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Luo L, Yan R, Zeng Q, Long Y, He X, Li K, Xu E. Radiofrequency Ablation of Hepatocellular Carcinomas Adjacent to the Gallbladder Without Isolation Under Contrast-Enhanced Ultrasound Monitoring: A Comparative Study with Long Term Follow-Up. J Hepatocell Carcinoma 2023; 10:631-642. [PMID: 37077303 PMCID: PMC10108906 DOI: 10.2147/jhc.s388738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/20/2023] [Indexed: 04/21/2023] Open
Abstract
Objective This study intends to compare the efficacy and safety between patients undergoing invasive isolation or monitoring measures and patients undergoing intra-operative contrast-enhanced ultrasound (CEUS) monitoring who underwent radiofrequency ablation (RFA) of hepatocellular carcinomas (HCC) adjacent to the gallbladder (GB). Methods We retrospectively assessed patients with HCC adjacent to the GB who underwent ultrasound-guided RFA. They were divided into two groups: group A was monitored under intra-operative CEUS, while group B was assisted by invasive auxiliary means. The efficacy, complications and survival were followed up and compared. Results Thirty-eight patients with 39 HCCs were enrolled into group A and 31 patients with 35 HCCs were enrolled into group B. The technique efficacy rates were both 100% in the two groups. There were no significant differences of the cumulative 1-, 3-, and 5-year local tumor progression, tumor-free survival and overall survival between the two groups (P = 0.851, 0.081 and 0.700, respectively). There were no significant differences of major and minor complications rates between the two groups (P = 1.000, 0.994, respectively). More importantly, no GB related complications occurred in group A. Conclusion Intra-operative CEUS monitoring without protective isolation of the GB might be also a potentially safe and effective method for the RFA of HCC adjacent to the GB, when compared with those assisted with invasive auxiliary means.
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Affiliation(s)
- Liping Luo
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, People’s Republic of China
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Ronghua Yan
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Qingjing Zeng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yinglin Long
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xuqi He
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Kai Li
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Kai Li, Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People’s Republic of China, Email
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, People’s Republic of China
- Correspondence: Erjiao Xu, Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, People’s Republic of China, Email
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Li L, Yao J, Yan X, Qi X, Liang P, Han Z, Liu F, Cheng Z, Luo Y, Zheng R, Cheng W, Wei Q, Yu S, Yu J, Yu X. Long-term efficacy and safety of microwave ablation for hepatocellular carcinoma adjacent to the gallbladder with a diameter ≤ 5 cm: a multicenter, propensity score matching study. Int J Hyperthermia 2023; 40:2248425. [PMID: 37607775 DOI: 10.1080/02656736.2023.2248425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To compare the long-term efficacy and safety of microwave ablation (MWA) as first-line therapy for hepatocellular carcinoma (HCC) adjacent versus nonadjacent to the gallbladder. MATERIALS AND METHODS From 2006 to 2018, 657 patients with ≤5 cm HCC who underwent percutaneous ultrasound-guided MWA as first-line therapy from 5 hospitals were enrolled in this retrospective study. Patients were grouped into the adjacent group (n = 49) and the nonadjacent group (n = 608) according to whether the tumor was adjacent to the gallbladder. Propensity score matching (PSM) was used to balance baseline variables between the two groups. RESULTS Forty-eight patient pairs were matched after PSM. For the PSM cohort, during a median follow-up time of 60 months, there were no differences in PFS (hazard ratio [HR], 1.011; 95% confidence interval [CI], 0.647-1.578; p = 0.963) or OS (HR 0.925; 95% CI 0.522-1.639; p = 0.789) between the adjacent and nonadjacent groups. Univariate and multivariate analyses revealed that the tumor adjacent to the gallbladder was not an independent risk factor for PFS or OS (all p > 0.05). Subgroup analysis showed comparable PFS and OS between the two groups in the <3 cm subgroup and the 3-5 cm subgroups (all p > 0.05). In addition to more use of assistive technology (p < 0.05), the adjacent group shared comparable local tumor progression, complications, technical success rate, and hospital stay (all p > 0.05) to the nonadjacent group. CONCLUSION There were comparable long-term efficacy and complications between patients with HCC adjacent and nonadjacent to the gallbladder treated with MWA.
