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de la Pinta C, Sevillano D, Colmenares R, Barrio S, Olavarria A, Palomera A, Romera R, Cobos J, Muriel A, Fernández E, Perna LC, Albillos A, Sancho S. Are liver contour and bone fusion comparable to fiducials for IGRT in liver SBRT? Tech Innov Patient Support Radiat Oncol 2023; 27:100215. [PMID: 37744524 PMCID: PMC10511841 DOI: 10.1016/j.tipsro.2023.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/28/2023] [Accepted: 06/19/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Liver stereotactic body radiotherapy (SBRT) is increasingly being used to treat tumours. The purpose of this study was to compare the differences in patient positioning when using implanted fiducials as surrogates compared to alternative methods based on liver contour or bone registration. Material and methods Eighteen patients treated with SBRT who underwent a fiducial placement procedure were included. Fiducial guidance was our gold standard to guide treatment in this study. After recording the displacements, when fusing the planning CT and CBCT performed in the treatment unit using fiducials, liver contour and bone reference, the differences between fiducials and liver contour and bone reference were calculated. Data from 88 CBCT were analyzed. The correlation between the displacements found with fiducials and those performed based on the liver contour and the nearest bone structure as references was determined. The mean, median, variance, range and standard deviation of the displacements with each of the fusion methods were obtained. μ, Ʃ, and σ values and margins were obtained. Results Lateral displacements of less than 3 mm with respect to the gold standard in 92% vs. 62.5% of cases using liver contour and bone references, respectively, with 93.2% vs. 65.9% in the AP axis and SI movement in 69.3% vs. 51.1%. The errors μ, σ and Ʃ of the fusions with hepatic contour and bone reference in SI were 0.26 mm, 4 mm and 3 mm, and 0.8 mm, 5 mm and 3 mm respectively. Conclusion Our study showed that displacements were smaller with the use of hepatic contour compared to bone reference and comparable to those obtained with the use of fiducials in the lateral, AP and SI motion axes. This would justify that hepatic contouring can be a guide in the treatment of patients in the absence of fiducials.
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Affiliation(s)
- C. de la Pinta
- Radiation Oncology Department. IRYCIS. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - D. Sevillano
- Medical Physics Department. Ramón y Cajal Hospital. IRYCIS, Crta Colmenar Viejo Km 9,100 28034, Madrid, Spain
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | - R. Colmenares
- Medical Physics Department. Ramón y Cajal Hospital. IRYCIS, Crta Colmenar Viejo Km 9,100 28034, Madrid, Spain
| | - S. Barrio
- Radiation Therapist. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - A. Olavarria
- Radiology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - A. Palomera
- Radiology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - R. Romera
- Radiology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - J. Cobos
- Radiology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - A. Muriel
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital, IRYCIS, CIBERESP. Universidad de Alcalá, Madrid, Spain
| | - E. Fernández
- Radiation Oncology Department. IRYCIS. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - LC. Perna
- Pathology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - A. Albillos
- Dept of Gastroenterology. Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD., Madrid, Spain
| | - S. Sancho
- Radiation Oncology Department. IRYCIS. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
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Wang F, Ma J, Wu L, Li N, Luo R, Wei G, Yang J. Percutaneous cryoablation of subcapsular hepatocellular carcinoma: a retrospective study of 57 cases. ACTA ACUST UNITED AC 2020; 26:34-39. [PMID: 31650975 DOI: 10.5152/dir.2019.18543] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aims to evaluate the safety and effectiveness of the percutaneous cryoablation for subcapsular hepatocellular carcinoma (HCC). METHODS A total of 57 patients with subcapsular (<1 cm form the liver edge) HCCs (68 lesions), who were treated with CT-guided percutaneous cryoablation in the Department of Interventional Radiology of our hospital between July 1, 2016 and September 1, 2018, were retrospectively included. Complete ablation rate, local tumor progression (LTP) and treatment-related complications were evaluated. Furthermore, the degree of intraoperative and postoperative pain was measured with the visual analog scale (VAS), and laboratory findings were compared before and after the procedure. RESULTS All patients successfully completed the treatment. The mean follow-up period was 12.8 months (range, 3-27 months), and the complete ablation rate was 97% (66/68). Local tumor progression occurred in 11 lesions (16.2%), and the 6-, 12- and 18-month cumulative LTP rates were 4.0%, 8.2% and 20.5%, respectively. Two patients (3.5%, 2/57) developed major complications, and 12 patients had minor complications (22.8%, 12/57). The mean VAS score during the operation was 1.65 points (range, 1-3 points). Postoperative pain worsened in 3 patients, and the VAS scores reached 4-5. Transient changes in biochemical and hematologic markers were observed. CONCLUSION Percutaneous cryoablation for subcapsular HCC is safe and effective, the procedure is simple and the patients suffer less pain.
