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Zhang YJ, Chen J, Zhou Z, Hu D, Wang J, Pan Y, Fu Y, Hu Z, Xu L, Chen MS. Transarterial Chemoembolization with Radiofrequency Ablation versus Surgical Resection for Small Late-Recurrence Hepatocellular Carcinoma. Radiology 2025; 314:e241096. [PMID: 39903071 DOI: 10.1148/radiol.241096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Abstract
Background Radiofrequency ablation (RFA) has comparable clinical outcomes to surgical resection (SR) for treating small recurrent hepatocellular carcinoma (HCC). However, whether combined transarterial chemoembolization (TACE) with RFA (hereafter, TACE-RFA) outperforms SR for treating small late-recurrence HCCs remains unknown. Purpose To compare the clinical outcome of TACE-RFA with that of SR in patients with small late-recurrence HCCs. Materials and Methods This randomized clinical trial recruited patients between July 2013 and March 2019. Patients with small late-recurrence HCCs (a single recurrent HCC nodule [≤ 5 cm in diameter] or three or fewer nodules [each ≤ 3 cm in diameter] and recurrence at least 12 months after radical therapy of primary HCC) were randomly assigned to receive TACE-RFA or SR. The primary end point was overall survival (OS). The secondary end points included recurrence-free survival (RFS) and the incidence of complications. OS and RFS were assessed using the Kaplan-Meier method and log-rank test. Results In the intention-to-treat analysis, 210 patients (mean age, 52 years ± 12 [SD]; 194 male) were included, with 105 patients in each group. The 1-, 3-, and 5-year OS rates were 99%, 81%, and 69%, respectively, in the TACE-RFA group and 96%, 81%, and 76%, respectively, in the SR group (hazard ratio [HR], 1.34; 95% CI: 0.81, 2.23; P = .26). The 1-, 3-, and 5-year RFS rates were 71%, 38%, and 24%, respectively, in the TACE-RFA group and 73%, 43%, and 29%, respectively, in the SR group (HR, 1.05; 95% CI: 0.76, 1.45; P = .78). The incidence of complications was greater in the SR group than in the TACE-RFA group (41% [43 of 104] vs 24% [23 of 96]; P = .01). Conclusion For patients with small late-recurrence HCCs, TACE-RFA did not yield better survival outcomes than SR. However, the incidence of complications was lower in patients who received TACE-RFA therapy. ClinicalTrials.gov Identifier: NCT01833286 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Ronot in this issue.
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Affiliation(s)
- Yao-Jun Zhang
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Jinbin Chen
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Zhongguo Zhou
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Dandan Hu
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Juncheng Wang
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Yangxun Pan
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Yizhen Fu
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Zili Hu
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Li Xu
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
| | - Min-Shan Chen
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd East, Guangzhou, Guangdong 510060, China
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Xia X, Li Y, Huang R, Wang Y, Xiong W, Zhou H, Li M, Lin X, Tang Y, Zhang B. A Lipiodol Pickering Emulsion Stabilized by Iron-Doped Carbon Nanozymes for Liver Transarterial Chemoembolization. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2025; 12:e2410873. [PMID: 39656891 PMCID: PMC11791992 DOI: 10.1002/advs.202410873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 11/04/2024] [Indexed: 12/17/2024]
Abstract
Transarterial chemoembolization (TACE) utilizing a water-in-oil lipiodol emulsion is a preferable therapeutic strategy for advanced liver cancer in clinical practice. However, the low stability of the lipiodol emulsion and poor efficacy of chemotherapeutic drug seriously undermine the efficiency of TACE. Herein, a novel lobaplatin-loaded lipiodol emulsion (denoted as ICN-LPE) is developed by constructing a lipiodol Pickering emulsion (LPE) stabilized with iron-doped carbon nanozymes (ICN) to mitigate the issue of lipiodol-water separation. This novel emulsion not only solves the instability of conventional lipiodol emulsions, but also facilitates the sustained release of lobaplatin. More importantly, upon entry into tumor cells, ICN catalyze the generation of reactive oxygen species via the Fenton-like reaction while simultaneously consuming intracellular glutathione, thereby inducing tumor cell death via chemodynamic therapy. By integrating chemotherapy and chemodynamic therapy, ICN-LPE demonstrates a synergistic antitumor effect and effectively inhibits tumor growth in a rabbit liver tumor model. Therefore, our ICN-LPE shows an appealing clinical application prospect for TACE.