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Affiliation(s)
- Lijuan Li
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Jundong Yao
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xizi Yan
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xiaoguang Qi
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanchun Luo
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiang Wei
- Department of Ultrasound, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Songyuan Yu
- Department of Ultrasound, Wuhan University of Science and Technology, Tianyou Hospital, Wuhan, China
| | - Jie Yu
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
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Liu J, Li L, Zeng Q, Zheng R, Li K. Prevention of major biliary complications by fusion imaging for thermal ablation of malignant liver tumors adjacent to the bile ducts: a preliminary comparative study. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4245-4253. [PMID: 36121457 DOI: 10.1007/s00261-022-03631-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Ultrasound (US)-guided thermal ablation (TA) may cause major biliary complications, particularly in patients with malignant liver tumors (MLTs) adjacent to the bile ducts. Fusion imaging (FI), is postulated to reduce complication rate; however, there is a lack of clinical data to support this theory. Thus, the aim of our study was to evaluate the safety and efficacy of FI for TA of MLTs proximal to the bile ducts. METHODS A retrospective single-center review was conducted on a total of 289 patients with 316 MLTs adjacent to the bile ducts. The patients were divided into two groups based on whether FI was used in the ablation procedures. The choice of the FI-assisted procedure always depends on different operation periods and whether registrations will succeed. The baseline demographics and outcomes of these patients were compared. The efficacy was determined at the 1-month follow-up using contrast-enhanced computed tomography/magnetic resonance. Biliary complications and local tumor progression were subsequently followed-up every 3-6 months. The last follow-up visit was before August 30, 2019. RESULTS Among the included tumors, the incidence rate of major biliary complications after ablation in the FI group was 1.6%, which was significantly lower than that in the non-FI group (7.9%, p = 0.005). There was no significant difference in the efficacy rates of the techniques [99.5% (185/186) versus 98.4% (123/125), p = 0.56] or local progression rates [3.8% (7/185) versus 5.7% (7/123), p = 0.61] between the FI and non-FI groups. CONCLUSION FI for US-guided TA could be a noninvasive means to decrease major biliary complications. Trial registration number and date of registration: retrospectively registered.
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Affiliation(s)
- Jia Liu
- Guangdong Key Laboratory of Liver Disease Research, Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Lu Li
- Department of Ultrasound, The Second Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, People's Republic of China
| | - Qingjing Zeng
- Guangdong Key Laboratory of Liver Disease Research, Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Rongqin Zheng
- Guangdong Key Laboratory of Liver Disease Research, Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, People's Republic of China.
| | - Kai Li
- Guangdong Key Laboratory of Liver Disease Research, Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, People's Republic of China.
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Koh JH, Tan DJH, Ong Y, Lim WH, Ng CH, Tay PWL, Yong JN, Muthiah MD, Tan EX, Pang NQ, Kim BK, Syn N, Kow A, Goh BKP, Huang DQ. Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria: a meta-analysis of 18,421 patients. Hepatobiliary Surg Nutr 2022; 11:78-93. [PMID: 35284509 DOI: 10.21037/hbsn-21-350] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022]
Abstract
Background Outcomes after liver resection (LR) and liver transplantation (LT) for hepatocellular carcinoma (HCC) are heterogenous and may vary by region, over time periods and disease burden. We aimed to compare overall survival (OS) and disease-free survival (DFS) between LT versus LR for HCC within the Milan criteria. Methods Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria. Meta-analyses and metaregression were conducted using random-effects models. Results We screened 2,278 studies and included 35 studies with 18,421 patients. LR was associated with poorer OS [hazard ratio (HR) =1.44; 95% confidence interval (CI): 1.14-1.81; P<0.01] and DFS (HR =2.71; 95% CI: 2.23-3.28; P<0.01) compared to LT, with similar findings among intention-to-treat (ITT) studies. In uninodular disease, OS in LR was comparable to LT (P=0.13) but DFS remained poorer (HR =2.95; 95% CI: 2.30-3.79; P<0.01). By region, LR had poorer OS versus LT in North America and Europe (P≤0.01), but not Asia (P=0.25). LR had inferior survival versus LT in studies completed before 2010 (P=0.01), but not after 2010 (P=0.12). Cohorts that underwent enhanced surveillance had comparable OS after LT and LR (P=0.33), but cohorts undergoing usual surveillance had worse OS after LR (HR =1.95; 95% CI: 1.24-3.07; P<0.01). Conclusions Mortality after LR for HCC is nearly 50% higher compared to LT. Survival between LR and LT were similar in uninodular disease. The risk of recurrence after LR is threefold that of LT.