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Affiliation(s)
- Fuming Wang
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianbing Ma
- Department of Radiology, The First Hospital of Jiaxing, Zhejiang, China
| | - Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital, Shandong, China
| | - Na Li
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Luo
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Guangxu Wei
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jijin Yang
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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An C, Huang Z, Ni J, Zuo M, Jiang Y, Zhang T, Huang JH. Development and validation of a clinicopathological-based nomogram to predict seeding risk after percutaneous thermal ablation of primary liver carcinoma. Cancer Med 2020; 9:6497-6506. [PMID: 32702175 PMCID: PMC7520297 DOI: 10.1002/cam4.3250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives To develop a clinicopathological‐based nomogram to improve the prediction of the seeding risk of after percutaneous thermal ablation (PTA) in primary liver carcinoma (PLC). Methods A total of 2030 patients with PLC who underwent PTA were included between April 2009 and December 2018. The patients were grouped into a training dataset (n = 1024) and an external validation dataset (n = 1006). Baseline characteristics were collected to identify the risk factors of seeding after PTA. The multivariate Cox proportional hazards model based on the risk factors was used to develop the nomogram, which was used for assessment for its predictive accuracy using mainly the Harrell's C‐index and receiver operating characteristic curve (AUC). Results The median follow‐up time was 30.3 months (range, 3.2‐115.7 months). The seeding risk was 0.89% per tumor and 1.5% per patient in the training set. The nomogram was developed based on tumor size, subcapsular, α‐fetoprotein (AFP), and international normalized ratio (INR). The 1‐, 2‐, and 3‐year cumulative seeding rates were 0.1%, 0.7% and 1.2% in the low‐risk group, and 1.7%, 6.3% and 6.3% in the high‐risk group, respectively, showing significant statistical difference (P < .001). The nomogram had good calibration and discriminatory abilities in the training set, with C‐indexes of 0.722 (95% confidence interval [CI]: 0.661, 0.883) and AUC of 0.850 (95% CI: 0.767, 0.934). External validation with 1000 bootstrapped sample sets showed a good C‐index of 0.706 (95% CI: 0.546, 0.866) and AUC of 0.736 (95% CI: 0. 646, 0.827). Conclusions The clinicopathological‐based nomogram could be used to quantify the probability of seeding risk after PTA in PLC.
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Affiliation(s)
- Chao An
- Department of Minimal invasive intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhimei Huang
- Department of Minimal invasive intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jiayan Ni
- Department of Minimal invasive intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Mengxuan Zuo
- Department of Minimal invasive intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yiquan Jiang
- Department of Minimal invasive intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tianqi Zhang
- Department of Minimal invasive intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jin-Hua Huang
- Department of Minimal invasive intervention, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Liu Y, Li X, Zhang LM, Chen J, Cai Y, Lin Y, Geng CJ, Wang K, Wang QQ, He CS, Zhong S. Safety and efficacy of a China-made cryoablation device in treatment of hepatocellular carcinoma smaller than 5 cm. Shijie Huaren Xiaohua Zazhi 2017; 25:426-431. [DOI: 10.11569/wcjd.v25.i5.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the safety and efficacy of a China-made cryoablation device in the treatment of hepatocellular carcinoma (HCC) smaller than 5 cm.
METHODS A total of 33 patients with HCC smaller than 5 cm were treated by cryoablation using a China-made cryoablation device under the guidance of computed tomography. Operation-associated complications within and after procedures were evaluated. The efficacy of target lesions within procedures and local recurrence rate after procedures were evaluated with imaging modalities.
