• Factor V deficiency
• Hepatocellular carcinoma
• Laparoscopic hepatectomy

• Hepatocellular carcinoma
• microvascular invasion
• recurrent
• survival
• treatment

To evaluate whether the pretreatment apparent diffusion coefficient (ADC) measured with diffusion weighted imaging (DWI) of tumor can be used as an imaging biomarker for predicting prognosis in solitary large hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization (TACE) immediately combined with radiofrequency ablation (RFA).

In this single institution retrospective study, 40 solitary large HCCs that underwent treatment with TACE immediately combined with RFA were analyzed. All patients underwent abdominal dynamic contrast-enhanced magnetic resonance imaging within one month before treatment with DWI, and ADC values in the lesions were measured by two independent radiologists. Associations among patients’ preoperative ADC values and objective response (OR), progression-free survival (PFS) and overall survival (OS) were examined. Survival curves were drawn with the Kaplan–Meier method, and differences were determined with the Log rank test. The Cox proportional-hazards model was used for univariate and multivariate analyses of PFS and OS.

Forty solitary large HCCs (mean 9.54 cm, range 5.04–16.06 cm) were successfully treated with TACE in immediate combination with RFA (OR 75%). The ADC values were significantly higher in the response group than the non-response group (1.51±0.32×10⁻³ mm²/s vs 1.09±0.17×10⁻³ mm²/s; P<0.001). As predicted on the basis of the ADC values, the optimal cutoff value for the efficacy of TACE combined with RFA was 1.32×10⁻³ mm²/s, with a predictive sensitivity of 0.63 and a specificity of 1.00. Patients with high ADC had longer PFS than those with low ADC (14.9 months vs 5.3 months; P<0.001) and had significantly longer survival rates (22.6 months vs 12.1 months; P=0.004).

Preoperative ADC values <1.32×10⁻³ mm²/s are an independent predictor of poorer prognosis in patients with solitary large HCCs who have undergone TACE immediately combined with RFA.

• TACE
• apparent diffusion coefficient
• radiofrequency ablation
• solitary large hepatocellular carcinoma

This study aimed to compare the efficacy between bipolar radiofrequency ablation (RFA), using twin internally cooled wet (TICW) electrodes, and switching monopolar RFA, using separable clustered (SC) electrodes, in the treatment of recurrent hepatocellular carcinoma (HCC) after locoregional treatment.

In this single-center, two-arm, parallel-group, randomized controlled study, we performed a 1:1 random allocation on eligible patients with recurrent HCC after locoregional treatment, to receive TICW-RFA or SC-RFA. The primary endpoint was the minimum diameter of the ablation zone per unit ablation time. Secondary endpoints included other technical parameters, complication rate, technical success and technique efficacy, and clinical outcomes.

Enrolled patients were randomly assigned to the TICW-RFA group (n = 40) or SC-RFA group (n = 37). The two groups did not show significant differences in the primary endpoint, the minimum diameter of the ablation zone per unit ablation time was 2.71 ± 0.98 mm/min and 2.61 ± 0.96 mm/min in the TICW-RFA and SC-RFA groups, respectively (p = 0.577). Total RF energy delivery (11.75 ± 9.04 kcal vs. 22.61 ± 12.98 kcal, p < 0.001) and energy delivery per unit time (0.81 ± 0.49 kcal/min vs. 1.45 ± 0.42 kcal/min, p < 0.001) of the TICW-RFA group were less than those of the SC-RFA group. No procedure-related death or major complications occurred. Technical success was achieved in all patients in both groups, and technique efficacy rates were 100% (46/46) in the TICW-RFA group and 95.0% (38/40) in the SC-RFA group (p = 0.213). The 1-year and 2-year cumulative LTP rates were 11.8% and 24.2%, respectively, in the TICW-RFA group, and 8.6% and 18.1%, respectively, in the SC-RFA group (p = 0.661).

