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Mankertz F, Gemeinhardt O, Felbor U, Hadlich S, Hosten N. Spacer-Supported Thermal Ablation to Prevent Carbonisation and Improve Ablation Size: A Proof of Concept Study. Biomedicines 2023; 11:biomedicines11020575. [PMID: 36831111 PMCID: PMC9952941 DOI: 10.3390/biomedicines11020575] [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: 01/23/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Thermal ablation offers a minimally invasive alternative in the treatment of hepatic tumours. Several types of ablation are utilised with different methods and indications. However, to this day, ablation size remains limited due to the formation of a central non-conductive boundary layer. In thermal ablation, this boundary layer is formed by carbonisation. Our goal was to prevent or delay carbonisation, and subsequently increase ablation size. We used bovine liver to compare ablation diameter and volume, created by a stand-alone laser applicator, with those created when utilising a spacer between laser applicator and hepatic tissue. Two spacer variants were developed: one with a closed circulation of cooling fluid and one with an open circulation into hepatic tissue. We found that the presence of a spacer significantly increased ablation volume up to 75.3 cm3, an increase of a factor of 3.19 (closed spacer) and 3.02 (open spacer) when compared to the stand-alone applicator. Statistical significance between spacer variants was also present, with the closed spacer producing a significantly larger ablation volume (p < 0.001, MDiff = 3.053, 95% CI[1.612, 4.493]) and diameter (p < 0.001, MDiff = 4.467, 95% CI[2.648, 6.285]) than the open spacer. We conclude that the presence of a spacer has the potential to increase ablation size.
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Affiliation(s)
- Fiona Mankertz
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence:
| | - Ole Gemeinhardt
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ute Felbor
- Institute for Human Genetics, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Stefan Hadlich
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Norbert Hosten
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
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2
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Sehmbi AS, Froghi S, Oliveira de Andrade M, Saffari N, Fuller B, Quaglia A, Davidson B. Systematic review of the role of high intensity focused ultrasound (HIFU) in treating malignant lesions of the hepatobiliary system. HPB (Oxford) 2021; 23:187-196. [PMID: 32830069 DOI: 10.1016/j.hpb.2020.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND High Intensity Focused Ultrasound (HIFU) is an emerging non-invasive, targeted treatment of malignancy. The aim of this review was to assess the efficacy, safety and optimal technical parameters of HIFU to treat malignant lesions of the hepatobiliary system. METHODS A systematic search of the English literature was performed until March 2020, interrogating Pubmed, Embase and Cochrane Library databases. The following key-words were input in various combinations: 'HIFU', 'High intensity focussed ultrasound', 'Hepatobiliary', 'Liver', 'Cancer' and 'Carcinoma'. Extracted content included: Application type, Exposure parameters, Patient demographics, and Treatment outcomes. RESULTS Twenty-four articles reported on the clinical use of HIFU in 940 individuals to treat malignant liver lesions. Twenty-one studies detailed the use of HIFU to treat hepatocellular carcinoma only. Mean tumour size was 5.1 cm. Across all studies, HIFU resulted in complete tumour ablation in 55% of patients. Data on technical parameters and the procedural structure was very heterogeneous. Ten studies (n = 537 (57%) patients) described the use of HIFU alongside other modalities including TACE, RFA and PEI; 66% of which resulted in complete tumour ablation. Most common complications were skin burns (15%), local pain (5%) and fever (2%). CONCLUSION HIFU has demonstrated benefit as a treatment modality for malignant lesions of the hepatobiliary system. Combining HIFU with other ablative therapies, particularly TACE, increases the efficacy without increasing complications. Future human clinical studies are required to determine the optimal treatment parameters, better define outcomes and explore the risks and benefits of combination therapies.
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Affiliation(s)
- Arjan S Sehmbi
- Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Garrod Building, Whitechapel, London, UK
| | - Saied Froghi
- Department of HPB & Liver Transplantation, Royal Free Hospital Hampstead, London, UK; Division of Surgery & Interventional Sciences, University College London, Royal Free Campus, Hampstead, London, UK.
| | | | - Nader Saffari
- Faculty of Engineering Sciences, University College London, Gower Street, London, UK
| | - Barry Fuller
- Division of Surgery & Interventional Sciences, University College London, Royal Free Campus, Hampstead, London, UK
| | - Alberto Quaglia
- Department of Pathology, Royal Free Hospital, Hampstead, London, UK
| | - Brian Davidson
- Department of HPB & Liver Transplantation, Royal Free Hospital Hampstead, London, UK; Division of Surgery & Interventional Sciences, University College London, Royal Free Campus, Hampstead, London, UK
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3
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Lewis AR, Padula CA, McKinney JM, Toskich BB. Ablation plus Transarterial Embolic Therapy for Hepatocellular Carcinoma Larger than 3 cm: Science, Evidence, and Future Directions. Semin Intervent Radiol 2019; 36:303-309. [PMID: 31680721 DOI: 10.1055/s-0039-1697641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Thermal ablation is widely regarded as definitive therapy for early-stage hepatocellular carcinoma, but its efficacy decreases in tumors greater than 3 cm. Extensive clinical studies have supported improved outcomes provided through combining transarterial embolic therapy with ablation in the treatment of larger tumors. This article will provide a survey of the science and data for combination therapy in both thermal and nonthermal ablation modalities, as well as describe emerging applications.
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Affiliation(s)
- Andrew R Lewis
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Carlos A Padula
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - J Mark McKinney
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Beau B Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
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4
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Yanagie H, Dewi N, Higashi S, Ikushima I, Seguchi K, Mizumachi R, Murata Y, Morishita Y, Shinohara A, Mikado S, Yasuda N, Fujihara M, Sakurai Y, Mouri K, Yanagawa M, Iizuka T, Suzuki M, Sakurai Y, Masunaga SI, Tanaka H, Matsukawa T, Yokoyama K, Fujino T, Ogura K, Nonaka Y, Sugiyama H, Kajiyama T, Yui S, Nishimura R, Ono K, Takamoto S, Nakajima J, Ono M, Eriguchi M, Hasumi K, Takahashi H. Selective boron delivery by intra-arterial injection of BSH-WOW emulsion in hepatic cancer model for neutron capture therapy. Br J Radiol 2017; 90:20170004. [PMID: 28406315 DOI: 10.1259/bjr.20170004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Boron neutron-capture therapy (BNCT) has been used to inhibit the growth of various types of cancers. In this study, we developed a 10BSH-entrapped water-in-oil-in-water (WOW) emulsion, evaluated it as a selective boron carrier for the possible application of BNCT in hepatocellular carcinoma treatment. METHODS We prepared the 10BSH-entrapped WOW emulsion using double emulsification technique and then evaluated the delivery efficacy by performing biodistribution experiment on VX-2 rabbit hepatic tumour model with comparison to iodized poppy-seed oil mix conventional emulsion. Neutron irradiation was carried out at Kyoto University Research Reactor with an average thermal neutron fluence of 5 × 1012 n cm-2. Morphological and pathological analyses were performed on Day 14 after neutron irradiation. RESULTS Biodistribution results have revealed that 10B atoms delivery with WOW emulsion was superior compared with those using iodized poppy-seed oil conventional emulsion. There was no dissemination in abdomen or lung metastasis observed after neutron irradiation in the groups treated with 10BSH-entrapped WOW emulsion, whereas many tumour nodules were recognized in the liver, abdominal cavity, peritoneum and bilateral lobes of the lung in the non-injected group. CONCLUSION Tumour growth suppression and cancer-cell-killing effect was observed from the morphological and pathological analyses of the 10BSH-entrapped WOW emulsion-injected group, indicating its feasibility to be applied as a novel intra-arterial boron carrier for BNCT. Advances in knowledge: The results of the current study have shown that entrapped 10BSH has the potential to increase the range of therapies available for hepatocellular carcinoma which is considered to be one of the most difficult tumours to cure.