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Affiliation(s)
- Xiancheng Xia
- Department of Interventional CenterBiomedical Innovation CenterThe Sixth Affiliated HospitalSun Yat‐Sen UniversityGuangzhou510655P. R. China
| | - Yang Li
- The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033P. R. China
| | - Rongkang Huang
- Department of General Surgery (Colorectal Surgery)Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesBiomedical Innovation CenterThe Sixth Affiliated HospitalSun Yat‐Sen UniversityGuangzhou510655P. R. China
| | - Yuanbin Wang
- Department of General Surgery (Colorectal Surgery)Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesBiomedical Innovation CenterThe Sixth Affiliated HospitalSun Yat‐Sen UniversityGuangzhou510655P. R. China
| | - Wenxuan Xiong
- Department of General Surgery (Colorectal Surgery)Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesBiomedical Innovation CenterThe Sixth Affiliated HospitalSun Yat‐Sen UniversityGuangzhou510655P. R. China
| | - Hui Zhou
- PCFM LabSchool of ChemistrySun Yat‐sen UniversityGuangzhou510006P. R. China
| | - Min Li
- Department of Gastrointestinal SurgeryThe Affiliated Dongguan Songshan Lake Central HospitalGuangdong Medical UniversityDongguan523326P. R. China
| | - Xidong Lin
- Future Technology SchoolShenzhen Technology UniversityShenzhen518118P. R. China
| | - Youchen Tang
- The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033P. R. China
| | - Bo Zhang
- Department of Interventional CenterBiomedical Innovation CenterThe Sixth Affiliated HospitalSun Yat‐Sen UniversityGuangzhou510655P. R. China
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Sugimoto K, Imajo K, Kuroda H, Murohisa G, Shiozawa K, Sakamaki K, Wada T, Takeuchi H, Endo K, Abe T, Matsui T, Murakami T, Yoneda M, Nakajima A, Kokubu S, Itoi T. Microwave ablation vs. single-needle radiofrequency ablation for the treatment of HCC up to 4 cm: A randomized-controlled trial. JHEP Rep 2025; 7:101269. [PMID: 39802807 PMCID: PMC11719385 DOI: 10.1016/j.jhepr.2024.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 10/25/2024] [Accepted: 11/04/2024] [Indexed: 01/16/2025] Open
Abstract
Background & Aims Radiofrequency ablation (RFA) is the standard treatment for small hepatocellular carcinoma (HCC), specifically for tumors <3 cm in size and numbering fewer than three, excluding surgical candidates. Microwave ablation (MWA) is an innovative approach believed to have theoretical benefits over RFA; however, these advantages are yet to be empirically verified. Therefore, we evaluated and compared the effectiveness of MWA and RFA in managing HCC tumors up to 4 cm in size. Methods In this multicenter randomized controlled trial conducted across five centers in Japan, eligible participants had up to 4 tumors, each up to 4 cm in size, and were not considered for surgery. Patients were randomly assigned to undergo MWA or RFA. The primary outcome was the rate of local tumor progression (LTP), whereas secondary outcomes included overall survival (OS) and intra- and extrahepatic recurrence-free survival (RFS) at the end of the 2-year follow up. Results In total, 240 participants were screened from July 12, 2018, to December 7, 2021. Four participants were excluded: three did not meet inclusion criteria, and one died from an unknown cause during treatment. Consequently, 119 (130 lesions) and 117 (136 lesions) participants were treated with MWA and RFA, respectively. The proportion of lesions with LTP at the 2-year follow up was significantly lower in the MWA group (20 [16.4%] lesions) than in the RFA group (38 [30.4%] lesions) (risk ratio, 0.54; p = 0.007). OS and both intra- and extrahepatic RFS did not significantly differ between groups. Conclusions MWA is more effective than RFA in reducing local tumor progression for HCC tumors up to 4 cm. However, no differences were observed in OS and RFS. Impact and implications While some randomized control trials (RCTs) have compared the efficacy of microwave ablation (MWA) and radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC), the superiority of MWA over RFA remains unverified despite its theoretical benefit. This study is the first to demonstrate the utility of MWA over single-needle RFA for patients with HCC, with a significant difference between the two groups in the proportion of lesions with local tumor progression after a 2-year follow up. Moreover, the two techniques were safe, with only two severe complications reported in the entire study cohort. Given that an RCT differs slightly from daily clinical situations, practical and anatomical criteria for selecting the optimal technique on a lesion-by-lesion basis are required.
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Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kento Imajo
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Hidekatsu Kuroda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Go Murohisa
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Kazue Shiozawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kentaro Sakamaki
- Faculty of Health Data Science, Juntendo University, Tokyo, Japan
| | - Takuya Wada
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hirohito Takeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kei Endo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Tamami Abe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takashi Matsui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takahiro Murakami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masato Yoneda
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Shigehiro Kokubu
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Lee CH, You GR, Jo HG, Jun CH, Cho EY, Kim IH, Choi SK, Yoon JH. Albumin-Bilirubin Grade as a Valuable Predictor of Recurrence and Prognosis in Patients with Hepatocellular Carcinoma Following Radiofrequency Ablation. Cancers (Basel) 2024; 16:4167. [PMID: 39766066 PMCID: PMC11674869 DOI: 10.3390/cancers16244167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 12/11/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025] Open
Abstract
Background/Objectives: Radiofrequency ablation (RFA) is an important local treatment for hepatocellular carcinoma (HCC). This study aimed to evaluate the characteristics of tumor recurrence after RFA and analyze predictors of tumor recurrence and survival in patients with HCC. Methods: We retrospectively reviewed data from treatment-naïve patients with HCC who underwent RFA for HCC treatment between 2008 and 2017 at four tertiary hospitals in South Korea. Results: A total of 636 patients with HCC treated with RFA were enrolled in the study. The mean age was 66.3 ± 10.4 years, with 75.0% of patients being male. Most patients (96.7%) had underlying liver cirrhosis, and viral hepatitis (types B and C) accounted for most cases. The average maximum tumor size was 2.2 ± 0.9 cm, with 84.3% of tumors being single lesions. During the follow-up period, 331 patients experienced recurrence, with 95.5% of cases being intrahepatic and one-fifth occurring at the RFA site. Most patients underwent RFA or transarterial chemoembolization as subsequent therapy for recurrence. Multivariate analysis revealed that age, the albumin-bilirubin (ALBI) grade, and Child-Pugh class B status were independent factors associated with tumor recurrence. Only the ALBI grade was significantly associated with mortality. Additionally, the ALBI grade differentiated between recurrence-free survival and overall survival in the Kaplan-Meier survival curve. Conclusions: The ALBI grade was independently associated with tumor recurrence and prognosis in patients with HCC following RFA. This grading system can help clinicians identify high-risk patients, optimize treatment strategies, and enhance patient care.