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Affiliation(s)
- Jin Hean Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuki Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Phoebe Wen Lin Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Eunice X Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Ning Qi Pang
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Biostatistics and Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alfred Kow
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Division of Surgery, Singapore General Hospital, Singapore, Singapore.,Liver Transplant Service, SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
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Yao J, Liu B, Wang X, Yu J, Cheng Z, Han Z, Liu F, Zheng R, Cheng W, Wei Q, Yu S, Li K, Chen P, Luo Y, Yu X, Liang P. Long-term efficacy of microwave ablation in the treatment of subcapsular hepatocellular carcinomas of ≤3 cm in diameter: a multicenter, propensity score-matched study. Int J Hyperthermia 2022; 39:209-216. [PMID: 35067144 DOI: 10.1080/02656736.2021.2023228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jundong Yao
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Binbin Liu
- Henan University of Science and Technology School of Nursing, Luoyang, China
| | - Xiaohui Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiang Wei
- Department of Ultrasound, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Songyuan Yu
- Department of Ultrasound, Wuhan University of science and technology, Tianyou Hospital, Wuhan, China
| | - Kai Li
- Chinese PLA Medical School, Beijing, China
| | - Peng Chen
- Chinese PLA Medical School, Beijing, China
| | - Yanchun Luo
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
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Yan Z, Jianmin D, Fengmei W, Zhengyi Q, Yandong W, Hongyu Z, Xiang J. The Effects of Liver Function Damage after Thermal Ablation on the Prognosis of HCC Patients and Its Prediction. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Gu X, Yuan Q, Zhang J, Yang Y. A randomized control study on anesthetic effects of flurbiprofen axetil combined with propofol on patients with liver cancer receiving microwave ablation. Pak J Med Sci 2020; 36:1275-1279. [PMID: 32968393 PMCID: PMC7501020 DOI: 10.12669/pjms.36.6.2091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the anesthetic effects of flurbiprofen axetil combined with propofol on patients with liver cancer receiving microwave ablation. Methods: Sixty patients (SA grade: I-II) who underwent microwave ablation for liver cancer in our hospital from May 2018 to May 2019 were selected and randomly divided into a study group and a control group (n=30) that were anesthetized through target-controlled infusion of propofol combined with intravenous infusion of flurbiprofen axetil and target-controlled infusion of propofol alone, respectively. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO2), numerical rating scale (NRS) score, adverse reactions and anesthetic effects (induction time, recovery time) of the two groups were compared before anesthesia (T0), at the beginning of puncture (T1), at the beginning of microwave ablation (T2), at the end of microwave ablation (T3) and one hour after surgery (T4). Results: MAP and HR of the study group were higher than those of the control group (P<0.05) at T2. There was no difference in SpO2 between the two groups (P>0.05). The anesthesia induction time and recovery time of the study group were significantly shorter than those of the control group (P<0.05). There was no difference in the NRS score between the two groups at T1 (P>0.05), but the study group had lower scores at T2-T4 (P<0.05). The incidence rate of postoperative adverse reactions was 13.33% in the study group and 46.67% in the control group, with a significant difference (P<0.05). Conclusion: Flurbiprofen axetil in combination with propofol exert evident anesthetic effects on patients with liver cancer receiving microwave ablation. The time of preoperative anesthesia induction and postoperative recovery time can be markedly shortened, and intraoperative vital signs can be maintained stable. This method is thus worthy of clinical promotion.
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Affiliation(s)
- Xingshi Gu
- Xingshi Gu, Department of Interventional Radiology, Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, P. R. China
| | - Qiang Yuan
- Qiang Yuan, Department of Interventional Radiology, Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, P. R. China
| | - Jian Zhang
- Jian Zhang, Department of Interventional Radiology, Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, P. R. China
| | - Yawen Yang
- Yawen Yang, Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, P. R. China
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8
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Li Z, Jiao D, Han X, Si G, Li Y, Liu J, Xu Y, Zheng B, Zhang X. Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma. Cancer Imaging 2020; 20:13. [PMID: 32000862 PMCID: PMC6993318 DOI: 10.1186/s40644-020-0294-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/20/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the method and effectiveness of transcatheter arterial chemoembolization (TACE) combined with simultaneous DynaCT-guided Microwave ablation (MWA) for the treatment of small hepatocellular carcinoma (SHCC). MATERIALS AND METHODS From June 2015 to May 2017, a total of 28 consecutive patients with SHCC received single treatment of TACE and 23 subjects received a combination treatment of TACE with simultaneous DynaCT-guided MWA. Following 1 month of treatment, the tumor response was assessed using the mRECIST criteria and the outcomes were analyzed including intervention-associated complications, changes in liver function, imaging response, and progression-free survival (PFS). RESULTS The technical success rate was 100%. The rates of CR (65%) in the combined TACE and MWA group were higher than those of the TACE group (46%). The rate of common adverse events, such as liver abscess, spontaneous bacterial peritonitis and liver dysfunction, in the combined TACE and MWA group (56%) was comparable to the corresponding rate of the TACE group (P > 0.411). The median and mean PFS of the TACE group were significantly lower than those of the combined TACE and MWA group (19.00 months vs. 29.00 months, 21.076 months vs. 24.693 months, p = 0.019, log-rank test). CONCLUSION Stereotactic DynaCT-guided MWA is a safe and effective method for the treatment of SHCC, which usually provides an effective tumor puncture path, notably for lesions that cannot be detected following TACE. Overall, the data suggested that this treatment method could improve the clinical outcome of patients with SHCC.
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Affiliation(s)
- Zhaonan Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Dechao Jiao
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Xinwei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
| | - Guangyan Si
- Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, 646000, China
| | - Yahua Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Juanfang Liu
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Yanneng Xu
- Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, 646000, China
| | - Bo Zheng
- Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, 646000, China
| | - Xun Zhang
- Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, 646000, China
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Abstract
In recent years, there has been increased utilization of microwave ablation (MWA) in the treatment of soft tissue tumors. MWA has several theoretical advantages over radiofrequency ablation (RFA) by achieving a more rapid and sustained heating of tissues, increased efficacy in tissues with poor thermal conductivity, and less susceptibility to heat sink effect. While its greater power output has led to appropriate caution when applying this energy to soft tissue tumors, many commonly held beliefs regarding contraindications to MWA are unsupported by data and have been passed along based on experience with RFA. The goal of this article is to review the use of MWA in challenging clinical situations along with the existing evidence for its use.
