurrence. This article reviews the current status of ablative therapies for non-hepatocellular liver tumors with a discussion of many of the clinically available approaches.
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Affiliation(s)
- Tyler P. Robinson
- Department of Surgery, Indiana University, Indianapolis, IN 46202, USA
- Correspondence: ; Tel.: +1-312-371-8360
| | - Travis Pebror
- Department of Interventional Radiology, Indiana University, Indianapolis, IN 46202, USA
| | - Matthew E. Krosin
- Department of Interventional Radiology, Indiana University, Indianapolis, IN 46202, USA
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Recent Advances in Stimuli-Responsive Doxorubicin Delivery Systems for Liver Cancer Therapy. Polymers (Basel) 2022; 14:polym14235249. [PMID: 36501642 PMCID: PMC9738136 DOI: 10.3390/polym14235249] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Doxorubicin (DOX) is one of the most commonly used drugs in liver cancer. Unfortunately, the traditional chemotherapy with DOX presents many limitations, such as a systematic release of DOX, affecting both tumor tissue and healthy tissue, leading to the apparition of many side effects, multidrug resistance (MDR), and poor water solubility. Furthermore, drug delivery systems' responsiveness has been intensively studied according to the influence of different internal and external stimuli on the efficiency of therapeutic drugs. In this review, we discuss both internal stimuli-responsive drug-delivery systems, such as redox, pH and temperature variation, and external stimuli-responsive drug-delivery systems, such as the application of magnetic, photo-thermal, and electrical stimuli, for the controlled release of Doxorubicin in liver cancer therapy, along with the future perspectives of these smart delivery systems in liver cancer therapy.
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Chen C, Wang Y, Li G, Xu L, Wang Y, Huang H, Wang B, Li W, He X. Feasibility of CT-CT fusion imaging for evaluation of the cryoablation margins in visible hepatocellular carcinoma on unenhanced CT images: Initial experience. J Interv Med 2019; 2:60-64. [PMID: 34805874 PMCID: PMC8562177 DOI: 10.1016/j.jimed.2019.09.003] [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] [Indexed: 11/30/2022] Open
Abstract
Objective To demonstrate the feasibility of CT-CT fusion imaging for assessment of the cryoablation margins in visible hepatocellular carcinoma (HCC) on unenhanced CT images. Methods This retrospective study analyzed 14 patients with 14 HCC lesions treated with CT-guided cryoablation. Nine lesions in nine patients who developed local tumor progression (LTP) during the follow-up period of at least 8 months were reviewed. The unenhanced CT data were used to retrospectively create fusion images of the intraoperative CT images on a workstation. The minimal ablative margin (MAM) was assessed on the fusion images. The concordance between the site of LTP and the MAM area was also assessed. Results Eight of the nine lesions with LTP were in the subcapsular region of the liver. Seven of the nine cases were treated by cryoablation combined with transcatheter arterial chemoembolization. The median time required to fuse the images for the nine lesions was 5:17 min (range, 5:04–7:37 min). The site of LTP relative to the HCC lesion was craniocaudal in nine, dorsoventral in six, and lateral in seven lesions. In all lesions, the site of LTP was congruent with the MAM area. Conclusions CT-CT fusion imaging enables a real-time intraoperative treatment evaluation for HCC lesions visible on unenhanced CT images. Fused imaging evaluation has proved to be an accurate and useful tool for assessment of the cryoablation margins.