RESULTS All 37 lesions of the 33 patients were successfully treated with a China-made cryablation device. Upon the finish of procedures, complete ablation was achieved in 83.78% (31/37) of lesions, and partial ablation was achieved in 16.22% (6/37). In a median follow-up period of 10.8 mo, 32 patients remained alive and 1 was lost to follow-up. The rate of local recurrence for target lesions was 30.3% (10/33), which is equal to that achieved with imported devices.
CONCLUSION Our findings suggest that the China-made cryoablation device is safe and effective for HCC smaller than 5 cm with the capability of destroying the whole tumor lesion.
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Schneider C, Johnson SP, Walker-Samuel S, Gurusamy K, Clarkson MJ, Thompson S, Song Y, Totz J, Cook RJ, Desjardins AE, Hawkes DJ, Davidson BR. Utilizing confocal laser endomicroscopy for evaluating the adequacy of laparoscopic liver ablation. Lasers Surg Med 2015; 48:299-310. [PMID: 26718623 PMCID: PMC4843950 DOI: 10.1002/lsm.22464] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2015] [Indexed: 12/19/2022]
Abstract
Background Laparoscopic liver ablation therapy can be used for the treatment of primary and secondary liver malignancy. The increased incidence of cancer recurrence associated with this approach, has been attributed to the inability of monitoring the extent of ablated liver tissue. Methods The feasibility of assessing liver ablation with probe‐based confocal laser endomicroscopy (CLE) was studied in a porcine model of laparoscopic microwave liver ablation. Following the intravenous injection of the fluorophores fluorescein and indocyanine green, CLE images were recorded at 488 nm and 660 nm wavelength and compared to liver histology. Statistical analysis was performed to assess if fluorescence intensity change can predict the presence of ablated liver tissue. Results CLE imaging of fluorescein at 488 nm provided good visualization of the hepatic microvasculature; whereas, CLE imaging of indocyanine green at 660 nm enabled detailed visualization of hepatic sinusoid architecture and interlobular septations. Fluorescence intensity as measured in relative fluorescence units was found to be 75–100% lower in ablated compared to healthy liver regions. General linear mixed modeling and ROC analysis found the decrease in fluorescence to be statistically significant. Conclusion Laparoscopic, dual wavelength CLE imaging using two different fluorophores enables clinically useful visualization of multiple liver tissue compartments, in greater detail than is possible at a single wavelength. CLE imaging may provide valuable intraoperative information on the extent of laparoscopic liver ablation. Lasers Surg. Med. 48:299–310, 2016. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Crispin Schneider
- Division of Surgery and Interventional Science, Royal Free Campus, University College London, Pond Street, NW3 2QG, London, UK
| | - Sean P Johnson
- Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Simon Walker-Samuel
- Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Royal Free Campus, University College London, Pond Street, NW3 2QG, London, UK
| | - Matthew J Clarkson
- Division of Tissue Engineering and Biophotonics, Kings College London Dental Institute, London, United Kingdom
| | - Stephen Thompson
- Division of Tissue Engineering and Biophotonics, Kings College London Dental Institute, London, United Kingdom
| | - Yi Song
- Division of Tissue Engineering and Biophotonics, Kings College London Dental Institute, London, United Kingdom
| | - Johannes Totz
- Division of Tissue Engineering and Biophotonics, Kings College London Dental Institute, London, United Kingdom
| | - Richard J Cook
- Division of Tissue Engineering and Biophotonics, Kings College London Dental Institute, London, United Kingdom
| | - Adrien E Desjardins
- Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
| | - David J Hawkes
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Brian R Davidson
- Division of Surgery and Interventional Science, Royal Free Campus, University College London, Pond Street, NW3 2QG, London, UK
