CT-Guided Percutaneous Microwave Ablation of Sclerosing Hepatic Carcinoma

Recent advances in recurrent hepatocellular carcinoma therapy

Hepatocellular carcinoma (HCC) is the most prevalent form of primary liver cancer, accounting for 75%-85% of cases. Although treatments are given to cure early-stage HCC, up to 50%-70% of individuals may experience a relapse of the illness in the liver after 5 years. Research on the fundamental treatment modalities for recurrent HCC is moving significantly further. The precise selection of individuals for therapy strategies with established survival advantages is crucial to ensuring better outcomes. These strategies aim to minimize substantial morbidity, support good life quality, and enhance survival for patients with recurrent HCC. For individuals with recurring HCC after curative treatment, no approved therapeutic regimen is currently available. A recent study presented novel approaches, like immunotherapy and antiviral medication, to improve the prognosis of patients with recurring HCC with the apparent lack of data to guide the clinical treatment. The data supporting several neoadjuvant and adjuvant therapies for patients with recurring HCC are outlined in this review. We also discuss the potential for future clinical and translational investigations.

Efficacy and Safety of MRI and CT Guided VX2 Hepatic Para-vascular Tumor Model in Rabbits

OBJECTIVE

To compare the efficacy and safety of 1.5 T MRI and CT-guided VX2 hepatic para-vascular tumor model in rabbits.

MATERIALS AND METHODS

Sixty New Zealand white rabbits were randomly and equally divided into MRI-guided group (n=30) and CT-guided group (n=30). Rabbit VX2 tumor fragments were implanted beside the rabbit hepatic great vessels under MRI and CT guidance in the MRI and CT group to evaluate the success rate of tumor model establishment, puncture needle display and tip peripheral vascular situation, operation time and safety.

RESULTS

In the MRI-guided group, 29 rabbits (29/30, 96.7%) had a successful establishment of liver tumor model, and 1 rabbit had needle metastasis. In the CT-guided group, 24 rabbits (24/30, 80%) had a successful establishment of liver tumor model, while 2 rabbits had needle metastasis, 3 rabbits had metastases in other parts of the liver, and 1 had an unknown cause of death. The differences in tumor model establishment success rate between the two groups were statistically significant (χ2 = 4.043, P < 0.05). The fold number of artifacts at T1WI was 7.26±0.38 for the 20 G coaxial puncture needle in the MRI-guided group and 2.51±0.57 for the 20 G coaxial puncture needle in the CT-guided group, and the difference was statistically significant (t=36.76, P < 0.001), but star-shaped hypodense artifacts would appear around the needle tip. The operation time was longer in the MRI-guided group than in the CT-guided group (13.32±2.45 minutes in the MRI-guided group vs. 8.42±1.46 minutes in the CTguided group; t=9.252, P < 0.001). A small number of ascites occurred in 2 patients (2/30, 6.67%) in the CT-guided group; no serious complications such as liver abscess, jaundice or diaphragmatic perforation were observed in both groups.

CONCLUSION

Compared with CT, MRI-guided hepatic para-vascular tumor implantation in rabbits might be a more effective modeling method. Although the needle tip pseudopacity of the puncture needle is large and the operation time is long, the incidence of complications is low.

Evaluation of short- and medium-term efficacy and complications of ultrasound-guided ablation for small liver cancer

BACKGROUND

To ensure clinical efficacy and prolong patient survival, treatments such as surgery and microwave ablation (MWA) are used for early liver cancer. MWA is preferred because it effectively preserves the normal liver tissue and causes transient coagulation necrosis of local liver tumor cells. However, due to technical limitations, the cancerous liver tissue cannot be completely ablated; therefore, the probability of local tumor recurrence is high.

AIM

To investigate the clinical efficacy and safety of ultrasound-guided percutaneous MWA in the treatment of small liver cancer.

METHODS

A total of 118 patients treated for small liver cancer in The Central Hospital of Yongzhou from January 2018 to April 2019 were selected. Sixty-six patients received ultrasound-guided percutaneous MWA (MWA group) and 52 received laparoscopic surgery (laparoscope group). The operation time, blood loss, hospital stay, and medical expenses of both groups were statistically analyzed. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB), alpha fetal protein (AFP), carcinoembryonic antigen (CEA), and peripheral blood regulatory T lymphocytes (Treg) levels were evaluated pre- and post-operatively. The cross-sectional area of tumors measured before and after ablation was analyzed statistically; the therapeutic effect was compared between both groups in terms of surgical complications, 2-year progression-free survival rate, and overall survival rate.

RESULTS

The operation time, blood loss, hospital stay, and medical expenses in the MWA group were lower than those of the laparoscope group, and the differences were significant (P < 0.05); these parameters, and ALT, AST, TBIL, and ALB levels were compared preoperatively between both groups, and there was no significance (P > 0.05). The operation time, blood loss, hospital stay, and medical expenses for 2 d and 1 wk after surgery, the ALT and AST of the MWA group were lower than those of the laparoscope group, and the difference was significant (P < 0.05). The operation time, blood loss, hospital stay, and medical expenses, and serum AFP, CEA, and Treg levels were measured preoperatively and 4 and 8 wk postoperatively, and there were no significant differences between the two groups (P > 0.05). Compared with preoperative levels, serum AFP, CEA, and Treg levels in both groups were decreased (P < 0.05). The lesion in the MWA group had a maximum area of 4.86 ± 0.90 cm2, 1.24 ± 0.57 cm2, and 0.31 ± 0.11 cm2 preoperatively, 1 and 3 mo postoperatively, respectively. Fifty-eight of them achieved complete response and eight achieved a partial response. After 2 years of follow-up, the progression-free and overall survival rates in the MWA group were 37.88% and 66.67%, respectively, compared with 44.23% and 76.92% in the laparoscope group, with no significant difference (P > 0.05).

CONCLUSION

The effects of ultrasound-guided percutaneous MWA in the treatment of small liver cancer are similar to those of laparoscopic surgery. However, ablation causes less trauma and liver dysfunction.