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Affiliation(s)
- Chao Chen
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Yaohui Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Guodong Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Haozhe Huang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Biao Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
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Chen C, Xu LC, Wang Y, Wang YH, Li GD, Huang HZ, Wang B, Li WT, He XH. Assessment of the cryoablation margin using MRI-CT fusion imaging in hepatic malignancies. Clin Radiol 2019; 74:652.e21-652.e28. [PMID: 31076083 DOI: 10.1016/j.crad.2019.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/22/2019] [Indexed: 01/04/2023]
Abstract
AIM To demonstrate the feasibility of magnetic resonance imaging (MRI)-computed tomography (CT) fusion imaging for the assessment of the ablative margin after cryoablation in hepatic malignancies. MATERIALS AND METHODS This retrospective study analysed 35 patients with 47 liver tumours treated with CT-guided cryoablation. Fusion images of pre-ablation MRI and intraoperative CT data were created on a workstation. Minimal ablative margin (MAM) assessment was categorised into three groups: (I) MAM <0 mm (tumour protruded through the ablation zone), (II) MAM 0-5 mm, and (III) MAM ≥5 mm. Local tumour progression (LTP) was assessed during follow-up. RESULTS MRI-CT fusion imaging was successfully achieved in 46 (97.9%) of 47 lesions. LTP was detected in 67.4% (31/46) of cases. Twenty-four (77.4%) of 31 LTPs occurred in the subcapsular region of the liver. Using fusion images, the MAM was classified as groups I, II, and III in 18, 25, and three tumours, respectively. In group I, LTP was found in 15 (83.3%) of 18 lesions, whereas in group II, LTP was detected in 16 (64%) of 25 lesions. The cumulative LTP rate in group II was significantly lower than that in group I (p=0.012). CONCLUSION Pre-ablation MRI and intraoperative CT fusion imaging is feasible and useful for evaluating the MAM of cryoablation in hepatic malignancies.
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Affiliation(s)
- C Chen
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - L C Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Y Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Y H Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - G D Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - H Z Huang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - B Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - W T Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
| | - X H He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
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Bouvry C, Palard X, Edeline J, Ardisson V, Loyer P, Garin E, Lepareur N. Transarterial Radioembolization (TARE) Agents beyond 90Y-Microspheres. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1435302. [PMID: 30687734 PMCID: PMC6330886 DOI: 10.1155/2018/1435302] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/19/2018] [Indexed: 12/14/2022]
Abstract
Liver malignancies, either primary tumours (mainly hepatocellular carcinoma and cholangiocarcinoma) or secondary hepatic metastases, are a major cause of death, with an increasing incidence. Among them, hepatocellular carcinoma (HCC) presents with a dark prognosis because of underlying liver diseases and an often late diagnosis. A curative surgical treatment can therefore only be proposed in 20 to 30% of the patients. However, new treatment options for intermediate to advanced stages, such as internal radionuclide therapy, seem particularly attractive. Transarterial radioembolization (TARE), which consists in the use of intra-arterial injection of a radiolabelled embolising agent, has led to very promising results. TARE with 90Y-loaded microspheres is now becoming an established procedure to treat liver tumours, with two commercially available products (namely, SIR-Sphere® and TheraSphere®). However, this technology remains expensive and is thus not available everywhere. The aim of this review is to describe TARE alternative technologies currently developed and investigated in clinical trials, with special emphasis on HCC.
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Affiliation(s)
- C. Bouvry
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, CNRS, ISCR (Institut des Sciences Chimiques de Rennes), UMR 6226, 35000 Rennes, France
| | - X. Palard
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, Inserm, LTSI (Laboratoire Traitement du Signal et de l'Image), UMR_S 1099, 35000 Rennes, France
| | - J. Edeline
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35000 Rennes, France
| | - V. Ardisson
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
| | - P. Loyer
- Univ Rennes, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35000 Rennes, France
| | - E. Garin
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35000 Rennes, France
| | - N. Lepareur
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35000 Rennes, France
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Cui W, Fan W, Huang K, Wang Y, Lu M, Yao W, Li J. Large hepatocellular carcinomas: treatment with transarterial chemoembolization alone or in combination with percutaneous cryoablation. Int J Hyperthermia 2018; 35:239-245. [PMID: 30200796 DOI: 10.1080/02656736.2018.1493235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Wei Cui
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenzhe Fan
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kunbo Huang
- Department of Ultrasonography, the First Hospital of China Medical University, ShenYang, China
| | - Yu Wang
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingjian Lu
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wang Yao
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaping Li
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Kis B, El-Haddad G, Sheth RA, Parikh NS, Ganguli S, Shyn PB, Choi J, Brown KT. Liver-Directed Therapies for Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma. Cancer Control 2018; 24:1073274817729244. [PMID: 28975829 PMCID: PMC5937250 DOI: 10.1177/1073274817729244] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) are primary liver cancers where all or most of the tumor burden is usually confined to the liver. Therefore, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease with minimal systemic side effects. The English medical literature and clinical trials were reviewed to provide a synopsis on the available liver-directed percutaneous therapies for HCC and IHC. Locoregional liver-directed therapies provide survival benefit for patients with HCC and IHC compared to best medical treatment and have lower comorbid risks compared to surgical resection. These treatment options should be considered, especially in patients with unresectable disease.