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Affiliation(s)
- Amanda R Smolock
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Colette Shaw
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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10
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Devcic Z, Elboraey M, Vidal L, Mody K, Harnois D, Patel T, Toskich BB. Individualized Ablation of Hepatocellular Carcinoma: Tailored Approaches across the Phenotype Spectrum. Semin Intervent Radiol 2019; 36:287-297. [PMID: 31680719 DOI: 10.1055/s-0039-1698755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ablation is now recommended by international guidelines for the definitive treatment of hepatocellular carcinoma (HCC). Extensive clinical studies have demonstrated outcomes comparable to surgical resection with shorter hospital stays, decreased costs, and improved quality of life. Successful ablation requires complete treatment of both tumor and margin while preserving critical adjacent structures. HCC exhibits highly variable presentations in both anatomic involvement and biology which have significant implications on choice of ablative therapy. There are now abundant ablation modalities and adjunctive techniques which can be used to individualize ablation and maximize curative results. This article provides a patient-centered summary of approaches to HCC ablation in the context of patient performance, hepatic reserve, tumor phenotype and biology, intra- and extrahepatic anatomy, and ablation technology.
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Affiliation(s)
- Zlatko Devcic
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Mohamed Elboraey
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Lucas Vidal
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - Kabir Mody
- Division of Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | - Denise Harnois
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - Tushar Patel
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - Beau B Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
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11
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Garnon J, Koch G, Caudrelier J, Ramamurthy N, Auloge P, Cazzato RL, Gangi A. Hydrodissection of the Gallbladder Bed: A Technique for Ablations Located Close to the Gallbladder. Cardiovasc Intervent Radiol 2019; 42:1029-1035. [PMID: 30963191 DOI: 10.1007/s00270-019-02218-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/02/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To report the technique of hydrodissection of the gallbladder bed, in order to separate the gallbladder wall from the liver surface during microwave ablation of liver malignancies located in segment V. MATERIALS AND METHODS Between January 2018 and March 2018, percutaneous hydrodissection of the gallbladder fossa was performed during four microwave ablation procedures in three patients (One patient was treated twice for the same lesion, making a total of four procedures for three lesions.) All treated lesions were located in segment V and abutting the gallbladder. Number of hydrodissection needles, volume of hydrodissection, repartition of hydrodissection, separation of tumour from the gallbladder post-hydrodissection, technical success of hydrodissection/ablation, and complications were recorded and evaluated. RESULTS Hydrodissection of the gallbladder fossa was technically feasible in all four procedures, and microwave ablation was performed at maximum power without any early interruption. Time to perform hydrodissection was 11.3 min on average (range 7-18 min). Minimal distance between the ablation area and the GB increased from virtual to 10 mm on average (range 6-13), with a mean volume of dissection of 65 ml (range 40-100). Technical success was 75%. There was no complication related to the hydrodissection itself, and no acute or delayed gallbladder complication. CONCLUSION Hydrodissection of the gallbladder bed is a feasible technique to separate the gallbladder from the liver surface. This could potentially decrease the risk of thermal injuries to the gallbladder wall when ablating tumours located in segment V.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France.
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Pierre Auloge
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
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Long Y, Yan R, Li K, Luo L, Zeng Q, Tan L, Zhang M, Zheng R, Xu E. Radiofrequency ablation of liver cancers adjacent to the gallbladder without gallbladder isolation under contrast-enhanced ultrasound monitoring: a preliminary study. Int J Hyperthermia 2018; 36:139-145. [PMID: 30489164 DOI: 10.1080/02656736.2018.1539776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the feasibility, safety and efficacy of intra-procedural contrast-enhanced ultrasound (CEUS) monitoring of the radiofrequency ablation (RFA) of liver cancers adjacent to gallbladder (GB) without GB isolation. MATERIALS AND METHODS From May 2016 to July 2017, patients with liver cancers adjacent to GB (≤10 mm) who intended to undergo ultrasound-guided RFA without GB isolation in our hospital were prospectively enrolled. During the RFA procedures, CEUS was employed to evaluate the therapeutic response and the perfusion of the intact GB wall. The outcomes of GB and liver cancers were followed up and recorded. RESULTS 23 patients (18 male, 5 female) with 23 liver cancers (mean 18 mm, range 8-34 mm) adjacent to GB were enrolled. There were 12 tumors that abutted the GB while 11 tumors located within 10 mm of the GB. After the RFA procedures, intra-procedural CEUS evaluation demonstrated the perfusion of the GB wall was intact in all 23 patients and technical success rate of RFA was 100% (23/23). According to the contrast-enhanced CT/MR one month after RFA, the technical efficacy rate was 100% (23/23). During the follow-up period (range: 12-23 months, median: 17 months), no local tumor progression occurred and no major complications arised. Overall survival at 1-year was 100%. Thickening of GB wall was detected in 11 patients. The thickness of GB wall returned to the pre-ablation level in five patients. CONCLUSION CEUS-monitored RFA of liver cancers adjacent to GB without GB isolation was feasible, safe and effective.