In this single-center randomized controlled study from a Korean tertiary referral hospital, TICW-RFA demonstrated similar therapeutic efficacy and safety profile for recurrent HCC after locoregional treatment compared with SC-RFA.

ClinicalTrials.gov (NCT03806218)

• C-arm cone-beam CT
• Large hepatocellular carcinoma
• MIYABI Angio-CT
• Radiofrequency ablation
• Transcatheter arterial chemoembolization

• Hepatocellular carcinoma
• Radiofrequency ablation
• Randomized controlled trial

• Ablative therapies
• cholangiocarcinoma (CCA)
• hepatocellular carcinoma (HCC)
• photodynamic therapy (PDT)
• radiofrequency ablation (RFA)

• Computed tomography-guided
• Hepatocellular carcinoma
• Recurrent
• Residual
• Transarterial embolization

• Hepatocellular carcinoma
• Radiofrequency ablation
• Safety
• Transarterial chemoembolization

Presented here is the clinical course of a 63-year-old patient with a central, large and unresectable hepatocellular carcinoma (HCC) with liver metastases and tumor invasion of the portal and hepatic veins. After the tumor had been diagnosed, the patient was immediately treated with proton beam therapy (PBT), at a total dose of 60 Gy (relative biological effectiveness) in 20 fractions administered within 4 wk. To manage the respiratory movements, at the Rinecker Proton Therapy Center, apneic oxygenation was given daily, under general anesthesia. The patient tolerated both the PBT and general anesthesia very well, and did now show any signs of acute or late toxicity. The treatment was followed by constant reductions in the tumor marker alpha-fetoprotein and the cholestatic parameters gamma-glutamyltransferase and alkaline phosphatase. The patient commenced an adjuvant treatment with sorafenib, given at 6-wk intervals, after the PBT. Follow-up with regular magnetic resonance imaging has continued for 40 mo so far, demonstrating remarkable shrinkage of the HCC (maximal diameter dropping from approximately 13 cm to 2 cm). To date, the patient remains free of tumor recurrence. PBT served as a safe and effective treatment method for an unresectable HCC with vascular invasion.

• Particle therapy
• Proton beam therapy
• Apneic oxygenation
• Unresectable
• Vascular invasion
• Hepatocellular carcinoma
• Intrahepatic metastasis

This study aimed to explore the efficacy and safety of drug-eluting bead (DEB) embolization (DEB-TACE) when combined with cryoablation in the treatment of unresectable hepatocellular carcinoma (HCC). The study was a single-center randomized controlled trial comprised of 60 patients with HCC conducted between August 2015 and October 2017. The patients were randomly divided into two groups: DEB-TACE combined with cryoablation (DEB-TACE-Cryo group) or cryoablation alone (Cryo group). Inter-group differences in overall survival, progression-free survival, and adverse reactions were assessed. The operative success rates were 82.7% and 77.4% in the DEB-TACE-Cryo group and Cryo group, respectively, with no operative mortality. The overall survival and progression-free survival in the DEB-TACE-Cryo group were significantly higher than those in the Cryo group (16.8 months vs.13.4 months, P = 0.0493; 8.1 months vs. 6.0 months, P = 0.0089, respectively). The postoperative complications in the two groups were rated as grade 1 or grade 2, according to guidelines set by the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 (CTCAE V4.0). We demonstrated that DEB-TACE combined with cryoablation was effective, well tolerated, and had a low complication rate. Therefore, this combination therapy may be a better choice for the treatment of unresectable hepatocellular carcinoma.