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Wang C, Wang H, Yang W, Hu K, Xie H, Hu KQ, Bai W, Dong Z, Lu Y, Zeng Z, Lou M, Wang H, Gao X, Chang X, An L, Qu J, Li J, Yang Y. Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma. Hepatology 2015; 61:1579-90. [PMID: 25284802 DOI: 10.1002/hep.27548] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 10/01/2014] [Indexed: 02/06/2023]
Abstract
UNLABELLED Radiofrequency ablation (RFA) is considered a curative treatment option for hepatocellular carcinoma (HCC). Growing data have demonstrated that cryoablation represents a safe and effective alternative therapy for HCC, but no randomized controlled trial (RCT) has been reported to compare cryoablation with RFA in HCC treatment. The present study was a multicenter RCT aimed to compare the outcomes of percutaneous cryoablation with RFA for the treatment of HCC. In all, 360 patients with Child-Pugh class A or B cirrhosis and one or two HCC lesions ≤ 4 cm, treatment-naïve, without metastasis were randomly assigned to cryoablation (n = 180) or RFA (n = 180). The primary endpoints were local tumor progression at 3 years after treatment and safety. Local tumor progression rates at 1, 2, and 3 years were 3%, 7%, and 7% for cryoablation and 9%, 11%, and 11% for RFA, respectively (P = 0.043). For lesions >3 cm in diameter, the local tumor progression rate was significantly lower in the cryoablation group versus the RFA group (7.7% versus 18.2%, P = 0.041). The 1-, 3-, and 5-year overall survival rates were 97%, 67%, and 40% for cryoablation and 97%, 66%, and 38% for RFA, respectively (P = 0.747). The 1-, 3-, and 5-year tumor-free survival rates were 89%, 54%, and 35% in the cryoablation group and 84%, 50%, and 34% in the RFA group, respectively (P = 0.628). Multivariate analyses demonstrated that Child-Pugh class B and distant intrahepatic recurrence were significant negative predictors for overall survival. Major complications occurred in seven patients (3.9%) following cryoablation and in six patients (3.3%) following RFA (P = 0.776). CONCLUSION Cryoablation resulted in a significantly lower local tumor progression than RFA, although both cryoablation and RFA were equally safe and effective, with similar 5-year survival rates.
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Affiliation(s)
- Chunping Wang
- Center of Therapeutic Research for Hepatocellular Carcinoma, Beijing the 302nd Hospital, Beijing, China
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Rong G, Bai W, Dong Z, Wang C, Lu Y, Zeng Z, Qu J, Lou M, Wang H, Gao X, Chang X, An L, Li H, Chen Y, Hu KQ, Yang Y. Long-term outcomes of percutaneous cryoablation for patients with hepatocellular carcinoma within Milan criteria. PLoS One 2015; 10:e0123065. [PMID: 25849963 PMCID: PMC4388736 DOI: 10.1371/journal.pone.0123065] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 02/27/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Accumulating evidences have suggested that percutaneous cryoablation could be a valuable alternative ablation therapy for HCC but there has been no large cohort-based analysis on its long-term outcomes. METHODS A series of 866 patients with Child-Pugh class A-B cirrhosis and HCC within Milan criteria who underwent percutaneous cryoablation was long-term followed. The safety, efficacy, 5-year survival, and prognostic factors of percutaneous cryoablation in the treatment of HCC were analyzed. RESULTS A total of 1197 HCC lesions were ablated with 1401 cryoablation sessions. Complete response (CR) was achieved in 1163 (97.2%) lesions and 832 (96.1%) patients with 34 (2.8%) major complications, but no treatment-related mortality. After a median of 30.9 months follow-up, 502 (60.3%) patients who achieved CR developed different types of recurrence. The cumulative local tumor recurrence rate was 24.2% at 5-years. Multiple tumor lesions, tumor size > 3 cm, and repeated ablation of same lesion were independent risk factors associated with local recurrence. The 5-year overall survival (OS) rates were 59.5%. Age < 36 years, HCC family history, baseline hepatitis B virus DNA >106 copies/ml, and three HCC lesions were independently and significantly negative predictors to the post-cryoablation OS. CONCLUSIONS Percutaneous cryoablation is an effective therapy for patients with HCC within Milan criteria, with comparable efficacy, safety and long-term survival to the reported outcomes of radiofrequency ablation.