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Affiliation(s)
- Chang Hun Lee
- Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea; (C.H.L.); (I.H.K.)
| | - Ga Ram You
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun 58128, Republic of Korea;
| | - Hoon Gil Jo
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan 54538, Republic of Korea; (H.G.J.); (E.Y.C.)
| | - Chung Hwan Jun
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea; (C.H.J.); (S.K.C.)
| | - Eun Young Cho
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan 54538, Republic of Korea; (H.G.J.); (E.Y.C.)
| | - In Hee Kim
- Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea; (C.H.L.); (I.H.K.)
| | - Sung Kyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea; (C.H.J.); (S.K.C.)
| | - Jae Hyun Yoon
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea; (C.H.J.); (S.K.C.)
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Varin E, Beunon P, N'Kontchou G, Petit A, Pescatori LC, Ganne-Carrié N, Nault JC, Seror O, Sutter O. Incidence and clinical impact of bile ducts changes after multibipolar radiofrequency ablation for hepatocellular carcinoma. Eur Radiol 2024; 34:5529-5540. [PMID: 38334763 DOI: 10.1007/s00330-024-10617-7] [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: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES This study aimed to evaluate the incidence and clinical implications of bile duct changes following multibipolar radiofrequency ablation (mbpRFA) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Radiological, clinical, and biological data from consecutive cirrhotic patients who underwent first-line mbpRFA between 2007 and 2014 for uninodular HCC ≤ 5 cm were retrospectively collected. Follow-up imaging was reviewed to identify bile duct changes and factors associated with biliary changes were assessed using multivariable analysis. Baseline and 6-month liver function tests were compared in patients with and without bile duct changes. Complications, cirrhosis decompensation, and survival rates were compared in both groups. RESULTS A total of 231 patients (mean age 68 years [39-85], 187 men) underwent 266 mbpRFA sessions for uninodular HCC (mean size 26 mm). Of these, 76 (33%) developed bile duct changes (upstream bile duct dilatations and/or bilomas) with a mean onset time of 3 months. Identified risk factors for these changes were the infiltrative aspect of the tumor (p = 0.035) and its location in segment VIII (p < 0.01). The average increase in bilirubin at 6 months was higher in the group with biliary changes (+2.9 vs. +0.4 µg/mL; p = 0.03). There were no significant differences in terms of complications, cirrhosis decompensation at 1 year (p = 0.95), local and distant tumor progression (p = 0.91 and 0.14 respectively), and overall survival (p = 0.4) between the two groups. CONCLUSION Bile duct changes are common after mbpRFA for HCC, especially in tumors with an infiltrative aspect or those located in segment VIII. These changes do not appear to negatively impact the course of cirrhosis at 1 year or overall survival. CLINICAL RELEVANCE STATEMENT Bile duct changes following mbpRFA for HCC are relatively common. Nevertheless, they do not raise clinical concerns in terms of complications, deterioration in liver function, or survival rates. Consequently, specific monitoring or interventions for these bile duct changes are not warranted. KEY POINTS • Bile duct changes are frequently observed after multibipolar radiofrequency ablation for hepatocellular carcinoma, occurring in 33% of cases in our study. • Patients with bile duct changes exhibited a higher increase in bilirubin levels at 6 months but no more cirrhosis decompensation or liver abscesses. • Biliary changes following multibipolar radiofrequency ablation for hepatocellular carcinoma are not alarming and do not necessitate any specific monitoring or intervention.
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Affiliation(s)
- Eloi Varin
- Interventional Radiology Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
| | - Paul Beunon
- Interventional Radiology Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
| | - Gisèle N'Kontchou
- Liver Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
| | - Arthur Petit
- Interventional Radiology Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
| | - Lorenzo-Carlo Pescatori
- Interventional Radiology Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Nathalie Ganne-Carrié
- Liver Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
- Centre de recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, F-75006, Paris, France
| | - Jean-Charles Nault
- Liver Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
- Centre de recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, F-75006, Paris, France
| | - Olivier Seror
- Interventional Radiology Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
- Centre de recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, F-75006, Paris, France
| | - Olivier Sutter
- Interventional Radiology Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France.