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Affiliation(s)
- Hironobu Yanagie
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan.,2 Department of Nuclear Engineering and Management, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,3 Cooperative Unit of Medicine and Engineering, The University of Tokyo Hospital, Tokyo, Japan
| | - Novriana Dewi
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan.,3 Cooperative Unit of Medicine and Engineering, The University of Tokyo Hospital, Tokyo, Japan
| | - Syushi Higashi
- 4 Department of Surgery, Kojinkai Medical City East Hospital, Miyazaki, Japan
| | - Ichiro Ikushima
- 5 Department of Radiology, Miyakonojyo Metropolitan Hospital, Miyazaki, Japan
| | - Koji Seguchi
- 4 Department of Surgery, Kojinkai Medical City East Hospital, Miyazaki, Japan
| | - Ryoji Mizumachi
- 6 Department of Pharmacology, Kumamoto Institute Branch, LSI Medience Co. Ltd, Kumamoto, Japan
| | - Yuji Murata
- 6 Department of Pharmacology, Kumamoto Institute Branch, LSI Medience Co. Ltd, Kumamoto, Japan
| | - Yasuyuki Morishita
- 7 Department of Human and Molecular Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsuko Shinohara
- 8 Department of Humanities, The Graduate School of Seisen University, Tokyo, Japan
| | - Shoji Mikado
- 9 Department of Physics, College of Industrial Technology, Nihon University, Chiba, Japan
| | - Nakahiro Yasuda
- 10 Research Institute of Nuclear Engineering, University of Fukui, Fukui, Japan
| | | | - Yuriko Sakurai
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan.,3 Cooperative Unit of Medicine and Engineering, The University of Tokyo Hospital, Tokyo, Japan
| | - Kikue Mouri
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan.,3 Cooperative Unit of Medicine and Engineering, The University of Tokyo Hospital, Tokyo, Japan
| | - Masashi Yanagawa
- 12 Veterinary Medical Center, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Tomoya Iizuka
- 13 Department of Veterinary Surgery, The University of Tokyo Veterinary Hospital, Tokyo, Japan
| | - Minoru Suzuki
- 14 Research Reactor Institute, Kyoto University, Osaka, Japan
| | | | | | - Hiroki Tanaka
- 14 Research Reactor Institute, Kyoto University, Osaka, Japan
| | - Takehisa Matsukawa
- 15 Department of Epidemiology and Environmental Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhito Yokoyama
- 15 Department of Epidemiology and Environmental Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Fujino
- 16 Department of Pathological Diagnosis, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Koichi Ogura
- 9 Department of Physics, College of Industrial Technology, Nihon University, Chiba, Japan
| | - Yasumasa Nonaka
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Hirotaka Sugiyama
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Tetsuya Kajiyama
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Sho Yui
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Ryohei Nishimura
- 13 Department of Veterinary Surgery, The University of Tokyo Veterinary Hospital, Tokyo, Japan
| | - Koji Ono
- 14 Research Reactor Institute, Kyoto University, Osaka, Japan
| | - Sinichi Takamoto
- 17 Department of Cardiac Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jun Nakajima
- 3 Cooperative Unit of Medicine and Engineering, The University of Tokyo Hospital, Tokyo, Japan.,18 Department of Pulmonary Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Minoru Ono
- 3 Cooperative Unit of Medicine and Engineering, The University of Tokyo Hospital, Tokyo, Japan.,19 Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masazumi Eriguchi
- 1 Department of Innovative Cancer Therapeutics: Alpha Particle and Immunotherapeutics, Meiji Pharmaceutical University, Tokyo, Japan.,20 Department of Surgery, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | | | - Hiroyuki Takahashi
- 2 Department of Nuclear Engineering and Management, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,3 Cooperative Unit of Medicine and Engineering, The University of Tokyo Hospital, Tokyo, Japan
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Pacella CM, Nasoni S, Grimaldi F, Di Stasio E, Misischi I, Bianchetti S, Papini E. Laser ablation with or without chemoembolization for unresectable neuroendocrine liver metastases: a pilot study. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije.15.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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6
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Riaz A, Lewandowski RJ, Salem R. Locoregional Therapies for Primary and Secondary Hepatic Malignancies. Cancer Treat Res 2016; 168:233-256. [PMID: 29206376 DOI: 10.1007/978-3-319-34244-3_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Management of hepatic malignancies is a multidisciplinary task with the involvement of hepatologists, medical/surgical oncologists, transplant surgeons, and interventional radiologists. The patients should be selected for a specific targeted therapy after multidisciplinary consensus. Interventional oncology has established its role in the management of hepatic malignancies. Image-guided locoregional therapies decrease the rate of systemic toxicity without compromising tumoricidal effect.
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Maurizio Pacella C, Francica G, Di Costanzo GG. Laser ablation: an alternative to radiofrequency ablation for hepatocellular carcinoma in cirrhotic patients? Hepat Oncol 2015; 2:111-115. [DOI: 10.2217/hep.15.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging & Interventional Radiology, Regina Apostolorum Hospital, 00041 Albano Laziale, Rome, Italy
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, 81030 Castelvolturno, Italy
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8
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WITHDRAWN: Selective enhancement of boron accumulation in tumours with intra-arterial administration of boron-entrapped water-in-oil-in-water emulsion as a novel boron carrier in VX-2 rabbit hepatic cancer model for neutron capture therapy. Pharmacotherapy 2015. [DOI: 10.1016/j.biopha.2014.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Costanzo GGD, Francica G, Pacella CM. Laser ablation for small hepatocellular carcinoma: State of the art and future perspectives. World J Hepatol 2014; 6:704-715. [PMID: 25349642 PMCID: PMC4209416 DOI: 10.4254/wjh.v6.i10.704] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 06/17/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
During the last two decades, various local thermal ablative techniques for the treatment of unresectable hepatocellular carcinoma (HCC) have been developed. According to internationally endorsed guidelines, percutaneous thermal ablation is the mainstay of treatment in patients with small HCC who are not candidates for surgical resection or transplantation. Laser ablation (LA) represents one of currently available loco-ablative techniques. In this article, the general principles, technique, image guidance, and patient selection are reported. Primary effectiveness, long-term outcome, and complications are also discussed. A review of published data suggests that LA is equivalent to the more popular and widespread radiofrequency ablation in both local tumor control and long-term outcome in the percutaneous treatment of early HCC. In addition, the LA technique using multiple thin laser fibres allows improved ablative effectiveness in HCCs greater than 3 cm. Reference centres should be equipped with all the available techniques so as to be able to use the best and the most suitable procedure for each type of lesion for each patient.
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10
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Paul SB, Sharma H. Role of Transcatheter Intra-arterial Therapies for Hepatocellular Carcinoma. J Clin Exp Hepatol 2014; 4:S112-21. [PMID: 25755602 PMCID: PMC4284218 DOI: 10.1016/j.jceh.2014.03.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 03/03/2014] [Indexed: 02/07/2023] Open
Abstract
Transcatheter intra-arterial therapies play a vital role in treatment of HCC due to the unique tumor vasculature. Evolution of techniques and newer efficacious modalities of tumor destruction have made these techniques popular. Various types of intra-arterial therapeutic options are currently available. These constitute: bland embolization, trans-arterial chemotherapy, trans-arterial chemo embolization with or without drug-eluting beads and trans-arterial radio embolization, which are elaborated in this review.
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Key Words
- AFP, alpha feto protein
- CR, complete response
- HAIC, hepatic artery infusion chemotherapy
- HCC, hepatocellular carcinoma
- LA, laser ablation
- OLT, orthotopic liver transplant
- PD, progressive disease
- PEI, percutaneous ethanol injection
- PR, partial response
- PVT, portal vein thrombosis
- RFA, ablation
- SD, stable disease
- TACE, trans-arterial chemoembolization
- TAE, Trans-arterial embolization
- TART, trans-arterial radiotherapy
- drug eluting bead (DEB)
- hepatocellular carcinoma (HCC)
- trans-arterial chemoembolization (TACE)
- trans-arterial embolization (TAE)
- trans-arterial radiotherapy (TART)
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Affiliation(s)
- Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Hanish Sharma
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
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11
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Yu H, Burke CT. Comparison of percutaneous ablation technologies in the treatment of malignant liver tumors. Semin Intervent Radiol 2014; 31:129-37. [PMID: 25071303 PMCID: PMC4078184 DOI: 10.1055/s-0034-1373788] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tumor ablation is a minimally invasive technique used to deliver chemical, thermal, electrical, or ultrasonic damage to a specific focal tumor in an attempt to achieve substantial tumor destruction or complete eradication. As the technology continues to advance, several image-guided tumor ablations have emerged to effectively manage primary and secondary malignancies in the liver. Percutaneous chemical ablation is one of the oldest and most established techniques for treating small hepatocellular carcinomas. However, this technique has been largely replaced by newer modalities including radiofrequency ablation, microwave ablation, laser-induced interstitial thermotherapy, cryoablation, high-intensity-focused ultrasound ablation, and irreversible electroporation. Because there exist significant differences in underlying technological bases, understanding each mechanism of action is essential for achieving desirable outcomes. In this article, the authors review the current state of each ablation method including technological and clinical considerations.
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Affiliation(s)
- Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles T. Burke
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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12
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Numerical simulations on conformable laser-induced interstitial thermotherapy through combined use of multi-beam heating and biodegradable nanoparticles. Lasers Med Sci 2014; 29:1505-16. [PMID: 24627283 DOI: 10.1007/s10103-014-1558-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
Clinically, precisely heating and thus completely ablating diseased tumor tissue through laser beam is still facing many technical challenges. In this study, numerical simulation of a conformal heating modality based on multi-beam laser along with biodegradable magnesium nanoparticles (Mg-NPs) was put forward to treat liver tumor with large size or irregular shape. Further, a Gaussian-like distribution was proposed to investigate the influence of Mg-NP deposition on the nanoenhanced laser-induced interstitial thermotherapy (LITT). A temperature feedback system was adopted to control the temperature range to avoid overheating. To preliminarily validate the heating enhancement induced by the applied multi-beam laser and Mg-NPs, a conceptual experiment was performed. Both theoretical simulation and experimental measurements demonstrated that multi-beam laser with Mg-NPs could improve efficiency in the conformal heating of tumors with irregular shape or large size. In addition, the distribution and content of Mg-NPs produced significant impact on thermotherapy: (1) The adjustable parameter σ in the Gaussian-like distribution could reflect various practical situations and diffusivities of Mg-NPs; (2) under the premise of the same concentration of Mg-NPs and short time to heat a small-sized target, the whole liver tumor containing Mg-NPs could not improve the efficiency as the nanoparticles limited the photons to be absorbed only around the fibers, while liver tumor partially containing Mg-NPs could improve the thermotherapy efficiency up to 20 %; and (3) the addition of Mg-NPs was rather beneficial for realizing a conformal heating as the residual thermal energy was much less than that without Mg-NPs. This study suggests a feasible and promising modality for planning a high-performance LITT in future clinics.