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Affiliation(s)
- Yinglin Long
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Ronghua Yan
- b Department of Radiology, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Kai Li
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Liping Luo
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Qingjing Zeng
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Lei Tan
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Man Zhang
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Rongqin Zheng
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Erjiao Xu
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
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Abstract
Tumour ablation is defined as the direct application of chemical or thermal therapy to eradicate or substantially destroy a tumour. Currently, minimally invasive ablation techniques are available for the local destruction of focal tumours in multiple organ sites. Microwave ablation (MWA) is premised on the biological response of solid tumours to tissue hyperthermia, and it is a relatively low-risk procedure. Due to several advantages of MWA, including higher thermal efficiency, higher capability for coagulating blood vessels, faster ablation time and the simultaneous application of multiple antennae, MWA could be a promising minimally invasive ablation technique for the treatment of solid tumours. Therefore, the use of MWA has developed rapidly in China during the last decade. Many successful studies have been performed, and widespread use has been achieved for multiple types of tumours in China, especially for liver cancer. This review will describe the state-of-the-art of MWA in China, including the development of MWA equipment and its application in the treatment of multiple types of tumours.
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Affiliation(s)
- Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
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14
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Zhang QB, Zhang XG, Jiang RD, Hu CX, Sun D, Ran L, Zhang ZL. Microwave ablation versus hepatic resection for the treatment of hepatocellular carcinoma and oesophageal variceal bleeding in cirrhotic patients. Int J Hyperthermia 2016; 33:255-262. [PMID: 27817240 DOI: 10.1080/02656736.2016.1257824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The aim of this study was to compare the results of microwave ablation (MWA) and hepatic resection (HR) when combined with pericardial devascularisation plus splenectomy (PCDV) for the treatment of patients with cirrhosis complicated by small hepatocellular carcinoma (HCC) and oesophageal variceal bleeding (EVB). MATERIALS AND METHODS Between 2001 and 2013, 73 patients (median age 53.2 years, 67% male) with small HCC and concomitant EVB who underwent MWA or HR for HCC and PCDV for cirrhotic portal hypertension were selected retrospectively for inclusion in this study. The overall survival curves and recurrence-free survival curves were calculated using the Kaplan-Meier method and compared using log-rank tests. Multivariate analysis was performed using the Cox regression model. RESULTS The 1-, 3- and 5-year overall survival rates were 95.2%, 71.4% and 38.1% and 96.7%, 53.3% and 43.3% for the HR and MWA groups, respectively; these did not differ significantly between the two groups. However, patients in the HR group had more post-operative complications (52.3% vs. 13.7%; p = 0.002). Multivariate analysis identified albumin and bilirubin levels and tumour size to be statistically significant and independent prognostic factors for overall survival, while BCLC stage was associated with poor recurrence-free survival. Furthermore, albumin levels were shown to be an independent predictive factor for post-operative complications. CONCLUSIONS For patients with small HCC and concomitant EVB, MWA plus PCDV may reduce the incidence of post-operative complications relative to and provide similar therapeutic benefits as HR plus PCDV, especially for patients with low albumin levels.
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Affiliation(s)
- Qiang-Bo Zhang
- a Department of General Surgery , Qilu Hospital, Shandong University , Jinan , China
| | - Xiu-Guo Zhang
- a Department of General Surgery , Qilu Hospital, Shandong University , Jinan , China
| | - Run-de Jiang
- a Department of General Surgery , Qilu Hospital, Shandong University , Jinan , China
| | - Chun-Xiao Hu
- a Department of General Surgery , Qilu Hospital, Shandong University , Jinan , China
| | - Dong Sun
- a Department of General Surgery , Qilu Hospital, Shandong University , Jinan , China
| | - Lin Ran
- a Department of General Surgery , Qilu Hospital, Shandong University , Jinan , China
| | - Zong-Li Zhang
- a Department of General Surgery , Qilu Hospital, Shandong University , Jinan , China
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Li Z, Zhang K, Lin SM, Mi DH, Cao N, Wen ZZ, Li ZX. Radiofrequency ablation combined with percutaneous ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia 2016; 33:237-246. [PMID: 27701918 DOI: 10.1080/02656736.2016.1237681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Zheng Li
- Department of General Surgery, First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, PR China
- Department of Oncology, Second People's Hospital of Gansu Province, Lanzhou, Gansu Province, PR China
| | - Kai Zhang
- Department of Infectious Disease, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, PR China
| | - Shu-Mei Lin
- Department of Infectious Disease, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, PR China
| | - Deng-Hai Mi
- Department of General Surgery, First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, PR China
- Department of Oncology, Second People's Hospital of Gansu Province, Lanzhou, Gansu Province, PR China
| | - Nong Cao
- Department of General Surgery, First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, PR China
| | - Zhi-Zhen Wen
- Department of Oncology, Second People's Hospital of Gansu Province, Lanzhou, Gansu Province, PR China
| | - Zhong-Xin Li
- Department of Oncology, Second People's Hospital of Gansu Province, Lanzhou, Gansu Province, PR China
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Ziemlewicz TJ, Wells SA, Lubner MG, Brace CL, Lee FT, Hinshaw JL. Hepatic Tumor Ablation. Surg Clin North Am 2016; 96:315-39. [PMID: 27017867 DOI: 10.1016/j.suc.2015.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tumor ablation is a safe and effective treatment available in the multidisciplinary care of the surgical oncology patient. The role of ablation is well established in the treatment of hepatocellular carcinoma and is becoming more accepted in the treatment of various malignancies metastatic to the liver, in particular colorectal cancer. Understanding the underlying technology, achieving appropriate applicator placement, using maximum energy delivery to create margins, and performing necessary adjunctive maneuvers are all required for successful tumor ablation.