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Boros C, Sutter O, Cauchy F, Ganne-Carrié N, Nahon P, N'kontchou G, Ziol M, Grando V, Demory A, Blaise L, Dondero F, Durand F, Soubrane O, Lesurtel M, Laurent A, Seror O, Nault JC. Upfront multi-bipolar radiofrequency ablation for HCC in transplant-eligible cirrhotic patients with salvage transplantation in case of recurrence. Liver Int 2024; 44:1464-1473. [PMID: 38581233 DOI: 10.1111/liv.15900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/13/2024] [Accepted: 03/04/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION We aim to assess the long-term outcomes of percutaneous multi-bipolar radiofrequency (mbpRFA) as the first treatment for hepatocellular carcinoma (HCC) in transplant-eligible cirrhotic patients, followed by salvage transplantation for intrahepatic distant tumour recurrence or liver failure. MATERIALS AND METHODS We included transplant-eligible patients with cirrhosis and a first diagnosis of HCC within Milan criteria treated by upfront mbp RFA. Transplantability was defined by age <70 years, social support, absence of significant comorbidities, no active alcohol use and no recent extrahepatic cancer. Baseline variables were correlated with outcomes using the Kaplan-Meier and Cox models. RESULTS Among 435 patients with HCC, 172 were considered as transplantable with HCCs >2 cm (53%), uninodular (87%) and AFP >100 ng/mL (13%). Median overall survival was 87 months, with 75% of patients alive at 3 years, 61% at 5 years and 43% at 10 years. Age (p = .003) and MELD>10 (p = .01) were associated with the risk of death. Recurrence occurred in 118 patients within Milan criteria in 81% of cases. Local recurrence was observed in 24.5% of cases at 10 years and distant recurrence rates were observed in 69% at 10 years. After local recurrence, 69% of patients were still alive at 10 years. At the first tumour recurrence, 75 patients (65%) were considered transplantable. Forty-one patients underwent transplantation, mainly for distant intrahepatic tumour recurrence. The overall 5-year survival post-transplantation was 72%, with a tumour recurrence of 2.4%. CONCLUSION Upfront multi-bipolar RFA for a first diagnosis of early HCC on cirrhosis coupled with salvage liver transplantation had a favourable intention-to-treat long-term prognosis, allowing for spare grafts.
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Affiliation(s)
- Carina Boros
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Olivier Sutter
- Interventional Radiology Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - François Cauchy
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, University of Geneva, Geneva, Switzerland
| | - Nathalie Ganne-Carrié
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| | - Pierre Nahon
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| | - Gisele N'kontchou
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Marianne Ziol
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
- Pathology Department, and Centre de ressources biologiques (BB-0033-00027) Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, APHP, Université Paris Norr, Bobigny, France
| | - Véronique Grando
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Alix Demory
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Lorraine Blaise
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Fédérica Dondero
- Department of HPB Surgery and Liver Transplantation, APHP, Beaujon Hospital-University of Paris Cité, Paris, France
| | - François Durand
- Liver Unit, Beaujon Hospital, APHP, Beaujon Hospital-University of Paris Cité, Paris, France
| | - Olivier Soubrane
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, APHP, Beaujon Hospital-University of Paris Cité, Paris, France
| | - Alexis Laurent
- Department of Digestive Surgery, Assistance Publique - Hôpitaux de Paris, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, Créteil, France
| | - Oliver Seror
- Interventional Radiology Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| | - Jean Charles Nault
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
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Alitti C, Rode A, Trillaud H, Merle P, Blanc JF, Blaise L, Demory A, Nkontchou G, Grando V, Ziol M, Nahon P, Ganne-Carrié N, Petit A, Seror O, Sutter O, Nault JC. Long-term oncological results of percutaneous radiofrequency ablation for intrahepatic cholangiocarcinoma. Liver Int 2024; 44:1363-1372. [PMID: 38436538 DOI: 10.1111/liv.15886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/01/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The effectiveness of percutaneous radiofrequency ablation (RFA) in intrahepatic cholangiocarcinomas (iCCA) remains insufficiently studied. METHODS We conducted a retrospective study including patients with histologically proven iCCA within Milan criteria treated by percutaneous RFA from 2000 to 2022. The primary outcome was overall survival in treatment-naive patients and secondary outcomes included ablation completeness, adverse events, local and distant recurrence. A total of 494 patients with hepatocellular carcinoma (HCC) on cirrhosis treated by RFA were included as a comparison group. Oncological events were analysed using Kaplan-Meier, log-rank and univariate/multivariate Cox models. RESULTS The main population included 71 patients, mostly cirrhotic (80%) with solitary tumours (66%) of a median size of 24 mm. Local recurrence was 45% at 5 years, lower in multibipolar versus monopolar RFA (22% vs. 55%, p = .007). In treatment-naive patients (n = 45), median overall and recurrence-free survivals were 26 and 11 months, respectively. Tumour size (p = .01) and Child-Pugh B (p = .001) were associated with death. The rate of distant recurrence was 59% at 5 years significantly lower for single tumours of less than 2 (p = .002) or 3 cm (p = .02). In cirrhotic patients naïve of previous treatment (n = 40), overall survival was shorter than in HCC (26 vs 68 months, p < .0001), with more local recurrences (p < .0001). Among distant recurrences, 50% were extrahepatic metastases compared to 12% in HCC (p < .001). CONCLUSION Multibipolar RFA provides better results in terms of tumour recurrence than monopolar RFA and could be used to treat small iCCA (<3 cm). Adjuvant chemotherapy should be discussed due to the frequent extra-hepatic metastasis at recurrence.