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Zou X, Liu Q, Zhou X, He G, Yu M, Han Z, Meng X, Su H. Ultrasound-guided percutaneous laser and ethanol ablation of rabbit VX2 liver tumors. Acta Radiol 2013; 54:181-7. [PMID: 23482351 DOI: 10.1258/ar.2012.110723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Only a small percentage of patients with hepatocellular carcinoma (HCC) may benefit out of surgical resection. Thus, lots of these patients are in need of local control, such as percutaneous ethanol injection (PEI), percutaneous laser ablation (PLA), or radiofrequency thermal ablation (RF). PURPOSE To investigate the effects of ultrasound-guided PLA combined with PEI on rabbit VX2 liver tumors, using conventional gray-scale ultrasonography (US), color/power Doppler (CD/PD)US, contrast-enhanced (CE) US, and histologic examination. MATERIAL AND METHODS VX2 tumors were implanted in the livers of 80 rabbits. Fourteen days after implantation, animals were randomly separated into four groups of 20 rabbits. Treatment of the four groups was with: (i) PLA; (ii) PEI; (iii) combined therapy of PLA immediately followed by PEI; and (iv) combined therapy of PEI immediately followed by PLA. Conventional gray-scale US, CD US, PD US, and CE US were performed before and after ablation. The effects on ablated areas were assessed by histologic examination. RESULTS Conventional gray-scale US showed a clear boundary around the ablated area in groups 1, 3, and 4. An isoechoic treated region with an irregular boundary was seen in group 2. On CE US, coagulated areas demonstrated a perfusion defect. Both conventional gray-scale US and CE US showed that the ablated volume in group 4 was larger than that in groups 1, 2, and 3. CD US and PD US demonstrated residual tumor in the periphery of ablated areas in groups 1 and 2, but not in groups 3 and 4. CE US demonstrated no residual tumor in group 4, unlike in groups 1, 2, and 3. Examination of treated tumors demonstrated necrosis in the ablated zones and increasing surrounding fibrous bands in the four treatment groups. Residual viable tissue in group 4 was less than that in groups 1, 2, and 3. CONCLUSION Combined therapy of PEI immediately followed by PLA can coagulate significantly larger volumes of tumor and reduce residual tumor.
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Affiliation(s)
- Xiaojuan Zou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qing Liu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaodong Zhou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guangbin He
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ming Yu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zenghui Han
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xin Meng
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haili Su
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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Ghanaati H, Alavian SM, Jafarian A, Ebrahimi Daryani N, Nassiri-Toosi M, Jalali AH, Shakiba M. Imaging and Imaging-Guided Interventions in the Diagnosis and Management of Hepatocellular Carcinoma (HCC)-Review of Evidence. IRANIAN JOURNAL OF RADIOLOGY 2012; 9:167-77. [PMID: 23407596 PMCID: PMC3569547 DOI: 10.5812/iranjradiol.8242] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/24/2012] [Accepted: 10/27/2012] [Indexed: 12/12/2022]
Abstract
The imaging of hepatocellular carcinoma (HCC) is challenging and plays a crucial role in the diagnosis and staging of the disease. A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC. Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable. In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated. In this paper, we aimed to review the evidence regarding imaging modalities and therapeutic interventions of HCC.
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Affiliation(s)
- Hossein Ghanaati
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Hossein Ghanaati, Medical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran. Tel.: +98-2166581516, Fax: +98-2166581578, E-mail:
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Hepatobilliary and Liver Transplantation Division, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasser Ebrahimi Daryani
- Department of Gastroenterology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Nassiri-Toosi
- Department of Gastroenterology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
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Ablation of hepatocellular carcinoma: an incomplete review. AJR Am J Roentgenol 2012; 198:W506; author reply W507. [PMID: 22528934 DOI: 10.2214/ajr.11.8112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Laser ablation for small hepatocellular carcinoma. Radiol Res Pract 2011; 2011:595627. [PMID: 22191028 PMCID: PMC3236316 DOI: 10.1155/2011/595627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 10/20/2011] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and is increasingly detected at small size (<5 cm) owing to surveillance programmes in high-risk patients. For these cases, curative therapies such as resection, liver transplantation, or percutaneous ablation have been proposed. When surgical options are precluded, image-guided tumor ablation is recommended as the most appropriate therapeutic choice in terms of tumor local control, safety, and improvement in survival. Laser ablation (LA) represents one of currently available loco-ablative techniques: light is delivered via flexible quartz fibers of diameter from 300 to 600 μm inserted into tumor lesion through either fine needles (21g Chiba needles) or large-bore catheters. The thermal destruction of tissue is achieved through conversion of absorbed light (usually infrared) into heat. A range of different imaging modalities have been used to guide percutaneous laser ablation, but ultrasound and magnetic resonance imaging are most widely employed, according to local experience and resource availability. Available clinical data suggest that LA is highly effective in terms of tumoricidal capability with an excellent safety profile; the best results in terms of long-term survival are obtained in early HCC so that LA can be proposed not only in unresectable cases but, not differently from radiofrequency ablation, also as the first-line treatment.
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Liu C, Liang P, Liu F, Wang Y, Li X, Han Z, Liu C. MWA combined with TACE as a combined therapy for unresectable large-sized hepotocellular carcinoma. Int J Hyperthermia 2011; 27:654-62. [PMID: 21966941 DOI: 10.3109/02656736.2011.605099] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of microwave ablation combined with transcatheter arterial chemoembolization for unresectable large-sized hepotocellular carcinoma. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Between May 2004 and December 2006, 34 consecutive patients with large unresectable hepatocellular carcinoma (>5 cm) were alternately enrolled in one of two treatment groups: group 1 (n = 18), in which TACE was performed alone, and group 2 (n = 16), in which percutaneous ablation of HCC with microwave ablation was performed 2-4 weeks after TACE. All patients were followed up for 2-28 months to observe long-term therapeutic effects and complications in both groups. Tumor reduction rates, median survival time, and cumulative survival rates in both groups were calculated by using the unpaired Student t test and Kaplan-Meier method. RESULTS Follow-up images showed reduction in tumor size was seen in 21 patients (61.7%; 7/18 in group 1, 14/16 in group 2), survival rates were better in group 2 than in group 1 (P = 0.003), during the median follow-up of 8 months, 10 patients (62.5%) remained alive in group 2, whereas 6 patients (33.3%) remained alive in group 1, the mean survival times were 6.13 months ± 0.83 in group 1 and 11.61 months ± 1.59 in group 2. CONCLUSION MWA combined with transcatheter arterial chemoembolization appears to be an effective and promising approach for the treatment of large-sized unresectable hepotocellular carcinoma. However, large-scale randomized clinical trials are needed to determine the future role of this treatment.
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Affiliation(s)
- Cun Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital , 28 Fuxing Road, Beijing , 100853, PR China
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18
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Simultaneous injection of autologous mononuclear cells with TACE in HCC patients; preliminary study. J Gastrointest Cancer 2011; 42:11-9. [PMID: 21046282 DOI: 10.1007/s12029-010-9218-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The discovery of the pluripotent stem cells made the prospect of cell therapy and tissue regeneration a clinical reality, especially with the evidence of contribution of the stem cells of bone marrow origin in hepatic regeneration. Infusion of bone marrow stem cells before trans-arterial chemoembolization may help to increase liver volume and consequently increase hepatic reserve in patients with HCC, and this may improve the outcome of this procedure. MATERIALS AND METHODS Four Child B class patients with unresectable hepatocellular carcinoma treated by transarterial chemoembolization were injected with autologous bone marrow mononuclear layer containing stem cell in the hepatic artery feeding the contralateral lobe of the liver in the same session, follow-up of the patients was done by doing liver profile and CT liver volumetry before the surgery and 3 months later. RESULTS We observed that patients receiving stem cell therapy simultaneously with TACE had shown a significant improvement in biological and volumetric parameters of liver function compared to those historically reported of patients receiving TACE only who usually shows deterioration of liver parameters. CONCLUSION BMC infusion into the hepatic artery synchronized with TACE for patients with chronic liver disease complicated with HCC is safe, feasible, and demonstrated an improvement in both biological and radiological volumetric parameters.
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19
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Yu H, Zhu GY, Xu RZ, Niu HZ, Lu Q, Li GZ, Wang ZY, Zhang DS, Gu N, Teng GJ. Arterial embolization hyperthermia using As2O3 nanoparticles in VX2 carcinoma-induced liver tumors. PLoS One 2011; 6:e17926. [PMID: 21448278 PMCID: PMC3063167 DOI: 10.1371/journal.pone.0017926] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 02/16/2011] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Combination therapy for arterial embolization hyperthermia (AEH) with arsenic trioxide (As(2)O(3)) nanoparticles (ATONs) is a novel treatment for solid malignancies. This study was performed to evaluate the feasibility and therapeutic effect of AEH with As(2)O(3) nanoparticles in a rabbit liver cancer model. The protocol was approved by our institutional animal use committee. METHODOLOGY/PRINCIPAL FINDINGS In total, 60 VX(2) liver-tumor-bearing rabbits were randomly assigned to five groups (n = 12/group) and received AEH with ATONs (Group 1), hepatic arterial embolization with ATONs (Group 2), lipiodol (Group 3), or saline (Group 4), on day 14 after tumor implantation. Twelve rabbits that received AEH with ATONs were prepared for temperature measurements, and were defined as Group 5. Computed tomography was used to measure the tumors' longest dimension, and evaluation was performed according to the Response Evaluation Criteria in Solid Tumors. Hepatic toxicity, tumor necrosis rate, vascular endothelial growth factor level, and microvessel density were determined. Survival rates were measured using the Kaplan-Meier method. The therapeutic temperature (42.5°C) was obtained in Group 5. Hepatotoxicity reactions occurred but were transient in all groups. Tumor growth was delayed and survival was prolonged in Group 1 (treated with AEH and ATONs). Plasma and tumor vascular endothelial growth factor and microvessel density were significantly inhibited in Group 1, while tumor necrosis rates were markedly enhanced compared with those in the control groups. CONCLUSIONS ATON-based AEH is a safe and effective treatment that can be targeted at liver tumors using the dual effects of hyperthermia and chemotherapy. This therapy can delay tumor growth and noticeably inhibit tumor angiogenesis.