• cryoablation
• doxorubicin
• hepasphere microsphere
• hepatocellular carcinoma
• transarterial chemoembolization

To retrospectively compare the outcome of chemolipiodolization with or without embolization in transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in Patients with hepatocellular carcinoma (HCC) within the Milan criteria. From August 2002 to December 2014, 112 patients (median age, 56.7 years; age range, 22–80 years; 97 men, 15 women) underwent TACE with gelatin sponge particle embolization, and 125 patients (median age, 56.6 years; age range, 23–82 years; 109 men, 16 women) underwent TACE without embolization. RFA was performed within 2 weeks after the TACE. Cumulative overall survival (OS) and disease-free survival (DFS) rates were compared before and after propensity score matching. Before matching, the 1-, 3-, and 5-year OS rate were 96%, 80%, and 62% for embolization group and 94%, 76%, and 59% for non-embolization group. The 1-, 3-, and 5-year DFS rate were 77%, 38%, and 30% for embolization group and 75%, 35%, and 26% for non-embolization group. After matching, the 1-, 3-, and 5-year OS rate were 97%, 82%, and 62% for embolization group and 92%, 74%, and 56% for non-embolization group. The 1-, 3-, and 5-year DFS rate were 79%, 36%, and 30% for embolization group and 74%, 33%, and 26% for non-embolization group. There were no significant difference in OS and DFS rates between the two groups before matching (P =0.999 and P =0.654) and after matching (P =0.951 and P =0.670). In conclusion, embolization in TACE combined with RFA could not improve the survival for patients with HCC within the Milan criteria.

• Milan criteria
• hepatocellular carcinoma
• propensity score matching analysis
• radiofrequency ablation
• transcatheter arterial chemoembolization

• Biomarker
• FGFR3
• Infiltrative hepatocellular carcinoma
• Mutation signatures
• Whole-exome sequencing

• bipolar radiofrequency ablation
• hepatocellular carcinoma
• survival
• transarterial chemoembolization

• CT fluoroscopy
• Hepatocellular carcinoma
• Miriplatin
• Radiofrequency ablation
• Transarterial injection

• Colorectal cancer
• HCC
• Hepatocellular carcinoma
• Microwave
• Neuroendocrine cancer
• Radiofrequency
• Tumor ablation

• evidence-based review
• hepatocellular carcinoma (HCC)
• transarterial chemoembolization (TACE)

To retrospectively evaluate the safety and efficacy of ultrasound-guided percutaneous microwave ablation (MWA) combined with simultaneous transarterial chemoembolization (TACE) in the treatment of patients with advanced intrahepatic cholangiocarcinoma (ICC).

All patients treated with ultrasound-guided percutaneous MWA combined with simultaneous TACE for advanced ICC at our institution were included. Posttreatment contrast-enhanced computed tomography and/or magnetic resonance imaging were retrieved and reviewed for tumor response to the treatment. Routine laboratory studies, including hematology and liver function tests were collected and analyzed. Procedure-related complications were reviewed and survival rates were analyzed.

From January 2011 to December 2014, a total of 26 advanced ICC patients were treated at our single institute with ultrasound-guided percutaneous MWA combined with simultaneous TACE. There were 15 males and eleven females with an average age of 57.9±10.4 years (range, 43–75 years). Of 26 patients, 20 (76.9%) patients were newly diagnosed advanced ICC without any treatment, and six (23.1%) were recurrent and treated with surgical resection of the original tumor. The complete ablation rate was 92.3% (36/39 lesions) for advanced ICC. There were no major complications observed. There was no death directly from the treatment. Median progression-free survival and overall survival were 6.2 and 19.5 months, respectively. The 6-, 12-, and 24-month survival rates were 88.5%, 69.2%, and 61.5%, respectively.

The study suggests that ultrasound-guided percutaneous MWA combined with simultaneous TACE therapy can be performed safely in all patients with advanced ICC. The complete ablation rate was high and there was no major complication. The overall 24-month survival was 61.5%.

• interventional radiology
• intrahepatic cholangiocarcinoma
• microwave ablation
• transarterial chemoembolization

• Combination therapy
• elastin-like polypeptide
• heat shock protein 90
• hepatocellular carcinoma
• thermal ablation

AIM: To investigate hepatic function after combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) with a short-term interval (0-2 d).