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Affiliation(s)
- Clémentine Alitti
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Agnès Rode
- Department of Radiology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Hervé Trillaud
- Department of Diagnostic and Interventional Radiology, University Hospital Bordeaux, Pessac, France
| | - Philippe Merle
- Cancer Research Center of Lyon (CRCL), INSERM U1052, Centre National de la Recherche Scientifique UMR5286, Lyon, France
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Lorraine Blaise
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Alix Demory
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Gisele Nkontchou
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Véronique Grando
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
| | - Marianne Ziol
- Pathology Department and Centre de Resources Biologiques (BB-0033-00027) Hôpitaux Universitaires Paris-Seine-Saint-Denis Avicenne Avicenne Hospital, APHP, Bobigny, France
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team «Functional Genomics of Solid Tumors», Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| | - Pierre Nahon
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team «Functional Genomics of Solid Tumors», Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| | - Nathalie Ganne-Carrié
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team «Functional Genomics of Solid Tumors», Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| | - Arthur Petit
- Interventional Radiology Unit, Avicenne Hospital, APHP, Bobigny, France
| | - Olivier Seror
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team «Functional Genomics of Solid Tumors», Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
- Interventional Radiology Unit, Avicenne Hospital, APHP, Bobigny, France
| | - Olivier Sutter
- Interventional Radiology Unit, Avicenne Hospital, APHP, Bobigny, France
| | - Jean-Charles Nault
- Liver Unit, Avicenne Hospital, APHP, Paris Nord University, Bobigny, France
- Cordeliers Research Center, Sorbonne Université, Inserm, Université de Paris, Team «Functional Genomics of Solid Tumors», Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
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Hong SJ, Kim JH, Yoon JH, Park JH, Yoon JH, Kim YJ, Yu SJ, Cho EJ, Lee JM. No-Touch Radiofrequency Ablation Using Twin Cooled Wet Electrodes for Recurrent Hepatocellular Carcinoma Following Locoregional Treatments. Korean J Radiol 2024; 25:438-448. [PMID: 38685734 PMCID: PMC11058422 DOI: 10.3348/kjr.2023.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To evaluate the therapeutic outcomes of no-touch radiofrequency ablation (NT-RFA) using twin cooled wet (TCW) electrodes in patients experiencing recurrent hepatocellular carcinoma (HCC) after undergoing locoregional treatments. MATERIALS AND METHODS We conducted a prospective, single-arm study of NT-RFA involving 102 patients, with a total of 112 recurrent HCCs (each ≤ 3 cm). NT-RFA with TCW electrodes was implemented under the guidance of ultrasonography (US)-MR/CT fusion imaging. If NT-RFA application proved technically challenging, conversion to conventional tumor puncture RFA was permitted. The primary metric for evaluation was the mid-term cumulative incidence of local tumor progression (LTP) observed post-RFA. Cumulative LTP rates were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard regression was used to explore factors associated with LTP. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat (ITT; including all patients) and per-protocol (PP; including patients not requiring conversion to conventional RFA alone) analyses were performed. RESULTS Conversion from NT-RFA to conventional RFA was necessary for 24 (21.4%) out of 112 tumors. Successful treatment was noted in 111 (99.1%) out of them. No major complications were reported among the patients. According to ITT analysis, the estimated cumulative incidences of LTP were 1.9%, 6.0%, and 6.0% at 1, 2, and 3 years post-RFA, respectively. In PP analysis, the cumulative incidence of LTP was 0.0%, 1.3%, and 1.3% at 1, 2, and 3 years, respectively. The number of previous locoregional HCC treatments (adjusted hazard ratio [aHR], 1.265 per 1 treatment increase; P = 0.004), total bilirubin (aHR, 7.477 per 1 mg/dL increase; P = 0.012), and safety margin ≤ 5 mm (aHR, 9.029; P = 0.016) were independently associated with LTP in ITT analysis. CONCLUSION NT-RFA using TCW electrodes is a safe and effective treatment for recurrent HCC, with 6.0% (ITT analysis) and 1.3% (PP analysis) cumulative incidence of LTP at 2 and 3-year follow-ups.