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Affiliation(s)
- Bela Kis
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ghassan El-Haddad
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rahul A Sheth
- 2 Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Nainesh S Parikh
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Suvranu Ganguli
- 3 Center for Image Guided Cancer Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul B Shyn
- 4 Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's, Boston, MA, USA
| | - Junsung Choi
- 1 Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Karen T Brown
- 5 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Liu Y, Li X, Zhang LM, Chen J, Cai Y, Lin Y, Geng CJ, Wang K, Wang QQ, He CS, Zhong S. Safety and efficacy of a China-made cryoablation device in treatment of hepatocellular carcinoma smaller than 5 cm. Shijie Huaren Xiaohua Zazhi 2017; 25:426-431. [DOI: 10.11569/wcjd.v25.i5.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the safety and efficacy of a China-made cryoablation device in the treatment of hepatocellular carcinoma (HCC) smaller than 5 cm.
METHODS A total of 33 patients with HCC smaller than 5 cm were treated by cryoablation using a China-made cryoablation device under the guidance of computed tomography. Operation-associated complications within and after procedures were evaluated. The efficacy of target lesions within procedures and local recurrence rate after procedures were evaluated with imaging modalities.
RESULTS All 37 lesions of the 33 patients were successfully treated with a China-made cryablation device. Upon the finish of procedures, complete ablation was achieved in 83.78% (31/37) of lesions, and partial ablation was achieved in 16.22% (6/37). In a median follow-up period of 10.8 mo, 32 patients remained alive and 1 was lost to follow-up. The rate of local recurrence for target lesions was 30.3% (10/33), which is equal to that achieved with imported devices.
CONCLUSION Our findings suggest that the China-made cryoablation device is safe and effective for HCC smaller than 5 cm with the capability of destroying the whole tumor lesion.
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Niu L, Luo X, Zeng J, Kong X, Fang G, Li Z, Li R, Xu K. Cryoablation Combined with Iodine-125 Implantation in the Treatment of Cardiac Metastasis from Alveolar Soft Part Sarcoma: A Case Report. Biomed Hub 2016; 1:1-8. [PMID: 31988888 PMCID: PMC6945912 DOI: 10.1159/000449403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/25/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives A 36-year-old Asian man was referred to our hospital with cardiac metastasis. He had a history of alveolar soft part sarcoma and initially underwent resection in 2005. Methods After exposing the tumor by thoracotomy, cryoablation was performed under ultrasound guidance. This treatment was combined with iodine-125 seed implantation to treat the cardiac metastasis. Results The patient had an uneventful recovery, and his cardiac function shows no obvious abnormalities. Imaging techniques suggest that cardiac metastasis was well controlled, and the patient is still alive 12 months after treatment. Conclusions Tumor cryoablation, combined with iodine seed implantations, may be regarded as a means of palliative treatment.
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Affiliation(s)
- Lizhi Niu
- Department of Surgery and Anesthesia, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Xiaomei Luo
- Jinan University School of Medicine, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | | | - Xiaofeng Kong
- Department of Oncology, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Gang Fang
- Department of Surgery and Anesthesia, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Zhonghai Li
- Department of Radiology, Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Rongrong Li
- Department of Ultrasound, Fuda Cancer Hospital, Jinan University School of Medicine (Guangzhou Fuda Cancer Hospital), Guangzhou Fuda Cancer Institute, Guangzhou, China
| | - Kecheng Xu
- Department of Oncology, Guangzhou Fuda Cancer Institute, Guangzhou, China
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Niu LZ, Li JL, Xu KC. Percutaneous Cryoablation for Liver Cancer. J Clin Transl Hepatol 2014; 2:182-8. [PMID: 26355719 PMCID: PMC4521246 DOI: 10.14218/jcth.2014.00017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/15/2014] [Accepted: 06/27/2014] [Indexed: 12/15/2022] Open
Abstract
Based on the primary tumor site, liver cancer can be divided into two categories: (1) primary liver cancer and (2) metastatic cancer to the liver from a distant primary site. Guided cryoablation via many imaging methods induces iceball formation and tumor necrosisand is an attractive option for treating unresectable hepatocellular carcinoma (HCC) and metastatic liver cancer. There are several advantages to using cryoablation for the treatment of liver cancer: it can be performed percutaneously, intraoperatively, and laparoscopically; iceball formation can be monitored; it has little impact on nearby large blood vessels; and it induces a cryo-immunological response in situ. Clinically, primary research has shown that percutaneous cryoablation of liver cancer is relatively safe and efficient, and it can be combined with other methods, such as radiation therapy, chemotherapy, and immunology, to control disease. Although research is preliminary, cryosurgery is fast becoming an alternative treatment method for HCC or liver tumors. Here, we review the mechanisms of liver tumor cryoablation, cryoablation program selection, clinical efficiency, and complications following treatment.