METHODS: A total of 115 patients with compensated liver cirrhosis underwent RFA combined with TACE at a time-interval of 0-2 d for the treatment of hepatocellular carcinoma (HCC) < 5.0 cm. There were 21 patients who received further hepatic directed treatment altering liver function within 12 mo after the combined therapy for HCC-recurrence, and were excluded. The remaining 94 patients who survived without HCC-recurrence were included in this retrospective study.

RESULTS: At 1 mo after treatment, Child-Pugh scores (CPs) remained unchanged in 89 of 94 patients (94.7%), and transiently increased by one-point in 5 patients (5.3%). However, the score returned to baseline score at 3 mo and was maintained until 6 mo in all patients. The baseline CPs of 8 or more was identified as a factor for transient rise of CPs after the treatment (CPs 8/9 vs 5/6/7; 21.4% vs 2.5%; P = 0.022). At 12 mo follow-up, CPs was unchanged in 90 patients (95.7%), and increased by one-point in 4 patients (4.3%). The rise of CPs at 12 mo was not statistically associated with the initial transient rise of CPs. There were procedure-related complications in 3 patients (3.2%), but the complications were resolved by medical and interventional treatments without hepatic functional sequelae.

CONCLUSION: The combined TACE and RFA with an interval of 0-2 d are safe for the management of HCC < 5 cm in cirrhotic patients.

• Child-Pugh score
• Liver cirrhosis
• Hepatocellular carcinoma
• Transcatheter arterial chemoembolization
• Radiofrequency ablation

• Aged
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation/adverse effects
• Catheter Ablation/mortality
• Chemoembolization, Therapeutic/adverse effects
• Chemoembolization, Therapeutic/mortality
• Chemotherapy, Adjuvant
• Female
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Neoadjuvant Therapy/adverse effects
• Neoadjuvant Therapy/mortality
• Neoplasm Recurrence, Local
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome

• AFP, alpha feto protein
• CR, complete response
• HAIC, hepatic artery infusion chemotherapy
• HCC, hepatocellular carcinoma
• LA, laser ablation
• OLT, orthotopic liver transplant
• PD, progressive disease
• PEI, percutaneous ethanol injection
• PR, partial response
• PVT, portal vein thrombosis
• RFA, ablation
• SD, stable disease
• TACE, trans-arterial chemoembolization
• TAE, Trans-arterial embolization
• TART, trans-arterial radiotherapy
• drug eluting bead (DEB)
• hepatocellular carcinoma (HCC)
• trans-arterial chemoembolization (TACE)
• trans-arterial embolization (TAE)
• trans-arterial radiotherapy (TART)

• AFP, alpha feto protein
• CT, computed tomography
• HCC, hepatocellular carcinoma
• HR, hepatic resection
• PEI, percutaneous ethanol injection
• PLA, percutaneous local ablation
• RFA, radiofrequency ablation
• USG, ultrasonography
• hepatocellular carcinoma (HCC)
• percutaneous liver ablation (PLA)
• radiofrequency ablation (RFA)

• ablation
• chemoembolization
• combination therapy
• hepatoma
• interventional radiology

• Animals
• Catheter Ablation/methods
• Humans
• Models, Biological
• Neoplasms/surgery
• Phantoms, Imaging
• Surgery, Computer-Assisted/instrumentation
• Surgery, Computer-Assisted/methods
• Swine
• Tomography, X-Ray Computed
• Torso/diagnostic imaging
• Torso/surgery

• P41 EB015898 NIBIB NIH HHS
• R01 CA124377 NCI NIH HHS
• R01 CA138586 NCI NIH HHS
• 7R01CA124377-05 NCI NIH HHS

• Biplane fluoroscopy
• Guidance
• Hepatocellular carcinoma
• Liver
• Radiofrequency ablation
• Transcatheter arterial chemoembolization, iodized oil
• Ultrasonography