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Affiliation(s)
- Seong Jun Hong
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hoan Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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Montalti R, Cassese G, Zidan A, Rompianesi G, Cesare Giglio M, Campanile S, Arena L, Maione M, Troisi RI. Local recurrence risk factors and outcomes in minimally invasive thermal ablation for liver tumors: a single-institution analysis. HPB (Oxford) 2024; 26:682-690. [PMID: 38342647 DOI: 10.1016/j.hpb.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/27/2023] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Minimally Invasive thermal ablation (MITA) of liver tumors is a commonly performed procedure, alone or in combination with liver resection. Despite being a first-option strategy for small lesions, it is technically demanding, and many concerns still exist about local disease control. METHODS Consecutive patients undergoing MITA from 1-2019 to 12-2022 were retrospectively enrolled. Risk factors of local recurrence were investigated through univariate and multivariable cox regression analysis. RESULTS At the multivariable analysis of the 207 nodules undergoing MITA, RFA was associated with worse local Recurrence Free Survival (lRFS) than MWA (HR 2.87 [95 % CI 0.96-8.66], p = 0.05), as well as a concomitant surgical resection (HR 3.89 [95 % CI 1.06-9.77], p = 0.02). A concomitant surgical resection showed worse lRFS in the subgroup analysis of both HCC (HR 3.98 [95 % CI 1.16-13.62], p = 0.02) and CRLM patients (HR 2.68 [95 % CI 0.66-5.92], p = 0.04). Interestingly, a tumor size between 30 and 40 mm was not associated to worse lRFS. CONCLUSION MWA may reduce the risk of local recurrence in comparison to RFA, while MITA associated to liver resection may face an increased risk of local recurrence. Further prospective studies are needed to confirm such results.
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Affiliation(s)
- Roberto Montalti
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy; Department of Public Health, Federico II University, Naples, Italy
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy.
| | - Ahmed Zidan
- Department of Surgery, Assiut University Hospital, Assiut, Egypt
| | - Gianluca Rompianesi
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Silvia Campanile
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Lorenza Arena
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Marco Maione
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
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Long Y, Zeng Q, He X, Wu Y, Ye H, Xu J, Chen J, Yuan L, Li H, Li K. Anatomical thermal ablation as an alternative to surgical resection for subcapsular hepatocellular carcinoma. Abdom Radiol (NY) 2024; 49:1144-1153. [PMID: 38289353 DOI: 10.1007/s00261-023-04150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE To simulate the advantages of anatomical resection, a new strategy of anatomical thermal ablation was proposed. The objective of this study was to evaluate the clinical value of anatomical thermal ablation (ATA) to treat subcapsular hepatocellular carcinoma by comparing it with anatomical resection (AR) and non-anatomical resection (NAR). METHODS This retrospective cohort study enrolled hepatocellular carcinoma patients with subcapsular tumor diameter ≤ 50 mm treated by ATA or surgical resection at our center from October 2015 to December 2018. ATA features ablation of the Glisson capsule, ablation of the liver parenchyma between the tumor and hepatic veins or inferior vena cava and then puncture from the surrounding part to the central part of the tumor. Outcome parameters were compared. RESULTS Seventy-six patients were grouped into ATA group, 95 patients into AR group and 41 patients into NAR group. The 1-, 2-, and 3-year local recurrence rates were 0.0%, 0.0%, 0.0% for ATA group, 0.0%, 1.4%, 1.4% for the AR group and 0.0%, 0.0%, and 0.0% for the NAR group, respectively (P = 0.449). The 1-, 2-, and 3-year progression-free survival rates were 90.6%, 80.9%, and 74.6% for ATA group, 91.5%, 80.2%, and 80.2% for the AR group and 82.9%, 73.8%, and 73.8% for the NAR group, respectively (P = 0.608). The 1-, 2-, and 3-year overall survival rates were 100.0%, 95.2%, and 95.2% for the ATA group, 96.8%, 95.6%, and 95.6% for the AR group and 97.6%, 95.0%, and 95.0% for the NAR group, respectively (P = 0.970). No difference was found in major complication rate among these groups (P = 0.091). CONCLUSION For subcapsular hepatocellular carcinoma, ATA could be an alternative to surgical resection with its comparable treatment effect and safety.
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Affiliation(s)
- Yinglin Long
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Xuqi He
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Yuxuan Wu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Huolin Ye
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Jianliang Xu
- Department of Liver Surgery, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Jianning Chen
- Department of Pathology, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Lianxiong Yuan
- Department of Science and Research, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Hua Li
- Department of Liver Surgery, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China.
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Ndhlovu E, Zhang BX, Chen XP, Zhu P. Thermal ablation for hepatic tumors in high-risk locations. Clin Res Hepatol Gastroenterol 2024; 48:102300. [PMID: 38367803 DOI: 10.1016/j.clinre.2024.102300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Thermal ablative techniques such as radiofrequency and microwave ablation are minimally invasive and cost-effective approaches that are currently being adopted as alternatives to surgical resection for primary and metastatic liver malignancies. However, they are considered to be relatively contraindicated for tumors in high-risk locations due to technical difficulties and a perceived increased risk of perioperative complications. Several techniques, including artificial ascites, non-touch multibipolar ablation, and laparoscopically assisted ablation, can be used to improve the outcomes of ablation for high-risk tumors. This review aims to provide a comprehensive summary of the techniques currently used to improve thermal ablation outcomes for high-risk liver tumors.