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Affiliation(s)
- Hui Yu
- Jiangsu Key Laboratory of Molecular Imaging
and Functional Imaging, Department of Radiology, Zhong-Da Hospital, Medical
School of Southeast University, Nanjing, China
| | - Guang-Yu Zhu
- Jiangsu Key Laboratory of Molecular Imaging
and Functional Imaging, Department of Radiology, Zhong-Da Hospital, Medical
School of Southeast University, Nanjing, China
| | - Rui-Zhi Xu
- Jiangsu Laboratory for Biomaterials and
Devices, State Key Laboratory of BioElectronics, School of Biological Science
and Medical Engineering, Southeast University, Nanjing, China
| | - Huan-Zhang Niu
- Jiangsu Key Laboratory of Molecular Imaging
and Functional Imaging, Department of Radiology, Zhong-Da Hospital, Medical
School of Southeast University, Nanjing, China
| | - Qin Lu
- Jiangsu Key Laboratory of Molecular Imaging
and Functional Imaging, Department of Radiology, Zhong-Da Hospital, Medical
School of Southeast University, Nanjing, China
| | - Guo-Zhao Li
- Jiangsu Key Laboratory of Molecular Imaging
and Functional Imaging, Department of Radiology, Zhong-Da Hospital, Medical
School of Southeast University, Nanjing, China
| | - Zi-Yu Wang
- Department of Pathology and Pathophysiology,
Medical School of Southeast University, Nanjing, China
| | - Dong-Sheng Zhang
- Department of Pathology and Pathophysiology,
Medical School of Southeast University, Nanjing, China
| | - Ning Gu
- Jiangsu Laboratory for Biomaterials and
Devices, State Key Laboratory of BioElectronics, School of Biological Science
and Medical Engineering, Southeast University, Nanjing, China
| | - Gao-Jun Teng
- Jiangsu Key Laboratory of Molecular Imaging
and Functional Imaging, Department of Radiology, Zhong-Da Hospital, Medical
School of Southeast University, Nanjing, China
- * E-mail:
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Di Matteo F, Grasso R, Pacella CM, Martino M, Pandolfi M, Rea R, Luppi G, Silvestri S, Zardi E, Costamagna G. EUS-guided Nd:YAG laser ablation of a hepatocellular carcinoma in the caudate lobe. Gastrointest Endosc 2011; 73:632-6. [PMID: 21030019 DOI: 10.1016/j.gie.2010.08.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 08/11/2010] [Indexed: 02/07/2023]
Affiliation(s)
- Francesco Di Matteo
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Via Álvaro del Portillo, 200, 00128 Rome, Italy
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21
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Chen X, Saidel GM. Modeling of laser coagulation of tissue with MRI temperature monitoring. J Biomech Eng 2011; 132:064503. [PMID: 20887037 DOI: 10.1115/1.4001395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Light energy from a laser source that is delivered into body tissue via a fiber-optic probe with minimal invasiveness has been used to ablate solid tumors. This thermal coagulation process can be guided and monitored accurately by continuous magnetic resonance imaging (MRI) since the laser energy delivery system does not interfere with MRI. This report deals with mathematical modeling and analysis of laser coagulation of tissue. This model is intended for "real-time" analysis of magnetic resonance images obtained during the coagulation process to guide clinical treatment. A mathematical model is developed to simulate the thermal response of tissue to a laser light heating source. For fast simulation, an approximate solution of the thermal model is used to predict the dynamics of temperature distribution and tissue damage induced by a laser energy line source. The validity of these simulations is tested by comparison with MRI-based temperature data acquired from in vivo experiments in rabbits. The model-simulated temperature distribution and predicted lesion dynamics correspond closely with MRI-based data. These results demonstrate the potential for using this combination of fast modeling and MRI technologies during laser heating of tissue for online prediction of tumor lesion size during laser heating.
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Affiliation(s)
- Xin Chen
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
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22
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Jin C, Zhu H, Wang Z, Wu F, Chen W, Li K, Su H, Zhou K, Gong W. High-intensity focused ultrasound combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: long-term follow-up and clinical analysis. Eur J Radiol 2010; 80:662-9. [PMID: 20864286 DOI: 10.1016/j.ejrad.2010.08.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 08/30/2010] [Accepted: 08/30/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE High-intensity focused ultrasound (HIFU) combined with transarterial chemoembolization (TACE) has been used to treat unresectable HCC, but its long-term effects and major prognostic factors remain to be determined. The purpose of this study was to assess its long-term effects and find major prognostic factors to help us select eligible patients in the future. METHODS 73 patients with unresectable HCC received follow-up after HIFU+TACE. The variables of sex, age, AFP level, liver function, tumor location, tumor number, tumor size, TNM staging (5th edition), TNM staging (6th edition), portal vein invasion, ultrasonic pathway of HIFU, TACE session and ablation response were evaluated by univariate analysis. Those variables with significant difference were assessed by multivariate analysis. RESULTS The mean follow-up time was 11.7±11.1 months (range, 1-60 months). The median survival time and overall survival rates of 1, 2, 3-year were 12 months, 49.1%, 18.8%, 8.4%, respectively. 45.2% patients achieved complete ablation. At the end of follow-up, 51 patients (69.9%) died from tumor progression (27 patients), liver function failure (18 patients), hemorrhage of upper digestive tract (3 patients) and infection (3 patients). 1 with liver abscess, 2 with serious skin burns and 2 with rib fracture were observed after HIFU. On univariate analysis, age (P=0.017), tumor size (P=0.000), tumor number (P=0.039), the 5th edition of TNM staging (P=0.023), portal vein invasion (P=0.02) and ablation response (P=0.000) had significant difference. On multivariate analysis, ablation response (P=0.001) and tumor size (P=0.013) were major prognostic factors. CONCLUSION HIFU combined with TACE is a safe method with a low rate of severe complications. As major prognostic factors, ablation response and tumor size may help us predict the survival and select eligible patients clinically.
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Affiliation(s)
- Chengbing Jin
- Clinical Center for Tumor Therapy, 2nd Affiliated Hospital of Chongqing Medical University, and Department of Bioengineering, Chongqing Medical University, Chongqing 40010, China
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Jeon UB, Lee JW, Choo KS, Kim CW, Kim S, Lee TH, Jeong YJ, Kang DH. Iodized oil uptake assessment with cone-beam CT in chemoembolization of small hepatocellular carcinomas. World J Gastroenterol 2009; 15:5833-7. [PMID: 19998505 PMCID: PMC2791277 DOI: 10.3748/wjg.15.5833] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [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 evaluate the utility of assessing iodized oil uptake with cone-beam computed tomography (CT) in transarterial chemoembolization (TACE) for small hepatocellular carcinoma (HCC).
METHODS: Cone-beam CT provided by a biplane flat-panel detector angiography suite was performed on eighteen patients (sixteen men and two women; 41-76 years; mean age, 58.9 years) directly after TACE for small HCC (26 nodules under 30 mm; mean diameter, 11.9 mm; range, 5-28 mm). The pre-procedural locations of the tumors were evaluated using triphasic multi-detector row helical computed tomography (MDCT). The tumor locations on MDCT and the iodized oil uptake by the tumors were analyzed on cone-beam CT and on spot image directly after the procedures.
RESULTS: All lesions on preprocedural MDCT were detected using iodized oil uptake in the lesions on cone-beam CT (sensitivity 100%, 26/26). Spot image depicted iodized oil uptake in 22 of the lesions (sensitivity 85%). The degree of iodized oil uptake was overestimated (9%, 2/22) or underestimated (14%, 3/22) on spot image in five nodules compared with that of cone-beam CT.
CONCLUSION: Cone-beam CT is a useful and convenient tool for assessing the iodized oil uptake of small hepatic tumors (< 3 cm) directly after TACE.
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Review on transarterial chemoembolization in hepatocellular carcinoma: Palliative, combined, neoadjuvant, bridging, and symptomatic indications. Eur J Radiol 2009; 72:505-16. [DOI: 10.1016/j.ejrad.2008.08.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/07/2008] [Accepted: 08/11/2008] [Indexed: 02/07/2023]
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Pacella CM, Valle D, Bizzarri G, Pacella S, Brunetti M, Maritati R, Osborn J, Stasi R. Percutaneous laser ablation in patients with isolated unresectable liver metastases from colorectal cancer: Results of a phase II study. Acta Oncol 2009; 45:77-83. [PMID: 16464799 DOI: 10.1080/02841860500438029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We prospectively evaluated the safety, local tumor control, and impact on survival parameters of percutaneous laser ablation (PLA) in patients with colorectal liver metastases not amenable to surgical resection. The study included 44 individuals with 75 unresectable liver metastases and no known extrahepatic disease. The median number of metastases treated for each patient was one, with a range of 1-4. Metastases had a median diameter of 3.4 cm (range 0.5-9 cm), and a median volume of 16.8 cm(3) (range 0.4-176.4 cm(3)). All patients also received systemic chemotherapy with modalities that differed according to the type of response to PLA. After treatment, 61% (46/75) of the tumors were ablated completely. The likelihood of achieving a complete ablation was significantly higher when metastases had a diameter <3.0 cm (p = 0.004). Overall survival was 30.0+/-12.7 months in patients with a complete ablation, and 20.2+/-10.2 months in those with a partial ablation (p = 0.002). There were no major complications during or after PLA, the most frequent side effect being abdominal pain that required analgesics. These findings indicate that PLA can be safely used as an adjunct to chemotherapy in unresectable colorectal liver metastases, and may have a positive impact on survival.