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Affiliation(s)
- Li-Zhi Niu
- Fuda Cancer Hospital, Jinan University School of Medicine, Tianhe District, Guangzhou, China
- Guangzhou Fuda Cancer Institute, Tianhe District, Guangzhou, China
| | - Jia-Liang Li
- Guangzhou Fuda Cancer Institute, Tianhe District, Guangzhou, China
| | - Ke-Cheng Xu
- Fuda Cancer Hospital, Jinan University School of Medicine, Tianhe District, Guangzhou, China
- Guangzhou Fuda Cancer Institute, Tianhe District, Guangzhou, China
- Correspondence to: Kecheng Xu, No.2 of Tangde West Rd, Tianhe District, Guangzhou, China. Tel: +86-020-38993994-8700, Fax: +86-020-38993994-8700. E-mail:
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Xu M, Xie F, Qian G, Jing Y, Zhang S, Gao L, Zheng T, Wu M, Yang J, Wei L. Peritumoral ductular reaction: a poor postoperative prognostic factor for hepatocellular carcinoma. BMC Cancer 2014; 14:65. [PMID: 24495509 PMCID: PMC3916808 DOI: 10.1186/1471-2407-14-65] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/03/2014] [Indexed: 12/17/2022] Open
Abstract
Background The role of ductular reaction (DR) in hepatocellular carcinoma (HCC) remains to be elucidated. Methods In this study, we tried to uncover possible effect by correlating peritumoral DR in a necroinflammatory microenvironment with postoperative prognosis in HCC. The expression of peritumoral DR/CK19 by immunohistochemistry, necroinflammation and fibrosis were assessed from 106 patients receiving curative resection for HCC. Prognostic values for these and other clinicopathologic factors were evaluated. Results Peritumoral DR significantly correlated with necroinflammation (r = 0.563, p = 3.4E-10), fibrosis (r = 0.435, p = 3.1E-06), AFP level (p = 0.010), HBsAg (p = 4.9E-4), BCLC stage (p = 0.003), TNM stage (p = 0.002), multiple nodules (p = 0.004), absence of tumor capsule (p = 0.027), severe microscopic vascular invasion (p = 0.031) and early recurrence (p = 0.010). Increased DR was significantly associated with decreased RFS/OS (p = 4.8E-04 and p = 2.6E-05, respectively) in univariate analysis and were identified as an independent prognostic factor (HR = 2.380, 95% CI = 1.250-4.534, p = 0.008 for RFS; HR = 4.294, 95% CI = 2.255-8.177, p = 9.3E-6 for OS) in multivariate analysis. Conclusions These results suggested that peritumoral DR in a necroinflammatory microenvironment was a poor prognostic factor for HCC after resection.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jiamei Yang
- Tumor Immunology & Gene Therapy Center, Eastern Hepatobiliary Hospital, The Second Military Medical University, Changhai Road, Shanghai 200438, China.
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Vincenot J, Melodelima D, Chavrier F, Vignot A, Kocot A, Chapelon JY. Electronic beam steering used with a toroidal HIFU transducer substantially increases the coagulated volume. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1241-54. [PMID: 23643055 DOI: 10.1016/j.ultrasmedbio.2013.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/29/2012] [Accepted: 01/27/2013] [Indexed: 05/09/2023]
Abstract
Treatment with high-intensity focused ultrasound is well established but requires extended treatment time. A device composed of 256 elements arranged on a toroidal transducer was developed to increase the coagulated volume. When all the elements are working in phase for 40 s, a volume of 6-8 cm(3) can be ablated. However, the mechanical juxtaposition of single lesions is still necessary for treating one tumor with a diameter of 2 cm. The objective of this study was to combine this toroidal transducer geometry with electronic beam steering to ablate tumors with adequate normal tissue margins and without any mechanical displacement of the high-intensity focused ultrasound device. In vitro tests demonstrated that the coagulated volume obtained from 130 s of total exposure has an average diameter of 41.4 ± 4.0 mm and an average length of 53.3 ± 6.1 mm. This single lesion can be used to treat various size of metastasis, located at depths in the liver ranging 5-45 mm.