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Affiliation(s)
- Guanghua Rong
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Wenlin Bai
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Zheng Dong
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Chunping Wang
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Yinying Lu
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Zhen Zeng
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Jianhui Qu
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Min Lou
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Hong Wang
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Xudong Gao
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Xiujuan Chang
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Linjing An
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Hongyan Li
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Yan Chen
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Ke-Qin Hu
- Division of Gastroenterology/Hepatology, University of California, Irvine, 101 the City Dr., Building 56, Ste. 237, Orange, CA 92868, United States of America
| | - Yongping Yang
- Center of Therapeutic Research for Liver Cancer, the 302 Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
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Advances in clinical application of cryoablation therapy for hepatocellular carcinoma and metastatic liver tumor. J Clin Gastroenterol 2014; 48:830-6. [PMID: 25148553 DOI: 10.1097/mcg.0000000000000201] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Although surgical resection and liver transplantation are the curative treatments, many of HCC patients do not qualify for these curative therapies at the presentation. Thus, ablation therapies are currently important modalities in HCC treatment. Among currently available ablation therapies, cryoablation (ie, cryotherapy) is a novel local therapeutic modality. However, cryoablation has not been widely used as one of ablation therapies for HCC, because of historical concerns about risk of bleeding when cryotherapy is delivered by early generation of the argon-helium device. Nevertheless, with technological advances and increased clinical experience in the past decade, clinical application of cryoablation for HCC management has significantly increased. Accumulating data have demonstrated that cryoablation is highly effective in local tumor control with well-acceptable safety profile, and the overall survival is comparable with that of radiofrequency ablation in patients with tumors <5 cm. Compared with radiofrequency ablation and other thermal-based modalities, cryoablation has several advantages, such as the ability to produce larger and precise zones of ablation. This article systemically reviews the advances in clinical application of cryoablation therapy for HCC, including the related mechanisms and technology, clinical indications, efficacy and safety profiles, and future research directions.
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Niu LZ, Li JL, Xu KC. Percutaneous Cryoablation for Liver Cancer. J Clin Transl Hepatol 2014; 2:182-8. [PMID: 26355719 PMCID: PMC4521246 DOI: 10.14218/jcth.2014.00017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/15/2014] [Accepted: 06/27/2014] [Indexed: 12/15/2022] Open
Abstract
Based on the primary tumor site, liver cancer can be divided into two categories: (1) primary liver cancer and (2) metastatic cancer to the liver from a distant primary site. Guided cryoablation via many imaging methods induces iceball formation and tumor necrosisand is an attractive option for treating unresectable hepatocellular carcinoma (HCC) and metastatic liver cancer. There are several advantages to using cryoablation for the treatment of liver cancer: it can be performed percutaneously, intraoperatively, and laparoscopically; iceball formation can be monitored; it has little impact on nearby large blood vessels; and it induces a cryo-immunological response in situ. Clinically, primary research has shown that percutaneous cryoablation of liver cancer is relatively safe and efficient, and it can be combined with other methods, such as radiation therapy, chemotherapy, and immunology, to control disease. Although research is preliminary, cryosurgery is fast becoming an alternative treatment method for HCC or liver tumors. Here, we review the mechanisms of liver tumor cryoablation, cryoablation program selection, clinical efficiency, and complications following treatment.
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Affiliation(s)
- Li-Zhi Niu
- Fuda Cancer Hospital, Jinan University School of Medicine, Tianhe District, Guangzhou, China
- Guangzhou Fuda Cancer Institute, Tianhe District, Guangzhou, China
| | - Jia-Liang Li
- Guangzhou Fuda Cancer Institute, Tianhe District, Guangzhou, China
| | - Ke-Cheng Xu
- Fuda Cancer Hospital, Jinan University School of Medicine, Tianhe District, Guangzhou, China
- Guangzhou Fuda Cancer Institute, Tianhe District, Guangzhou, China
- Correspondence to: Kecheng Xu, No.2 of Tangde West Rd, Tianhe District, Guangzhou, China. Tel: +86-020-38993994-8700, Fax: +86-020-38993994-8700. E-mail:
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Sun L, Zhang W, Liu H, Yuan J, Liu W, Yang Y. Computed tomography imaging-guided percutaneous argon-helium cryoablation of muscle-invasive bladder cancer: initial experience in 32 patients. Cryobiology 2014; 69:318-22. [PMID: 25169033 DOI: 10.1016/j.cryobiol.2014.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the initial clinical experience of computed tomography (CT) imaging-guided percutaneous cryotherapy of bladder cancer. PATIENTS AND METHODS This study was approved by the human subjects committee. Written informed consent was obtained from all patients. Thirty-two patients (22 males and 10 females; mean age, 62.7 years) with muscle-invasive bladder cancer were treated with CT imaging-guided percutaneous cryoablation. By using CT imaging system and local anesthesia in patients, a single or multiple 1.47 mm cryoprobes were used to freeze the target bladder tumor (mean tumor size, 2.8 cm; range, 1.3-4.5 cm) with a dual freeze-thaw cycle. Follow-up was performed to assess the clinical and technical outcome of patients treated with cryoablation for a minimum of 6 months (mean, 33 months; range, 6-48 months). Tumors were considered completely ablated if there was no evidence to suggest tumor enhancement at follow-up CT images. RESULTS Bladder cryoablation was clinically and technically successful in all 32 cases, 30 of which required only one treatment session. Bladder integrity was maintained in all patients. Major complications were not observed in any patient. CONCLUSION Our initial experience of a minimally invasive method for ablating bladder tumors with CT imaging-guided percutaneous argon-helium cryoablation appears to be favorable, with acceptable operative and short-term clinical outcomes. The technique is safe and effective for the treatment of patients with muscle-invasive bladder cancer; however, long-term follow-up is needed.