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Affiliation(s)
- Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA.
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706, USA
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
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Dou JP, Yu J, Cheng ZG, Han ZY, Liu FY, Yu XL, Liang P. Ultrasound-Guided Percutaneous Microwave Ablation for Hepatocellular Carcinoma in the Caudate Lobe. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1825-1833. [PMID: 27126238 DOI: 10.1016/j.ultrasmedbio.2016.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
Treatment for liver tumors in the caudate lobe is challenging because of their location and complex anatomy. This study was intended to evaluate the feasibility, efficacy and tolerability of ultrasound-guided percutaneous microwave (MW) ablation for treating hepatocellular carcinoma (HCC) in the caudate lobe. From December 2011 to May 2015, a total of 20 patients (mean age: 62 ± 11 y) with HCC in the caudate lobe were enrolled in this study. Patient characteristics and tumor features were analyzed. The epigastric approach, intercostal approach and the combination were used in 4, 14 and 2 patients, respectively. Contrast-enhanced ultrasound (CEUS) guidance and temperature monitoring were applied as ancillary techniques. Ethanol injection was performed for tumors adjacent to the inferior vena cava or hepatic hilum. Contrast images were performed to evaluate treatment response after ablation. Technical success, technique efficacy, local tumor progression and complications were documented. Technique efficacy was achieved in 18 patients (18/20, 90%). Two patients received (125)I brachytherapy as palliative therapy for residual tumors that could not be ablated technically after the first ablation. Technical success was achieved in 16 patients (16/20, 80%). In 2 patients, ablation was completed after two sessions. CEUS was applied in 5 patients and temperature monitoring in 2 patients. Eight patients received an ethanol injection during ablation. Eleven patients achieved a minimum 5-mm safety margins. Local tumor progression was detected in 3 patients (16.7%, 3/18) during a median follow-up of 18.4 mo (range: 3-45 mo). Tumors in these 3 patients were all larger than 2.0 cm. No major or minor complications were observed. In conclusion, ultrasound-guided percutaneous microwave ablation combined with CEUS, temperature monitoring, and ethanol injection is a tolerable and relatively effective treatment for HCC in the caudate lobe.
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Affiliation(s)
- Jian-Ping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
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18
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Zhang K, Yu J, Zhou F, Yu X, Li X, Wang J, Han Z, Cheng Z, Liang P. Impact of timing and cycles of systemic chemotherapy on survival outcome of colorectal liver metastases patients treated by percutaneous microwave ablation. Int J Hyperthermia 2016; 32:531-8. [DOI: 10.3109/02656736.2016.1156169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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19
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Abstract
Surveillance programs and widespread use of medical imaging have increased the detection of hepatic tumors. When feasible, surgical resection is widely accepted as the curative treatment of choice, but surgical morbidity and mortality has spurred the development of minimally invasive ablative technologies over the last 2 decades. Microwave ablation has emerged as a promising thermal ablation modality with improving oncologic efficacy due to technical improvements and image guidance strategies. This article provides an overview of microwave application in liver tumors, and we discuss currently available equipment, clinical efficacy, and safety and provide comparisons with other commonly used therapies. This article also introduces advanced ablative techniques and combination therapies that may help achieve precise ablation and further enhance the efficacy of microwave ablation.
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20
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Yang X, Yu J, Liang P, Yu X, Cheng Z, Han Z, Liu F. Ultrasound-guided percutaneous ethanol ablation for primary non-parasitic splenic cysts in 15 patients. Abdom Radiol (NY) 2016; 41:538-44. [PMID: 27039325 DOI: 10.1007/s00261-015-0584-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to evaluate the feasibility, safety, and efficacy of ultrasound (US)-guided percutaneous ethanol ablation (PEA) for primary non-parasitic splenic cysts. MATERIALS AND METHODS Between February 2006 and February 2015, 15 patients (4 men and 11 women; mean age, 33 ± 15.3 years; age range, 17-65 years) with primary non-parasitic splenic cysts were treated with US-guided PEA. 99.5% absolute ethanol in an amount of approximately 50%-100% of the aspirated volume was injected into each cyst and no more than 240 mL. Standard laboratory tests (hemogram, coagulation, serum, and biochemical tumor marker levels) were performed before and after PEA. RESULTS The median follow-up time was 18.7 months (range 2.8-59.2 months). During follow-up, seven cysts after treatment had disappeared completely, while the other eight cysts had decreased significantly in size. The 3-, 6-, 12-, and 24-month volume reduction rates were 49.7%, 87.6%, 94.3%, and 96.7%. Serum tumor marker CA19-9 levels significantly decreased. Mild adverse reactions included moderate pain in four (26.7%), unbearable pain in one (6.67%), fever in two (13.3%) and slight intracystic bleeding in one (6.67%). There were no serious complications. CONCLUSION US-guided PEA appears to be a safe and effective minimally invasive technique for management of primary non-parasitic splenic cysts.