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Affiliation(s)
- Claudio M Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Italy.
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Hou YB, Chen MH, Yan K, Wu JY, Yang W. Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment. World J Gastroenterol 2009; 15:2638-43. [PMID: 19496195 PMCID: PMC2691496 DOI: 10.3748/wjg.15.2638] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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 evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA.
METHODS: A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 ± 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 ± 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo.
RESULTS: In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04).
CONCLUSION: PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.
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Pacella CM, Francica G, Di Lascio FML, Arienti V, Antico E, Caspani B, Magnolfi F, Megna AS, Pretolani S, Regine R, Sponza M, Stasi R. Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. J Clin Oncol 2009; 27:2615-21. [PMID: 19332729 DOI: 10.1200/jco.2008.19.0082] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Percutaneous laser ablation (PLA) has been proposed as an active treatment in patients with hepatocellular carcinoma (HCC). However, large multicenter studies using this technique have not been reported. PATIENTS AND METHODS We retrospectively analyzed treatment and survival parameters of 432 cirrhotic patients with nonsurgical early HCC (single nodule < or = 4 cm or three nodules < or = 3 cm each) who had received PLA in nine Italian centers. RESULTS Single tumors were seen in 344 (80%) of 432 patients, and two to three nodules were seen in 88 patients (20%), for a total of 548 tumors. An initial complete response after PLA was observed in 338 patients (78%). Median overall survival time was 47 months (95% CI, 41 to 53 months). The 3- and 5-year cumulative survival rates were 61% and 34%, respectively. In multivariate analysis, independent predictors of survival were serum albumin levels more than 3.5 g/dL (P = .002; risk ratio [RR] = 0.580; 95% CI, 0.409 to 0.821), the achievement of a complete tumor ablation (P = .001; RR = 0.517; 95% CI, 0.346 to 0.771), and age less than 73 years (P < .001; RR = 0.466; 95% CI, 0.320 to 0.681). Child-Turcotte-Pugh class A patients had a 5-year cumulative survival rate of 41%; this figure increased up to 60% with a median survival time of 63 months (95% CI, 48 to 78 months) in patients with tumors < or = 2.0 cm. CONCLUSION This analysis confirms that a complete tumor ablation results in improved survival in patients with nonsurgical HCC. Ideal candidates for PLA are younger patients with normal serum albumin levels and tumor size < or = 2 cm.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Radiology and Diagnostic Imaging and Medical Sciences, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy.
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Abstract
A wide range of local thermal ablative therapies have been developed in the treatment of non resectable hepatocellular carcinoma (HCC) in the last decade. Laser ablation (LA) and radiofrequency ablation (RFA) are the two most widely used of these. This article provides an up to date overview of the role of laser ablation in the local treatment of HCC. General principles, technique, image guidance and patient selection are discussed. A review of published data on treatment efficacy, long term outcome and complication rates of laser ablation is included and comparison with RFA made. The role of laser ablation in combination with transcatheter arterial chemoembolization is also discussed.
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Jiang ZX, Peng WJ, Li WT, Tang F, Liu SY, Qu XD, Wang JH, Lu HF. Effect of b value on monitoring therapeutic response by diffusion-weighted imaging. World J Gastroenterol 2008; 14:5893-9. [PMID: 18855990 PMCID: PMC2751901 DOI: 10.3748/wjg.14.5893] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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 explore the diffusion gradient b-factor that optimizes both apparent diffusion coefficient (ADC) measurement and contrast-to-noise (CNR) for assessing tumor response to transarterial chemoembolization (TACE) in a rabbit model.
METHODS: Twelve New Zealand white rabbits bearing VX2 tumors in the liver were treated with TACE. Diffusion-weighted imaging (DWI) with various b values was performed using the same protocol before and 3 d after treatment with TACE. ADC values and CNR of each tumor pre- and post-treatment with different b factors were analyzed. Correlation between ADC values and extent of necrosis in histological specimens was analyzed by a Pearson’s correlation test.
RESULTS: The quality of diffusion-weighted images diminished as the b value increased. A substantial decrease in the mean lesion-to-liver CNR was observed on both pre- and post-treatment DW images, the largest difference in CNR pre- and post-treatment was manifested at a b value of 1000 s/mm2 (P = 0.036 ). The effect of therapy on diffusion early after treatment was shown by a significant increase in ADCs (P = 0.007), especially with large b factors (≥ 600 s/mm2). The mean percentage of necrotic cells present within the tumor was 76.3%-97.5%. A significant positive correlation was found between ADC values and the extent of necrosis with all b values except for b200, a higher relative coefficient between ADC values and percentage of necrosis was found on DWI with b1000 and b2000 (P = 0.002 and 0.006, respectively).
CONCLUSION: An increasing b value of up to 600 s/mm2 would increase ADC contrast pre- and post-treatment, but decrease image quality. Taking into account both CNR and ADC measurement, diffusion-weighted imaging obtained with a b value of 1000 s/mm2 is recommended for monitoring early hepatic tumor response to TACE.
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Abdalla EK, Denys A, Hasegawa K, Leung TWT, Makuuchi M, Murthy R, Ribero D, Zorzi D, Vauthey JN, Torzilli G. Treatment of large and advanced hepatocellular carcinoma. Ann Surg Oncol 2008; 15:979-85. [PMID: 18236115 DOI: 10.1245/s10434-007-9727-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 07/03/2007] [Accepted: 07/06/2007] [Indexed: 12/23/2022]
Affiliation(s)
- Eddie K Abdalla
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Pacella CM, Stasi R, Bizzarri G, Pacella S, Graziano FM, Guglielmi R, Papini E. Percutaneous laser ablation of unresectable primary and metastatic adrenocortical carcinoma. Eur J Radiol 2007; 66:88-94. [PMID: 17498906 DOI: 10.1016/j.ejrad.2007.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Revised: 04/04/2007] [Accepted: 04/05/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the feasibility, safety, and clinical benefits of percutaneous laser ablation (PLA) in patients with unresectable primary and metastatic adrenocortical carcinoma (ACC). PATIENTS AND METHODS Four patients with hepatic metastases from ACC and a Cushing's syndrome underwent ultrasound-guided PLA. In one case the procedure was performed also on the primary tumor. RESULTS After three sessions of PLA, the primary tumor of 15 cm was ablated by 75%. After 1-4 (median 1) sessions of PLA, five liver metastases ranging from 2 to 5 cm were completely ablated, while the sixth tumor of 12 cm was ablated by 75%. There were no major complications. Treatment resulted in an improvement of performance status and a reduction of the daily dosage of mitotane in all patients. The three patients with liver metastases presented a marked decrease of 24-h urine cortisol levels, an improved control of hypertension and a mean weight loss of 2.8 kg. After a median follow-up after PLA of 27.0 months (range, 9-48 months), two patients have died of tumor progression, while two other patients remain alive and free of disease. CONCLUSIONS Percutaneous laser ablation is a feasible, safe and well tolerated procedure for the palliative treatment of unresectable primary and metastatic ACC. Further study is required to evaluate the impact of PLA on survival.
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Affiliation(s)
- Claudio M Pacella
- Regina Apostolorum Hospital, Department of Diagnostic Imaging and Interventional Radiology, Via San Francesco 50, Albano Laziale, Rome 00041, Italy.
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Higgins MC, Soulen MC. Multimodality Approaches for Control of Hepatocellular Carcinoma. Tech Vasc Interv Radiol 2007; 10:64-6. [DOI: 10.1053/j.tvir.2007.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Vallone P, Catalano O, Izzo F, Siani A. Combined ethanol injection therapy and radiofrequency ablation therapy in percutaneous treatment of hepatocellular carcinoma larger than 4 cm. Cardiovasc Intervent Radiol 2006; 29:544-51. [PMID: 16528626 DOI: 10.1007/s00270-005-0173-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Optimal treatment of large-sized hepatocellular carcinoma (HCC) is still debated, because percutaneous ablation therapies alone do not always achieve complete necrosis. OBJECTIVE To report our experience in the treatment of patients with HCC larger than 4 cm in diameter by combined percutaneous ethanol injection and radiofrequency thermal ablation. METHODS In a 5-year period there were 40 consecutive patients meeting the inclusion criteria (24 men and 16 women; age range 41-72 years, mean 58 years). These subjects had a single HCC larger than 4 cm. Twelve subjects also had one or two additional nodules smaller than 4 cm (mean 1.2 nodules per patient). Patients were submitted to one to three sessions consisting of ethanol injection at two opposite tumor poles (mean 12 ml) and then of radiofrequency application through one or two electrodes placed at the tumor center (mean treatment duration 30 min). RESULTS Complete necrosis was obtained in all cases with one to three sessions (mean 1.3 sessions per patient). All patients experienced pain and fever but one only subject had a major complication requiring treatment (abscess development and fistulization). Overall follow-up was 7-69 months. Two patients showed local recurrence and 9 developed new etherotopic HCC nodules. Seven subjects died during follow-up while 33 were free from recurrence 8-69 months after treatment. CONCLUSION A combination of ethanol injection and radiofrequency ablation is effective in the treatment of large HCC.