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Affiliation(s)
- Elijah Ndhlovu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China.
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12
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Chen JJ, Jin ZC, Zhong BY, Fan W, Zhang WH, Luo B, Wang YQ, Teng GJ, Zhu HD. Locoregional therapies for hepatocellular carcinoma: The current status and future perspectives. United European Gastroenterol J 2024; 12:226-239. [PMID: 38372444 PMCID: PMC10954431 DOI: 10.1002/ueg2.12554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/07/2024] [Indexed: 02/20/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common cancers and a leading cause of cancer-related mortality. Locoregional therapies (LRTs) play a crucial role in HCC management and are selectively adopted in real-world practice across various stages. Choosing the best form of LRTs depends on technical aspects, patient clinical status and tumour characteristics. Previous studies have consistently highlighted the efficacy of combining LRTs with molecular targeted agents in HCC treatment. Recent studies propose that integrating LRTs with immune checkpoint inhibitors and molecular targeted agents could provide substantial therapeutic benefits, a notion underpinned by both basic and clinical evidence. This review summarised the current landscape of LRTs in HCC and discussed the anticipated outcomes of combinations with immunotherapy regimens.
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Affiliation(s)
- Jian-Jian Chen
- Department of Radiology, Center of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Zhi-Cheng Jin
- Department of Radiology, Center of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Bin-Yan Zhong
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei-Hua Zhang
- Department of Radiology, Center of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Biao Luo
- Department of Radiology, Center of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yu-Qing Wang
- Department of Radiology, Center of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Gao-Jun Teng
- Department of Radiology, Center of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Hai-Dong Zhu
- Department of Radiology, Center of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Hu Q, Tian Z, Sun Y, Zhang B, Tang Z. Safety and efficacy of indocyanine green fluorescence imaging for real-time guidance of laparoscopic thermal ablation in patients with liver cancer. Int J Hyperthermia 2024; 41:2306818. [PMID: 38403276 DOI: 10.1080/02656736.2024.2306818] [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: 08/18/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 02/27/2024] Open
Abstract
PURPOSE To evaluate the safety and efficacy of indocyanine green fluorescence imaging for real-time guidance of laparoscopic thermal ablation in patients with liver cancer. MATERIALS AND METHODS A total of 27 patients with 40 liver lesions underwent fluorescence-assisted laparoscopic ablation between January 2020 to March 2023. The sensitivity of indocyanine green (ICG)-fluorescence imaging, technique effectiveness rate and complications of fluorescence-assisted laparoscopic thermal ablation were evaluated. RESULTS In total, 33 out of the 40 lesions were identified by ICG-fluorescence imaging technique, with the sensitivity of 82.5%. The sensitivity of ICG-fluorescence imaging of tumor detection in liver surface of parenchyma was significantly higher than that in the deeply located hepatic parenchyma (96.8% vs 33.3%, p = 0.002). ICG-fluorescence imaging procedures detected 4 lesions that cannot be seen on intraoperative ultrasound. It provides clear demarcation lines on the hepatic surface. Technical success is achieved if the necrotic zone had at least a 5 mm ablative margin around the outer edge of the ICG-fluorescence image. Technical success of fluorescence laparoscopic radiofrequency ablation (FLRFA) and fluorescence laparoscopic microwave ablation (FLMWA) was 100% (27/27). Technical effectiveness is defined by the complete necrotic lesions of the local tumor tissue during follow-up. According to the CT/MRI one month after FLRFA or FLMWA, the technical efficacy rate was 92.5% (37/40) and local tumor progression occurred in 7.5% (3/40) of the enrolled lesions. During the follow-up period, no major complications were observed. CONCLUSION ICG-fluorescence imaging guided laparoscopic thermal ablation was feasible, safe and effective.