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Li J, Chen J, Zhou L, Zeng J, Yao F, Wu B, Fang G, Deng C, Chen Z, Leng Y, Xu K, Niu L, Zuo J, Xu K. Comparison of dual- and triple-freeze protocols for hepatic cryoablation in a Tibet pig model. Cryobiology 2012; 65:68-71. [PMID: 22561141 DOI: 10.1016/j.cryobiol.2012.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/11/2012] [Accepted: 04/12/2012] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to compare a dual-freeze protocol with a triple-freeze protocol for hepatic cryoablation in a porcine model. Eighteen cryoablations were performed over an exposed operation field in nine normal porcine livers, using dual- (10-5-10-5) and triple-freeze (5-5-5-5-10-5) protocols. Changes in the temperature of the cryoprobes and the diameter of the iceballs were recorded during the ablation, and pathological changes in the cryozones (zones of tissue destruction) were assessed seven days after the procedure. Use of two and three freeze-thaw cycles produced iceballs of different diameters. Seven days after cryosurgery, the triple-freeze protocol was associated with a larger zone of complete necrosis than the dual-freeze protocol, although the two protocols produced cryozones and cryolesions of similar length, and in both cases the cryozones contained five areas of destruction. With the same freezing time (20 min), the triple-freeze protocol may be a more powerful liver ablation method than the dual-freeze protocol.
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Affiliation(s)
- Jialiang Li
- Guangzhou Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510305, China
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Niu L, Li J, Chen J, Zhou L, Wu B, Zeng J, Fang G, Deng C, Yao F, Chen Z, Leng Y, Deng M, Deng C, Zhang B, Liao M, Xu K, Zuo J, Xu K. Comparison of dual- and triple-freeze protocols for pulmonary cryoablation in a Tibet pig model. Cryobiology 2012; 64:245-9. [PMID: 22366171 DOI: 10.1016/j.cryobiol.2012.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to compare a dual-freeze protocol with a triple-freeze protocol for pulmonary cryoablation in a porcine lung model. Five dual- (10-5-10-5) and five triple-freeze (5-5-5-5-10-5) cryoablations were performed on an exposed operation field in normal porcine lung. Changes in the temperature of the cryoprobes and the diameter of the iceballs were measured during the ablation and pathologic changes in the cryozones (zones of tissue destruction) were reviewed 7 days after the procedure. The diameter of the iceball surface differed between the two protocols. Pathologically, the triple-freeze protocol was associated with a longer complete necrosis zone than the dual-freeze protocol, though the two protocols produced cryolesions and cryozones of similar length, and in both cases there were five areas of tissue destruction. With the same duration of freezing (20 min), the triple-freeze protocol may be better for pulmonary cryoablation than the dual-freeze protocol.