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Affiliation(s)
- Paolo Vallone
- Department of Radiology, National Cancer Institute, Fondazione Pascale, via Semmola, 80131 Naples, Italy
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Zangos S, Eichler K, Balzer JO, Straub R, Hammerstingl R, Herzog C, Lehnert T, Heller M, Thalhammer A, Mack MG, Vogl TJ. Large-sized hepatocellular carcinoma (HCC): a neoadjuvant treatment protocol with repetitive transarterial chemoembolization (TACE) before percutaneous MR-guided laser-induced thermotherapy (LITT). Eur Radiol 2006; 17:553-63. [PMID: 16896704 DOI: 10.1007/s00330-006-0343-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 05/03/2006] [Accepted: 05/22/2006] [Indexed: 02/07/2023]
Abstract
This study aims to evaluate the efficacy and safety of a neoadjuvant treatment protocol with repeated transarterial chemoembolization (TACE) before MR-guided laser-induced thermotherapy (LITT) for large-sized hepatocellular carcinomas (HCC). Repeated TACE (mean, 3.5 treatments per patient) was performed in 48 patients with neoadjuvant intention (the largest lesion was between 50 and 80 mm in diameter, and there were no more than five lesions). For the TACE treatment, we used 10 mg/m(2) mitomycin, 10 ml/m(2) Lipiodol and microspheres. The tumor volume was measured by MRI. Lipiodol retention of the tumors was evaluated with CT. After the diameter of the tumors had decreased to less than 50 mm, the patients were treated with MR-guided LITT 4 to 6 weeks after embolization. Repeated TACE reduced the tumor size in 32 patients (66.7%), forming the basis for performing MR-guided LITT procedures. These patients received one to four laser treatments (mean, 1.9 per patient) for tumor ablation, resulting in a median survival of 36.0 months after the first treatment. For the remaining patients, no reduction in tumor size was achieved in 12 patients and disease progression in 4 patients. Neoadjuvant TACE appears to be an effective treatment of large-sized HCC, which extends the indication for MR-guided LITT.
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MESH Headings
- Aged
- Aged, 80 and over
- Angiography, Digital Subtraction
- Antibiotics, Antineoplastic/administration & dosage
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/therapy
- Catheter Ablation
- Chemoembolization, Therapeutic/adverse effects
- Chemoembolization, Therapeutic/methods
- Contrast Media
- Echo-Planar Imaging
- Female
- Follow-Up Studies
- Humans
- Hyperthermia, Induced/adverse effects
- Hyperthermia, Induced/methods
- Iodized Oil
- Lasers
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/pathology
- Liver Neoplasms/therapy
- Magnetic Resonance Imaging/methods
- Male
- Microspheres
- Middle Aged
- Mitomycin/administration & dosage
- Neoadjuvant Therapy
- Survival Analysis
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Tumor Burden/drug effects
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Affiliation(s)
- Stephan Zangos
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
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Fan ZH, Chen MH, Dai Y, Wang YB, Yan K, Wu W, Yang W, Yin SS. Evaluation of primary malignancies of the liver using contrast-enhanced sonography: correlation with pathology. AJR Am J Roentgenol 2006; 186:1512-9. [PMID: 16714638 DOI: 10.2214/ajr.05.0943] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Our purpose was to investigate the correlation of contrast-enhanced sonographic patterns with the histopathology of primary malignancies of the liver. MATERIAL AND METHODS Of the 318 contrast-enhanced sonographic examinations performed between April and September 2004, 95 patients with 117 lesions confirmed by surgery or biopsy pathology were reviewed in this study. We analyzed the enhancement time and patterns according to the types and degrees of pathologic differentiation. RESULTS All 65 moderately to poorly differentiated hepatocellular carcinomas (HCCs) enhanced in the arterial phase, and 96.9% (63 lesions) of them quickly washed out in the portal venous phase. All 32 well-differentiated HCCs enhanced in the arterial phase, and 50.0% (16 lesions) washed out slowly during the late phase. The washout time of the two differentiated types was significantly different (p < 0.05). Seventy-five percent of the clear cell carcinomas (12/16) enhanced in the arterial phase, 25% (4/16) did not enhance until the portal venous phase, and 31.3% (5/16) of the clear cell carcinomas washed out slowly during the late phase. The enhancement and washout times of clear cell carcinomas were significantly different than those of moderately to poorly differentiated HCCs (p < 0.05). All four intrahepatic cholangiocarcinomas presented the same patterns as moderately to poorly differentiated HCCs: enhanced in the arterial phase and quickly washed out in the portal venous phase. Among the 72 lesions enhanced homogeneously, 46 lesions (63.9%) were smaller than 3 cm. Thirty-seven lesions (82.2%) of the 45 lesions that enhanced heterogeneously were larger than 3 cm (including the four cholangiocarcinomas). Larger lesions were mainly less differentiated. There were significant differences in tumor sizes in regard to cellular differentiations and types. CONCLUSION Our study showed that the enhancement manifestations of primary malignancies of the liver are related to pathologic types and grades. Contrast-enhanced sonograms may provide the histopathologic information for malignant tumors of the liver.
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Affiliation(s)
- Zhi-Hui Fan
- Department of Ultrasound, School of Oncology, Peking University, 52 Fu-cheng Rd., Beijing 100036, People's Republic of China
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Ferrari FS, Stella A, Pasquinucci P, Vigni F, Civeli L, Pieraccini M, Magnolfi F. Treatment of small hepatocellular carcinoma: a comparison of techniques and long-term results. Eur J Gastroenterol Hepatol 2006; 18:659-72. [PMID: 16702857 DOI: 10.1097/00042737-200606000-00014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to compare the results over time of transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), laser thermal ablation (LTA) and combined therapy in the treatment of small hepatocellular carcinoma. METHODS Between 1998 and 2004, 131 cirrhosis patients (99 Child-Pugh class A, 32 Child-Pugh class B) with a small hepatocellular carcinoma were included in the study; 34 were treated with PEI, 46 with LTA, 18 with TACE and 33 with combined therapy. RESULTS No major complication occurred during any procedure. Computed tomography scan showed that complete necrosis was achieved in 81% of treated nodules (120 out of 148); as a whole, the disease relapsed in 42 (32.0%) patients (with a disease-free interval of 17.0+/-13.7 months). The cumulative survival rates were 81.9, 35.7 and 20.8% at 12, 36 and 60 months respectively. A univariate analysis of survival showed statistically significant differences in the comparison between Child-Pugh class A with respect to Child-Pugh class B (P<0.0001) and between nodules with a diameter of 20 mm or less as opposed to larger than 20 mm (P=0.001). Patients subjected to LTA showed a statistically significant longer survival than those treated with TACE and PEI. CONCLUSIONS LTA proves to be the most effective treatment, affording reduced invasiveness, a limited number of sessions, complete necrosis in almost all cases and better total survival in the treated patients.
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Pacella CM, Bizzarri G, Francica G, Forlini G, Petrolati A, Valle D, Anelli V, Bianchini A, Nuntis SD, Pacella S, Rossi Z, Osborn J, Stasi R. Analysis of factors predicting survival in patients with hepatocellular carcinoma treated with percutaneous laser ablation. J Hepatol 2006; 44:902-9. [PMID: 16545480 DOI: 10.1016/j.jhep.2006.01.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 01/15/2006] [Accepted: 01/22/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS The factors which predict the long-term outcome in patients with hepatocellular carcinoma who are treated with percutaneous laser ablation (PLA) are not well established. METHODS We prospectively analyzed treatment and survival parameters of 148 cirrhotic patients with nonsurgical hepatocellular carcinoma who had undergone PLA at a single institution during an 11-year period. RESULTS Single tumors were seen in 129 of 148 (87%) patients, and 2-3 nodules were seen in 19 (13%) patients, for a total of 169 tumors. The median overall time survival was 39 months (95% confidence interval [CI], 30-47 months). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 89, 75, 52, 43, and 27%, respectively. From multiple regression analysis, the independent predictors of survival were found to be tumor grading (P=0.002; risk ratio [RR] 0.37, 95% CI 0.20-0.70), bilirubin levels < or =2.5mg/dl (P=0.014; RR 1.58, 95% CI 1.09-2.28), and the achievement of complete tumor ablation (P=0.020; RR 0.53, 95% CI 0.31-0.90). An initial complete tumor ablation was the only factor associated with longer survival in patients with Child-Turcotte-Pugh class A cirrhosis (P=0.012; hazard ratio [HR] 0.48, 95% CI 0.23-1.03). CONCLUSIONS A complete tumor ablation results in improved survival in all patients with nonsurgical hepatocellular carcinoma. Ideal candidates for PLA are those with a well-differentiated histology, and normal bilirubin levels.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Via San Francesco, 50-00041, Albano Laziale, Rome, Italy.