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Affiliation(s)
- Xiaohuan Yang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
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21
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Yu JI, Park HC, Oh D, Noh JM, Jung SH, Kim HY, Shin SW, Cho SK, Sinn DH, Paik YH, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC. Combination treatment of trans-arterial chemo-embolisation, radiotherapy and hyperthermia (CERT) for hepatocellular carcinoma with portal vein tumour thrombosis: Interim analysis of prospective phase II trial. Int J Hyperthermia 2016; 32:331-8. [PMID: 26915594 DOI: 10.3109/02656736.2016.1144895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives This study evaluated the objective response to and toxicity of trans-arterial chemo-embolisation (TACE) followed by radiotherapy and hyperthermia (CERT) in hepatocellular carcinoma patients with portal vein tumour thrombosis. Methods The study design was a single-centre prospective phase II trial. Patients were first treated with TACE, with the first hyperthermia session 1 week later. Respiration-gated radiotherapy (RT) was delivered in 10 fractions of 3-5 Gy after another week. Six sessions of hyperthermia were delivered twice a week according to an energy escalation protocol. Response evaluation was planned at 1 month after RT completion using the modified Response Evaluation Criteria in Solid Tumors (RECIST). Toxicity was determined using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Results Interim analysis was conducted on patients enrolled from October 2013 to November 2014. During this period, 46 patients (90.2%) who received at least one hyperthermia session were eligible and enrolled. Median follow-up was 6.7 months (range 2.0-15.0 months). Complete response was observed in 10 (21.7%) patients and partial response in 27 (47.8%). Most toxicities were grade I or II. One death was related to severe pneumonia of unknown cause in the left lung and one patient could not complete planned treatment because of continuous elevation of bilirubin after TACE. Late, asymptomatic gastroduodenal toxicities were noticed in 13 (28.3%) patients. Conclusion Preliminary evaluation of CERT showed a promising response rate with acceptable toxicities.
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Affiliation(s)
- Jeong Il Yu
- a Department of Radiation Oncology , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Hee Chul Park
- a Department of Radiation Oncology , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul ;,b Department of Medical Device Management and Research , SAIHST, Sungkyunkwan University , Seoul
| | - Dongryul Oh
- a Department of Radiation Oncology , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Jae Myoung Noh
- a Department of Radiation Oncology , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Sang Hoon Jung
- a Department of Radiation Oncology , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Hye Yeong Kim
- a Department of Radiation Oncology , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Sung Wook Shin
- c Department of Radiology , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Sung Ki Cho
- c Department of Radiology , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Dong Hyun Sinn
- d Department of Medicine , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Yong-Han Paik
- d Department of Medicine , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Geum-Youn Gwak
- d Department of Medicine , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Moon Seok Choi
- d Department of Medicine , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Joon Hyeok Lee
- d Department of Medicine , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Kwang Cheol Koh
- d Department of Medicine , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Seung Woon Paik
- d Department of Medicine , Samsung Medical Centre, Sungkyunkwan University School of Medicine , Seoul
| | - Byung Chul Yoo
- e Department of Medicine , Konkuk University Medical Centre, Konkuk University , Seoul , Korea
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Sun X, Li RU, Zhang B, Yang Y, Cui Z. Treatment of liver cancer of middle and advanced stages using ultrasound-guided percutaneous ethanol injection combined with radiofrequency ablation: A clinical analysis. Oncol Lett 2016; 11:2096-2100. [PMID: 26998128 PMCID: PMC4774433 DOI: 10.3892/ol.2016.4180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/02/2016] [Indexed: 01/07/2023] Open
Abstract
Liver cancer is a malignancy of the digestive system and has a high morbidity and mortality rate. Local intervention has become a viable option in identifying liver treatment. The aim of the present study was to analyze the clinical effects of treating liver cancer in middle and advanced stages using ultrasound-guided percutaneous ethanol injection (PEI) in tumors combined with radiofrequency ablation (RFA). A total of 100 patients with stage III-IV liver cancers were selected to participate in the study. Patients were divided into groups. In group A, treatment was initiated with PEI and after 1-2 weeks RFA was applied while in group B treatment was initiated with RFA and after 1-2 weeks PEI was applied. Patients in group C received PEI and RFA simultaneously. The clinical effects in the 3 groups were compared after 6-month follow ups. The volume of tumor ablation necrosis in group A was significantly greater than that in the groups B and C, while the size was significantly smaller compared to groups B and C after ablation. For group A, the complete ablation rate was significantly higher than that in groups B and C, and the differences were statistically significant (P<0.05). Liver damage indices, including raising levels of glutamic-pyruvic transaminase and total bilirubin, were significantly decreased in group A (P<0.05). The survival rate in group A was also significantly higher than in groups B and C (P<0.05). In conclusion, for patients with liver cancer in middle and advanced stages, the treatment method using PEI followed by RFA was more beneficial in terms of improving the tumor ablation rate, alleviating liver damages and increasing survival rates.