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Affiliation(s)
- Lizhi Niu
- Guangzhou Fuda Cancer Hospital, Guangzhou, China
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Lee SM, Won JY, Lee DY, Lee KH, Lee KS, Paik YH, Kim JK. Percutaneous cryoablation of small hepatocellular carcinomas using a 17-gauge ultrathin probe. Clin Radiol 2011; 66:752-9. [PMID: 21513923 DOI: 10.1016/j.crad.2011.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/22/2011] [Accepted: 02/02/2011] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the feasibility and safety of percutaneous cryoablation (PCA) of small hepatocellular carcinomas (HCCs) using a 17 G ultrathin cryoprobe. MATERIALS AND METHODS Twenty patients (male:female ratio14:6) with 20 HCCs, who were not surgical candidates, underwent ultrasound (US)-guided PCA for treatment of HCCs. Single HCCs less than 3cm in diameter were included in this study. Ablation was performed using a 17 G cryoprobe. The effectiveness was determined by the changes in alpha-foetoprotein level and degree of tumour necrosis on follow-up computed tomography (CT); complete response (100% necrosis), partial response (100%>necrosis≥30%), stable disease (any cases not qualifying for either partial response or progressive disease) and progressive disease (increase of at least 20% in diameter of viable tumour). Haemoglobin, white blood cell count (WBC), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and total bilirubin were compared before and after the procedure, and the technical feasibility, complications, clinical outcomes and survival of each patient were also evaluated. RESULTS All procedures were technically successful. Each patient complained of negligible pain and there was no other procedure-related complication or mortality. The mean level of alpha-foetoprotein declined significantly from 53.2 to 20.4ng/ml 1 month after the procedure (p<0.05). At 1-month follow-up CT, there were 13 complete responses, four partial responses, three patients with stable disease, and no patients had progressive disease. Six of seven lesions that did not present with a complete response underwent further treatment. On long-term follow up (6-30 months; mean 20.7), a local recurrence was seen in one of 13 lesions (8%) with complete response revealed. Laboratory findings showed no significant changes except for the transient increase of SGOT and SGPT. CONCLUSION US-guided PCA using a 17 G cryoprobe was feasible and safe for the treatment of HCC smaller than 3cm.
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Affiliation(s)
- S M Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, 712 Eonjuro, Gangnam-gu, Seoul 135-720, Korea
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Rudich N, Zamir G, Pappo O, Shlomai Z, Faroja M, Weiss ID, Wald H, Galun E, Peled A, Wald O. Focal liver necrosis appears early after partial hepatectomy and is dependent on T cells and antigen delivery from the gut. Liver Int 2009; 29:1273-84. [PMID: 19538448 DOI: 10.1111/j.1478-3231.2009.02048.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Progressive liver failure may develop following removal of a large part of the liver or transplantation of a small for size liver graft. The pathophysiology of this clinical syndrome is only partially understood. METHODS We assessed liver damage and hepatocyte 5-bromo-2'-deoxyuridine (BrdU) incorporation following partial hepatectomy (PH) in C57BL/6, BALB/C and immune-deficient mice. Hepatic lymphocyte subpopulations were characterized. Lipopolysaccharide (LPS) treatment and bowel decontamination determined the role of gut antigens. RESULTS Discrete, round necrotic lesions were observed as early as 2 h following 70%, but not 30% PH. In immune competent mice the extent of hepatocyte necrosis inversely correlated with BrdU incorporation. T, natural killer and natural killer T cells were recruited to the liver early after PH; however, only T-cell depletion abrogated hepatic necrosis. Hepatic injury was significantly reduced in non-obese diabetic/severe combined immunodeficient mice undergoing PH, while BrdU incorporation was not affected. Liver injury was augmented by LPS injection and reduced by gut decontamination. CONCLUSIONS A distinct pattern of early focal hepatic necrosis is observed following extensive PH in mice. T cells infiltrating the liver immediately after PH and gut-derived antigens are indispensable for the observed liver necrosis and may thus provide therapeutic targets to ameliorate liver damage following PH.
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Affiliation(s)
- Noam Rudich
- Laboratory for Surgical Research, Hadassah University Hospital, Jerusalem, Israel
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Abstract
Hepatocellular carcinoma is increasingly detected at small size, usually 5 cm or smaller in diameter. For small hepatocellular carcinoma, percutaneous ablation is a potentially curative treatment. Ethanol injection is able to achieve a complete response of 70-80% and a 5-year survival of 40-60% in the treatment of hepatocellular carcinoma of 3 cm or less. Radiofrequency ablation has emerged as the more powerful alternative method. Randomized controlled trials show that radiofrequency ablation offers a higher complete response at fewer treatment sessions and better survival compared with ethanol injection. Microwave ablation has been demonstrated to be equivalent to radiofrequency ablation in both local efficacy and long-term outcome. Laser ablation is mainly applied in clinical settings in Europe. Nowadays, percutaneous ablation is commonly accepted as the best option for patients with small hepatocellular carcinoma who are not candidates for surgical resection or liver transplantation. However, whether it can compete with surgery as the first-line treatment has long been debated. There are some retrospective studies and only a few randomized controlled trials to compare the two modalities. The currently available data are not robust enough to draw a solid conclusion. This review article provides an overview of the current status of percutaneous ablation in management of small hepatocellular carcinoma and also focuses on comparison with surgical resection.