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Affiliation(s)
- Lijun Sun
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, China.
| | - Wei Zhang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, China
| | - Heliang Liu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, China
| | - Weiying Liu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, China
| | - Yan Yang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, China
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Cryotherapy for cirrhosis-based hepatocellular carcinoma: a single center experience from 1595 treated cases. Front Med 2014; 9:63-71. [DOI: 10.1007/s11684-014-0342-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/22/2014] [Indexed: 12/24/2022]
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Yang YP, Qu JH, Chang XJ, Lu YY, Bai WL, Dong Z, Wang H, An LJ, Xu ZX, Wang CP, Zeng Z, Hu KQ. High intratumoral metastasis-associated in colon cancer-1 expression predicts poor outcomes of cryoablation therapy for advanced hepatocellular carcinoma. J Transl Med 2013; 11:41. [PMID: 23414367 PMCID: PMC3599141 DOI: 10.1186/1479-5876-11-41] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 02/07/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cryoablation is one of the local therapies for hepatocellular carcinoma (HCC), but its safety and effect has not been studied in patients with Child class A or B and Barcelona Clinic Liver Cancer (BCLC) stage C HCC. Metastasis-associated in colon cancer-1 (MACC1) overexpression has been associated with poor prognosis of HCC, but its predictive value to post-cryoablation outcomes remains unknown in patients with BCLC stage C HCC. METHODS This study assessed the safety and outcomes of cryoablation measured by time to progression (TTP) and overall survival (OS), and predictive value of MACC1 mRNA and protein overexpression in tumorous tissue to post-cryoablation outcomes in 120 advanced HCC patients with child-pugh class A or B by quantitative polymerase chain reaction and immunohistochemical staining. The potenial correlation of MACC1 and c-Met expression to tumor cell proliferation and apoptosis was also analyzed. RESULTS The cryoablation in patients with advanced unresectable HCC resulted in a median TTP and OS of 5.5 (4.2- 6.7) months and 10.5 (9.0-12.0) months, respectively and no significant complications, comparable to the historical report for RFA therapy. The MACC1 mRNA and nuclear protein expression was significantly increased in tumorous tissues in these patients than that in normal liver tissue controls. Higher expression of MACC1 mRNA and nuclear protein in tumorous tissues in these patients was associated with shorter post cryoablation median TTP and OS than that with lower MACC1 expression. CONCLUSIONS Cryoablation is a safe and effective therapeutic option for patients with advanced HCC and Child-pugh class A or B cirrhosis; and a higher intratumoral expression of MACC1 or nuclear translocation predicts poor outcomes of cryotherapy in these patients.
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Affiliation(s)
- Yong-Ping Yang
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
- Beijing Institute for Infectious Disease, Beijing, China
| | - Jian-Hui Qu
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Xiu-Juan Chang
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Yin-Ying Lu
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Wen-Lin Bai
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Zheng Dong
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Hong Wang
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Lin-Jing An
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Zhong-Xian Xu
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Chun-Ping Wang
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Zhen Zeng
- Center of Therapeutic Research for Liver Cancer, the 302nd Hospital, 100 Xi Si Huan Middle Road, Beijing 100039, China
| | - Ke-Qin Hu
- Division of Gastroenterology/Hepatology, University of California, 101 the City Dr., Building 56, Ste. 237, Irvine, CA 92868, USA
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