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Pacella CM, Bizzarri G, Francica G, Bianchini A, De Nuntis S, Pacella S, Crescenzi A, Taccogna S, Forlini G, Rossi Z, Osborn J, Stasi R. Percutaneous laser ablation in the treatment of hepatocellular carcinoma with small tumors: analysis of factors affecting the achievement of tumor necrosis. J Vasc Interv Radiol 2006; 16:1447-57. [PMID: 16319150 DOI: 10.1097/01.rvi.90000172121.82299.38] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To identify the factors that affect the achievement of tumor necrosis with percutaneous laser ablation (PLA) in patients with hepatocellular carcinoma (HCC) and tumor size no larger than 4.0 cm. MATERIALS AND METHODS Ultrasound-guided biopsy results were retrospectively studied in 99 lesions (range, 0.5-4.0 cm; mean, 2.7 cm) from 82 patients (44 men, 38 women; age range, 50-80 years; median, 68 y) who had undergone PLA. RESULTS Complete tumor ablation was obtained in 90 lesions (90.9%). Of the nine cases in which complete tumor necrosis was not achieved, six had tumors located in sites that did not allow the optimal placement of fibers, and five of these had a tumor diameter greater than 3 cm. Early discontinuation of PLA as a result of decompensation of liver cirrhosis was the reason for not achieving a complete tumor ablation in three other cases. There was a clear relationship between the energy delivered and the volume of necrosis achieved (r = 0.56; P < .001) regardless of the initial size of HCC tumors. The number of illuminations required, and consequently the amount of energy delivered, was also affected by tumor location. In fact, lesions adjacent to large vessels (> or = 3 mm) required a greater number of illuminations than the other lesions to achieve complete ablation (2.9 +/- 1.4 vs 2.3 +/- 0.9; P = .043). The eight cases with undifferentiated histology required more illuminations than the cases with other histologic types (3.4 +/- 0.9 vs 2.2 +/- 0.9; P < .001). However, these cases were located in sites that did not allow the optimal placement of fibers, therefore requiring multiple treatments. CONCLUSION PLA is a highly effective treatment in HCC with a tumor size of 4.0 cm or smaller. In this setting, two variables, tumor size and tumor location, affect the achievement of complete tumor ablation and the number of treatments required to obtain tumor necrosis.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Rome, Italy.
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Maataoui A, Qian J, Mack MG, Khan MF, Oppermann E, Roozru M, Schmidt S, Bechstein WO, Vogl TJ. Liver Metastases in Rats: Chemoembolization Combined with Interstitial Laser Ablation for Treatment. Radiology 2005; 237:479-84. [PMID: 16244257 DOI: 10.1148/radiol.2372041494] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess the effect of transcatheter arterial chemoembolization (TACE) combined with laser-induced thermotherapy (LITT) for treatment of liver metastases in an animal model. MATERIALS AND METHODS All experiments were approved by the German government and the institutional animal research review board. After subcapsular liver implantation of colorectal cancer cells in 30 WAG rats (on day 0), the animals were randomly assigned to three interventional treatment groups. In the 10 rats in group A, TACE was performed: Fourteen days after cancer cell implantation and within 20 minutes after laparotomy and retrograde placement of a microcatheter into the gastroduodenal artery, these rats were injected with mitomycin (0.1 mg), iodized oil (0.1 mL), and degradable starch microspheres (5.0 mg). In the 10 rats in group B, LITT was performed: Also on day 14, the tumors in these animals were exposed to Nd:YAG laser light of 1064 nm at 2 W for 5 minutes. In the 10 rats in group C, combined treatment was administered: TACE was performed on day 14, and LITT was performed on day 21. Tumor volumes were measured before (on day 13) and after (on day 28) treatment with magnetic resonance (MR) imaging, and the mean tumor growth ratio (day 13 tumor volume divided by day 28 tumor volume) was calculated. RESULTS The mean tumor volumes measured before and after the treatments were, respectively, 0.11 and 0.60 cm(3) in group A, 0.11 and 0.68 cm(3) in group B, and 0.11 and 0.35 cm(3) in group C. The mean tumor growth ratio was 5.42 in group A, 6.14 in group B, and 3.15 in group C. According to Bonferroni test results, compared with the rats in groups A and B (controls), the group C rats had significantly inhibited tumor growth (P < .01 for both comparisons). CONCLUSION Use of combined TACE-LITT treatment, compared with the use of TACE or LITT alone, significantly inhibits tumor growth.
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Affiliation(s)
- Adel Maataoui
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, 60590 Frankfurt, Germany.
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Trerotola SO. Can Combination Therapy for Colorectal Liver Metastases Improve Results over Chemoembolization or Ablation Alone? Radiology 2005; 237:381-2. [PMID: 16244245 DOI: 10.1148/radiol.2372050845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
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Braga L, Guller U, Semelka RC. Pre-, peri-, and posttreatment imaging of liver lesions. Radiol Clin North Am 2005; 43:915-27, viii. [PMID: 16098347 DOI: 10.1016/j.rcl.2005.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article provides an overview of current treatment approaches in patients with primary or secondary liver diseases. Emphasis is placed on MR imaging prior, during, and after various treatments, including liver resection, systemic chemotherapy, transcatheter arterial chemoembolization, ablative therapies, and liver transplantation. Findings described for MR imaging are directly applicable to findings for CT and potentially contrast-enhanced ultrasound. The authors' description, however, will deal mainly with MR imaging as this is the their preferred approach due to diagnostic accuracy and patient safety, and the findings are most demonstrative on MR imaging.
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Affiliation(s)
- Larissa Braga
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7510, Chapel Hill, NC 27599-7510, USA
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Sakr AA, Saleh AA, Moeaty AAA, Moeaty AA. The combined effect of radiofrequency and ethanol ablation in the management of large hepatocellular carcinoma. Eur J Radiol 2005; 54:418-25. [PMID: 15899345 DOI: 10.1016/j.ejrad.2004.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Revised: 06/18/2004] [Accepted: 06/25/2004] [Indexed: 12/31/2022]
Abstract
Only a small percentage of patients with large hepatocellular carcinoma (HCC) may benefit out of surgical resection. Thus, most of these patients are in need of a form of local control, such as ethanol ablation, transarterial chemoembolization (TACE), radiofrequency thermal ablation (RF), or laser induced thermotherapy (LITT). The purpose of this study was to assess the short-term effect of sequential RF and ethanol ablation in the management of large HCC (>5 cm). Our series included 40 patients with large HCC tumors (>5 cm in diameter). We adopted a protocol of overlapping RF applications, followed by repeated ethanol ablation sessions. Our results showed that the volume of tumor coagulative necrosis initially induced by RF has significantly risen after adjuvant ethanol ablation sessions (P < 0.001). Patients who achieved complete tumor necrosis after RF ablation were 52.5% of the series. This percent has jumped to 80% of the series at the end of the protocol. This indicates that such combined protocol is more effective than RF alone. Besides, it is valuable in reducing the number of RF sessions.
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Affiliation(s)
- Ayman A Sakr
- Department of Radiation Sciences, Radiology Unit, Medical Research Institute, University of Alexandria, 165 Horreya Avenue, El Hadara, Alexandria, Egypt.
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Abstract
Several different technologies have been employed for the local ablation of tissue by thermal techniques. At the present time the most widely favoured technique is radiofrequency ablation (RFA) but developments in other techniques, e.g. microwave may change this. In many countries RFA or percutaneous ethanol injection (PEI) are accepted therapies for patients with Childs Pugh Class A or B cirrhosis and early hepatocellular carcinoma (HCC). Results for RFA in large series of patients with liver metastases from colon cancer are very promising. Five-year survival rates of 26% from the time of first ablation and 30% from the diagnosis of liver metastases for patients with limited (<6, <5 cm) liver disease who are not surgical candidates compares well with post resection series where 5-year survival rates vary between 29% and 39% in operable candidates. Sufficient experience has now been gained in lung and renal ablation to show that these are minimally invasive techniques which can produce effective tumour destruction with a limited morbidity. More novel areas for ablation such as adrenal or pelvic recurrence are being explored.
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Affiliation(s)
- A R Gillams
- Department of Medical Imaging, The Middlesex Hospital, Mortimer Street, London, W1T 3AA, UK.
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Nikfarjam M, Muralidharan V, Christophi C. Mechanisms of Focal Heat Destruction of Liver Tumors. J Surg Res 2005; 127:208-23. [PMID: 16083756 DOI: 10.1016/j.jss.2005.02.009] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Revised: 01/11/2005] [Accepted: 02/06/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND Focal heat destruction has emerged as an effective treatment strategy in selected patients with malignant liver tumors. Radiofrequency ablation, interstitial laser thermotherapy, and microwave treatment are currently the most widely applied thermal ablative techniques. A major limitation of these therapies is incomplete tumor destruction and overall high recurrences. An understanding of the mechanisms of tissue injury induced by focal hyperthermia is essential to ensure more complete tumor destruction. Here, the currently available scientific literature concerning the underlying mechanisms involved in the destruction of liver tumors by focal hyperthermia is reviewed. METHODS Medline was searched from 1960 to 2004 for literature regarding the use of focal hyperthermia for the treatment of liver tumors. All relevant literature was searched for further references. RESULTS Experimental evidence suggests that focal hyperthermic injury occurs in two distinct phases. The first phase results in direct heat injury that is determined by the total thermal energy applied, tumor biology, and the tumor microenvironment. Tumors are more susceptible to heat injury than normal cells as the result of specific biological features, reduced heat dissipating ability, and lower interstitial pH. The second phase of hyperthermic injury is indirect tissue damage that produces a progression of tissue injury after the cessation of the initial heat stimulus. This progressive injury may involve a balance of several factors, including apoptosis, microvascular damage, ischemia-reperfusion injury, Kupffer cell activation, altered cytokine expression, and alterations in the immune response. Blood flow modulation and administration of thermosensitizing agents are two methods currently used to increase the extent of direct thermal injury. The processes involved in the progression of thermal injury and therapies that may potentially modulate them remain poorly understood. CONCLUSION Focal hyperthermia for the treatment of liver tumors involves complex mechanisms. Evidence suggests that focal hyperthermia produces both direct and indirect tissue injury by differing underlying processes. Methods to enhance the effects of treatment to achieve complete tumor destruction should focus on manipulating these processes.
