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Giorgio A, Gatti P, Montesarchio L, Merola MG, Amendola F, Calvanese A, Iaquinto G, Fontana M, Ciracì E, Semeraro S, Santoro B, Coppola C, Matteucci P, Giorgio V. Microwave Ablation in Intermediate Hepatocellular Carcinoma in Cirrhosis: An Italian Multicenter Prospective Study. J Clin Transl Hepatol 2018; 6:251-257. [PMID: 30271736 PMCID: PMC6160301 DOI: 10.14218/jcth.2018.00013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/04/2018] [Accepted: 04/16/2018] [Indexed: 02/07/2023] Open
Abstract
Background and Aims: To report long-term results in treatment of intermediate hepatocellular carcinoma (HCC) in cirrhotics using new high-powered microwaves (MWS) ablation alone. Methods: This multicenter study included 215 cirrhotics (age range: 67-84 years; 137 males; 149 Child A, 66 Child B) who underwent percutaneous ultrasound-guided high-powered MWS ablation instead of transarterial chemoembolization. Among the patient population, 109 had a single nodule (Ø 5.3-8 cm) [group A], 70 had 2 nodules (Ø 3-6 cm) [group B] and 36 had 3-5 nodules (Ø 1.5-6.8 cm) [group C]. MWS ablation efficacy was evaluated using enhanced-computed tomography and/or magnetic resonance imaging. Primary end-point was 5-year cumulative overall survival (OS). Results: On enhanced-computed tomography and/or magnetic resonance imaging, complete ablation rates were 100% for 1.5-3.5 cm nodules. In nodules >3.5-5 cm, it was 89% for the first ablation and 100% for the second. For lesions >5-8 cm, ablation was up to 92%. Overall, 1-, 3- and 5-year survival rates were 89, 60, and 21%, respectively. The cumulative OS rate of group A was 89%, 66% and 34% at 1, 3 and 5 years. The cumulative OS rate of group B was 88%, 60% and 11% at 1, 3 and 5 years. The cumulative OS rate of group C was 86%, 55% and 0%. The 5-year survival rate was significantly different among the groups (p <0.001). One patient died from rupture of HCC. Upon multivariate analysis, preablation total bilirubin >1.5 mg/dL was an independent factor for predicting lower survival. Conclusions: Percutaneous MWS ablation of intermediate HCC is safe and effective in inducing large volume of necrosis in intermediate HCC nodules, providing long-term survival rates similar to transarterial chemoembolization. Preablation total bilirubin >1.5 mg/dL as expression of liver function reserve is the main factor predicting a worse outcome.
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Affiliation(s)
- Antonio Giorgio
- Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
- Department of Surgery, Interventional Ultrasound Unit, Ruesch Clinical Institute, Naples, Italy
| | - Pietro Gatti
- Department of Internal Medicine, Interventional Ultrasound Unit, Ostuni Hospital, Ostuni, Italy
| | - Luca Montesarchio
- Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | | | - Ferdinando Amendola
- Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | - Andrea Calvanese
- Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | - Gaetano Iaquinto
- Interventional Ultrasound Unit, S. Rita Medical-Surgical Hospital, Atripalda, Italy
| | - Massimiliano Fontana
- Interventional Ultrasound Unit, S. Rita Medical-Surgical Hospital, Atripalda, Italy
| | - Emanuela Ciracì
- Department of Internal Medicine, Interventional Ultrasound Unit, Ostuni Hospital, Ostuni, Italy
| | - Stefano Semeraro
- Department of Internal Medicine, Interventional Ultrasound Unit, Ostuni Hospital, Ostuni, Italy
| | - Bruno Santoro
- Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte, Italy
| | - Carmine Coppola
- Department of Internal Medicine, Hepatology Interventional Unit, Gragnano Hospital, Gragnano, Italy
| | - Paolo Matteucci
- Department of Radiation Oncology, Campus Biomedico University, Rome, Italy
| | - Valentina Giorgio
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence to: Antonio Giorgio, Tortorella Clinical Hospital, Salerno 80131, Italy. Tel: +39-081-248-3198, E-mail:
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Giorgio A, Montesarchio L, Gatti P, Amendola F, Matteucci P, Santoro B, Merola MG, Merola F, Coppola C, Giorgio V. Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance. J Gastrointestin Liver Dis 2017; 25:205-11. [PMID: 27308652 DOI: 10.15403/jgld.2014.1121.252.chu] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up. METHODS From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions. RESULTS The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%). CONCLUSIONS CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.
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Affiliation(s)
- Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
| | - Luca Montesarchio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Piero Gatti
- Department of Oncology, University Hospital of Bari, Bari, Italy
| | - Ferdinando Amendola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Paolo Matteucci
- Radiotherapy and Oncology Department, Campus Biomedico University, Rome, Italy
| | - Bruno Santoro
- Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | | | - Francesca Merola
- Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | - Carmine Coppola
- Hepatology and Interventional US Unit, Gragnano Hospital, Gragnano, Italy
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Giorgio A, Merola MG, Montesarchio L, Merola F, Santoro B, Coppola C, Gatti P, Amendola F, DI Sarno A, Calvanese A, Matteucci P, Giorgio V. Sorafenib Combined with Radio-frequency Ablation Compared with Sorafenib Alone in Treatment of Hepatocellular Carcinoma Invading Portal Vein: A Western Randomized Controlled Trial. Anticancer Res 2017; 36:6179-6183. [PMID: 27793949 DOI: 10.21873/anticanres.11211] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022]
Abstract
AIM To compare in a randomized controlled trial (RCT) 3-year survival of cirrhotic patients with hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT) treated with sorafenib plus percutaneous radiofrequency ablation (RFA) of both intraparenchymal HCC and PVTT (combination Group) or sorafenib alone (sorafenib-alone Group). PATIENTS AND METHODS Ninety-nine consecutive Child A cirrhotics were randomized to receive RFA of both HCC and main portal vein tumor thrombus (MPVTT) plus sorafenib (n=49) or sorafenib alone (n=50). RESULTS One-, 2- and 3-year survival rates were 60%, 35% and 26%, respectively, in the combination group and 37% and 0 % at 1- and 2-year, respectively, in the sorafenib alone group. At multivariate analysis, the combination of RFA of both HCC and MPVTT was the only factor predicting survival. CONCLUSION Use of RFA of both HCC and MPVTT plus sorafenib significantly increases 3-year survival compared to sorafenib alone.
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Affiliation(s)
- Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy .,Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | | | - Luca Montesarchio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Francesca Merola
- Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | - Bruno Santoro
- Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | | | - Pietro Gatti
- Internal Medicine Unit, Ostuni Hospital, Brindisi, Italy
| | - Ferdinando Amendola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | | | - Andrea Calvanese
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Paolo Matteucci
- Radiotherapy and Oncology Department, Campus Biomedico University, Rome, Italy
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