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Affiliation(s)
- Xiao-Yu Yin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
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Melodelima D, N'Djin WA, Parmentier H, Chesnais S, Rivoire M, Chapelon JY. Thermal ablation by high-intensity-focused ultrasound using a toroid transducer increases the coagulated volume. Results of animal experiments. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:425-435. [PMID: 19081666 DOI: 10.1016/j.ultrasmedbio.2008.09.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 07/21/2008] [Accepted: 09/19/2008] [Indexed: 05/27/2023]
Abstract
Surgical resection is the only treatment of colorectal liver metastases that can ensure long-term survival and cure in some patients. However, only 20% of patients are suitable for surgery. As a result, many nonresectional modalities of treatment have been assessed to provide an alternative to liver resection. Several limitations have been observed when using these techniques and available evidence is limited. Here, we report that a new design of high intensity focused ultrasound transducer can significantly enlarge the coagulated volume over short periods of time and that treatment in the liver can be guided in real-time using an integrated ultrasound imaging probe. Our long-term objective is to develop a device that can be used during surgery for eventual clinical use in conjunction with resection. Eight ultrasound emitters, divided into 256 elements, were created by sectioning a single toroid piezocomposite transducer. The focal zone was conical in shape and located 70 mm from the transducer; enabling the treatment of deep-seated tumors. A single thermal lesion was created when the eight emitters performed alternative and consecutive 5-s ultrasound exposures. This article presents in vivo evidence that the coagulated volume obtained from a 40 s total exposure in the liver was 7.0 +/- 2.5 cm(3) (minimum 1.5 - maximum 20.0 cm(3)) with an average diameter of 17.5 +/- 3.8 mm (minimum 10.0 - maximum 29.0 mm). All lesions were visible with high contrast on sonograms. The correlation between the diameter of lesions observed on sonograms and during gross examination was 92%. This method also allowed the user to easily enlarge the coagulated volume by juxtaposing single lesions. This approach may have a role in treating unresectable colorectal liver metastases and may also be used in conjunction with resection to extend its limits.
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Finite element modeling of cooled-tip probe radiofrequency ablation processes in liver tissue. Comput Biol Med 2008; 38:694-708. [DOI: 10.1016/j.compbiomed.2008.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 03/10/2008] [Accepted: 03/18/2008] [Indexed: 11/18/2022]
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Kontos M, Felekouras E, Fentiman IS. Radiofrequency ablation in the treatment of primary breast cancer: no surgical redundancies yet. Int J Clin Pract 2008; 62:816-20. [PMID: 18412934 DOI: 10.1111/j.1742-1241.2007.01676.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/INTRODUCTION Radiofrequency energy has emerged as a new tool for the local destruction of cancer by inducing thermal tissue necrosis in the target region. Radiofrequency ablation (RFA) has recently been used to treat breast cancer primaries, potentially offering all the advantages of minimally invasive techniques. METHODS/EVIDENCE Nine published studies addressing the role of RFA in the treatment of breast cancer have been identified and analysed, in six, first-line RFA was followed by surgical removal and there were 12 failures in 108 ablations. Three further studies involved RFA without subsequent excision and in 1/60 there was a local relapse after 4 months (follow-up range: 15-29 months). DISCUSSION Existing RFA techniques may not be able to destroy the whole of the malignant lesion, because of local conditions allowing cancer cells to survive within the target area or because electrodes cannot be accurately directed to the tumour site with ultrasound. Additionally, distant in-breast cancers can be missed on pre/intraoperative imaging. Histological information is unavailable after tissue destruction so that the opportunity to reassess tumour grade based on more extensive sampling is lost, but this can be improved by more extensive sampling with vacuum-assisted core biopsy. CONCLUSIONS Before RFA can be safely used in the treatment of breast cancer primaries, several criteria need to be met. These include development of RFA devices and techniques, standardisation of the treatment protocol, including imaging and selection of patients, and establishment of a feasible post-treatment follow-up strategy.
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Affiliation(s)
- M Kontos
- Academic Oncology, Guy's Hospital, London, UK
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