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Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
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Jansen MC, van Hillegersberg R, Chamuleau RAFM, van Delden OM, Gouma DJ, van Gulik TM. Outcome of regional and local ablative therapies for hepatocellular carcinoma: a collective review. Eur J Surg Oncol 2005; 31:331-47. [PMID: 15837037 DOI: 10.1016/j.ejso.2004.10.011] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Revised: 09/14/2004] [Accepted: 10/01/2004] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Transcatheter arterial (chemo) embolization (TACE), cryoablation (CA) and percutaneous ethanol injection (PEI) were the first regional and local ablative techniques that came into use for irresectable HCC. Radiofrequency ablation (RFA) and interstitial laser coagulation (ILC) followed and have now evolved rapidly. It would not be ethical to compare resection with ablation in patients well enough to undergo major surgery. Therefore, hepatic resection and hepatic transplantation remain the only curative treatment options for HCC. METHODS On the basis of a Medline literature search and the authors' experiences, the principles, current status and prospects of TACE and local ablative techniques in HCC are reviewed. RESULTS Complete tumour necrosis can be achieved in 60-100% of patients treated with PEI (70-100%), cryoablation (60-85%), RFA (80-90%) or ILC (70-97%). After TACE significant tumour response is achieved in 17-61.9% but complete tumour response is rare (0-4.8%) as viable tumour cells remain after TACE. Five-year survival rates are available for TACE (1-8%), PEI (0-70%) and cryoablation (40%). Only PEI and RFA were compared in one RCT. RFA was associated with fewer treatment sessions and a higher complete necrosis rate. Furthermore, all techniques are associated with low morbidity and mortality, but cryoablation seems to be associated with a higher morbidity rate. CONCLUSION TACE has shown to be a valuable therapy with survival benefits in strictly selected patients with unresectable HCC. RFA and PEI are now considered as the local ablative techniques of choice for the treatment of, preferably small, HCC. When tumours are located close to bile ducts or large vessels, PEI remains a valuable therapy. Completeness of ablation can be more easily monitored during cryoablation and another advantage of cryoablation is the possibility of edge freezing. The results of ILC are comparable to RFA with only few side effects and high tumour response rates.
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Affiliation(s)
- M C Jansen
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P.O. Box 22660, 1105 AZ Amsterdam, The Netherlands
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Wu F, Wang ZB, Chen WZ, Zou JZ, Bai J, Zhu H, Li KQ, Jin CB, Xie FL, Su HB. Advanced hepatocellular carcinoma: treatment with high-intensity focused ultrasound ablation combined with transcatheter arterial embolization. Radiology 2005; 235:659-67. [PMID: 15858105 DOI: 10.1148/radiol.2352030916] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate ultrasonographically (US)-guided high-intensity focused ultrasound ablation combined with transcatheter arterial chemoembolization (TACE) in the treatment of stage IVA hepatocellular carcinoma (HCC). MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. From November 1998 to May 2000, 50 consecutive patients with stage IVA HCC (TNM classification, T4N0-1M0) were alternately enrolled in one of two treatment groups: group 1 (n = 26), in which TACE was performed alone, and group 2 (n = 24), in which transcutaneous ablation of HCC with high-intensity focused ultrasound was performed 2-4 weeks after TACE. The tumors were 4-14 cm in diameter (mean, 10.5 cm). Immediate therapeutic effects were assessed at follow-up with Doppler US and computed tomography or magnetic resonance imaging. All patients were followed up for 3-24 months (mean, 8 months) to observe long-term therapeutic effects and complications in both groups. Tumor reduction rates, median survival time, and cumulative survival rates in both groups were calculated by using the unpaired Student t test and Kaplan-Meier method. RESULTS No severe complication was observed after focused ultrasound ablation, and no unexpected side effects were noted after TACE. Follow-up images showed absence or reduction of blood supply in the lesions after focused ultrasound ablation when compared with blood supply after TACE alone. The median survival time was 11.3 months in group 2 and 4.0 months in group 1 (P = .004). The 6-month survival rate was 80.4%-85.4% in group 2 and 13.2% in group 1 (P = .002), and the 1-year survival rate was 42.9% and 0%, respectively. Median reductions in tumor size as a percentage of initial tumor volume at 1, 3, 6, and 12 months after treatment, respectively, were 28.6%, 35.0%, 50.0%, and 50.0% in group 2 and 4.8%, 7.7%, 10.0%, and 0% in group 1 (P < .01). CONCLUSION The combination of high-intensity focused ultrasound ablation and TACE is a promising approach in patients with advanced-stage HCC, but large-scale randomized clinical trials are necessary for confirmation.
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Affiliation(s)
- Feng Wu
- Institute of Ultrasonic Engineering in Medicine and Clinical Center for Tumor Therapy of the 2nd Affiliated Hospital, Chongqing University of Medical Sciences, 1 Medical College Rd, Box 153, Chongqing 400016, China.
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Qian J, Ni L, Maataoui A, Oppermann E, Vogt TJ. [Experimental study in the effects of combined transarterial chemoembolization and laser thermotherapy in hepatocellular carcinoma]. Curr Med Sci 2005; 25:332-4. [PMID: 16201288 DOI: 10.1007/bf02828159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Indexed: 05/04/2023]
Affiliation(s)
- Jun Qian
- Röntgenabteilung, Xiehe Klinik, Tongji Medizinische Institut, Huazhong Universität für Wissenschaft und Technik. Wuhan 430022, China
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Guan YS, Sun L, Zhou XP, Li X, Zheng XH. Hepatocellular carcinoma treated with interventional procedures: CT and MRI follow-up. World J Gastroenterol 2004; 10:3543-8. [PMID: 15534903 PMCID: PMC4611989 DOI: 10.3748/wjg.v10.i24.3543] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In the past decade, a variety of interventional procedures have been employed for local control of hepatocellular carcinoma (HCC). These include transcather arterial chemoembolization (TACE) and several tumour ablation techniques, such as percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), or percutaneous microwave coagulation therapy (PMC), laser-induced interstitial thermotherapy (LITT), etc. For a definite assessment of the therapeutic efficacy of interventional procedures, histological examination using percutaneous needle biopsy may be the most definite assessment of the therapeutic efficacy of interventional therapy, however, it is invasive and the specimen retrieved does not always represent the entire lesion owing to sampling errors. Therefore, computed tomography (CT) and magnetic resonance imaging (MRI) play a crucial role in follow-up of HCC treated by interventional procedures, by which the local treatment efficacy, recurrent disease and some of therapy-induced complications are evaluated. Contrast enhanced axial imaging (CT or MR imaging) may be the most sensitive test for assessing the therapeutic efficacy. The goal of the review was to describe the value of CT and MRI in the evaluation of interventional treatments.
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Affiliation(s)
- Yong-Song Guan
- Department of Radiology, Huaxi Hospital, Sichuan University, 37 Guoxuexiang, Chengdu 610041, Sichuan Province, China.
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Maataoui A, Qian J, Vossoughi D, Khan MF, Oppermann E, Bechstein WO, Vogl TJ. Transarterial chemoembolization alone and in combination with other therapies: a comparative study in an animal HCC model. Eur Radiol 2004; 15:127-33. [PMID: 15580507 DOI: 10.1007/s00330-004-2517-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Revised: 08/27/2004] [Accepted: 09/02/2004] [Indexed: 12/14/2022]
Abstract
The purpose of this study is to compare transarterial chemoembolization (TACE) alone and in combination with other therapies in an animal model. Subcapsular implantation of a solid Morris hepatoma 3924A in the liver was carried out in 50 male ACI rats (day 0). Tumor volume (V1) was measured by MRI (day 13). After laparotomy and retrograde placement of a catheter into the gastroduodenal artery (day 14), the following protocols of the interventional procedure were applied: TACE (mitomycin C + lipiodol) + immunotherapy (group A: TNFalpha + IL-2, group B: OK-432 + IL-2); TACE + antiangiogenesis therapy (group C: TNP-470, group D: endostatin); TACE alone in group E (control group). Tumor volume (V2) was assessed by MRI and the mean ratio of x (V2/V1) was calculated. Data were analyzed using Dunnett's t test (comparing therapeutic groups with the control group) and the Student-Newman-Keuls test (comparing significant therapeutic groups). Multivariate analysis showed a significant reduction in the tumor growth rate (P<0.05) in groups B (x=6.53) and C (x=4.01) compared to the mean ratio of the control group E (x=9.14). Significant results were observed in group C (P<0.05) in comparison with the other therapeutic groups. TACE combined with immunotherapy (OK-432) and antiangiogenesis therapy (TNP-470) retards tumor growth compared with TACE alone in an HCC animal model.
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Affiliation(s)
- A Maataoui
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
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Abstract
Thermal ablation, as a form of minimally invasive therapy for hepatocellular carcinoma (HCC), has become an important treatment modality. Because of the limitations of surgery, the techniques of thermal ablation have become standard therapies for HCC in some situations. This article reviews 4 thermal ablation techniques-radiofrequency (RF) ablation, microwave ablation, laser ablation, and cryoablation. Each of these techniques may have a role in treating HCC, and the mechanisms, equipment, patient selection, results, and complications of each are considered. Furthermore, combined therapies consisting of thermal ablation and adjuvant chemotherapy also show promise for enhancing these techniques. Important areas of research into thermal ablation remain, including improving the ability of ablation to treat larger tumors, determining the indications for each thermal ablation modality, optimizing image guidance, and obtaining good outcome data on the efficacy of these techniques.
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Affiliation(s)
- Hayden W Head
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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