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Affiliation(s)
- Xue Sun
- Department of Medical Ultrasonics, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - R U Li
- Department of Medical Ultrasonics, The Third Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Botao Zhang
- Department of Medical Ultrasonics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Yuejie Yang
- Department of Medical Ultrasonics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Zhifei Cui
- Department of Medical Ultrasonics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
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Wang S, Tan L, Liang P, Liu T, Wang J, Fu C, Yu J, Dou J, Li H, Meng X. Layered MoS2 nanoflowers for microwave thermal therapy. J Mater Chem B 2016; 4:2133-2141. [DOI: 10.1039/c6tb00296j] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Layered BSA-MoS2 nanoflowers are designed and synthesized as excellent microwave (MW) hyperthermia susceptive agents for in vivo cancer therapy via MW irradiation at 1.8 W, 450 MHz, which shows great potential for green tumor thermotherapy.
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Affiliation(s)
- Shengping Wang
- Department of Materials Science and Engineering
- Jinan University
- Guangzhou
- P. R. China
| | - Longfei Tan
- Laboratory of Controllable Preparation and Application of Nanomaterials
- Center for Micro/nanomaterials and Technology
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing
| | - Ping Liang
- Chinese PLA General Hospital
- Beijing
- P. R. China
| | - Tianlong Liu
- Laboratory of Controllable Preparation and Application of Nanomaterials
- Center for Micro/nanomaterials and Technology
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing
| | - Jingzhuo Wang
- School of Electronic Engineering
- Huaihai Institute of Technology
- Lianyungang 222005
- P. R. China
| | - Changhui Fu
- Laboratory of Controllable Preparation and Application of Nanomaterials
- Center for Micro/nanomaterials and Technology
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing
| | - Jie Yu
- Chinese PLA General Hospital
- Beijing
- P. R. China
| | | | - Hong Li
- Department of Materials Science and Engineering
- Jinan University
- Guangzhou
- P. R. China
| | - Xianwei Meng
- Laboratory of Controllable Preparation and Application of Nanomaterials
- Center for Micro/nanomaterials and Technology
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing
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Zhai H, Liang P, Yu XL, Cheng Z, Han ZY, Liu F, Yu J. Microwave ablation in treating intrahepatic recurrence of hepatocellular carcinoma after liver transplantation: An analysis of 11 cases. Int J Hyperthermia 2015; 31:863-8. [DOI: 10.3109/02656736.2015.1091953] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Electric Ablation with Irreversible Electroporation (IRE) in Vital Hepatic Structures and Follow-up Investigation. Sci Rep 2015; 5:16233. [PMID: 26549662 PMCID: PMC4637899 DOI: 10.1038/srep16233] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/09/2015] [Indexed: 02/07/2023] Open
Abstract
Irreversible electroporation (IRE) with microsecond-pulsed electric fields (μsPEFs) can effectively ablate hepatocellular carcinomas in animal models. This preclinical study evaluates the feasibility and safety of IRE on porcine livers. Altogether, 10 pigs were included. Computed tomography (CT) was used to guide two-needle electrodes that were inserted near the hilus hepatis and gall bladder. Animals were followed-up at 2 hours and at 2, 7 and 14 days post-treatment. During and after μsPEF ablation, electrocardiographs found no cardiovascular events, and contrast CT found no portal vein thrombosis. There was necrosis in the ablation zone. Mild cystic oedema around the gall bladder was found 2 hours post-treatment. Pathological studies showed extensive cell death. There was no large vessel damage, but there was mild endothelial damage in some small vessels. Follow-up liver function tests and routine blood tests showed immediate liver function damage and recovery from the damage, which correlated to the pathological changes. These results indicate that μsPEF ablation affects liver tissue and is less effective in vessels, which enable μsPEFs to ablate central tumour lesions close to the hilus hepatis and near large vessels and bile ducts, removing some of the limitations and contraindications of conventional thermal ablation.
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Su Z, Li K, Xu E, Wu L, Wang X, Li L, Wang J, Lin P, Chen Y, Zhang Y, Li J, Dufour C, Mory B, Zheng R. A clinical validation study for the feasibility and reliability of three-dimensional ultrasound-ultrasound automatic image registration. Int J Hyperthermia 2015; 31:875-82. [DOI: 10.3109/02656736.2015.1073370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Li X, Han Z, Cheng Z, Yu J, Yu X, Liang P. Clinical significance of preoperative platelet-to-lymphocyte ratio in recurrent hepatocellular carcinoma after thermal ablation: A retrospective analysis. Int J Hyperthermia 2015; 31:758-63. [DOI: 10.3109/02656736.2015.1068958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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