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Affiliation(s)
- Qitao Hu
- Department of Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
| | - Zhou Tian
- Department of Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
| | - Yongji Sun
- Department of Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
| | - Bo Zhang
- Department of Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhe Tang
- Department of Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Hu L, Lin J, Wang A, Shi X, Qiao Y. Comparison of liver resection and radiofrequency ablation in long-term survival among patients with early-stage hepatocellular carcinoma: a meta-analysis of randomized trials and high-quality propensity score-matched studies. World J Surg Oncol 2024; 22:56. [PMID: 38369480 PMCID: PMC10875898 DOI: 10.1186/s12957-024-03330-8] [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: 11/04/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Whether radiofrequency ablation (RFA) and liver resection (LR) are comparable treatments for early-stage hepatocellular carcinoma (HCC) is controversial. We conducted this study to provide ample clinical evidence for the argument. METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched (PSM) studies that compared long-term outcomes of both RFA and LR for patients with early-stage HCC. The hazard ratios (HRs) with 95% confidence intervals (95% CI) of overall survival (OS) and disease-free survival (DFS) were calculated. RESULTS Thirty-six studies consisting of six RCTs and 30 PSM studies were included in this study, and a total of 7384 patients were involved, with 3694 patients being treated with LR and 3690 patients with RFA. Meta-analysis showed that LR provided better OS and DFS than RFA (HR: 1.22, 95% CI: 1.13-1.31; HR: 1.56, 95% CI: 1.39-1.74, respectively). A sensitivity analysis indicated that the results were stable. For the subgroup of patients with BCLC 0 stage, RFA and LR resulted in similar OS and DFS. For the subgroup of patients with single tumor sizes less than 3 cm, RFA reached similar OS (HR: 1.19, 95% CI: 0.90-1.58) but worse DFS compared with LR (HR: 1.45, 95% CI: 1.11-1.90). For the subgroup of ablation margin larger than 0.5 cm, LR still resulted in better OS than RFA (HR: 1.29, 95% CI: 1.09-1.53); while the ablation margin was larger than 1 cm, both RFA and LR resulted in similar OS. The modality of RFA was also a factor that affected results. Subgroup analysis showed that patients receiving ultrasound-guided RFA had worse OS and DFS than LR (HR: 1.24, 95% CI: 1.14-1.36; HR: 1.44, 95% CI: 1.25-1.66, respectively). CONCLUSIONS Meta-analysis showed that LR provided better OS and DFS for patients with early-stage HCC. However, RFA and LR had similar effects on long-term survival in patients with BCLC 0 stage HCC. RFA and LR probably had similar effects on OS in patients with solitary HCC less than 3 cm or when the ablation margin was larger than 1 cm which need more studies to confirm. The effects of different modalities of RFA on long-term survival are needed for further assessment.
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Affiliation(s)
- Lingbo Hu
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Taizhou Enze Medical Center (Group), Enze Hospital, Taizhou, Zhejiang, China
| | - Jiangying Lin
- Department of Blood Purification, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Aidong Wang
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Taizhou Enze Medical Center (Group), Enze Hospital, Taizhou, Zhejiang, China
| | - Xingpeng Shi
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Taizhou Enze Medical Center (Group), Enze Hospital, Taizhou, Zhejiang, China
| | - Yingli Qiao
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China.
- Department of Hepatopancreatobiliary Surgery, Taizhou Enze Medical Center (Group), Enze Hospital, Taizhou, Zhejiang, China.
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15
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Abdelhamed W, El-Kassas M. Hepatocellular carcinoma recurrence: Predictors and management. LIVER RESEARCH (BEIJING, CHINA) 2023; 7:321-332. [PMID: 39958776 PMCID: PMC11791921 DOI: 10.1016/j.livres.2023.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/14/2023] [Accepted: 11/17/2023] [Indexed: 02/18/2025]
Abstract
Hepatocellular carcinoma (HCC), the sixth most common cancer globally, is associated with high mortality rates and more than 830,000 annual deaths. Despite advances in the available management options including surgical resection and local ablative therapies, recurrence rates after the initial treatment exceed 50%, even among patients who have undergone curative-intent therapy. Moreover, postsurgical HCC recurrence occurs in about 70% of cases five years postoperatively. The management of recurrent HCC remains undefined. This review discusses different predictors for HCC recurrence after each treatment modality and different approaches available to stratify these patients. More specific guidelines for managing HCC recurrence and strict surveillance protocols for such recurrence after initial HCC management are needed.
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Affiliation(s)
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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16
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Cha DI, Lee MW, Hyun D, Ahn SH, Jeong WK, Rhim H. Combined Transarterial Chemoembolization and Radiofrequency Ablation for Hepatocellular Carcinoma Infeasible for Ultrasound-Guided Percutaneous Radiofrequency Ablation: A Comparative Study with General Ultrasound-Guided Radiofrequency Ablation Outcomes. Cancers (Basel) 2023; 15:5193. [PMID: 37958370 PMCID: PMC10650828 DOI: 10.3390/cancers15215193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/07/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the therapeutic outcomes of transarterial chemoembolization combined with radiofrequency ablation (TACE + RFA) for hepatocellular carcinomas (HCC) measuring ≤3 cm infeasible for ultrasound (US)-guided percutaneous RFA. METHODS Twenty-four patients who underwent fluoroscopy-guided TACE + RFA for single HCC between January 2012 and December 2016 were screened. To evaluate the TACE + RFA outcomes compared with those of US-guided RFA, 371 patients who underwent US-guided RFA during the same period were screened. We compared local tumor progression (LTP) and intrahepatic distant recurrence (IDR) between the two groups before and after propensity score (PS) matching, and performed univariable and multivariable Cox proportional hazard regression analyses for all patients. RESULTS PS matching yielded 21 and 42 patients in the TACE + RFA and US-guided RFA groups, respectively. Cumulative LTP rates after PS matching were not significantly different between the two groups at 1 (0.0% vs. 7.4%, p = 0.072), 2 (10.5% vs. 7.4%, p = 0.701), and 5 years (16.9% vs. 10.5%, p = 0.531). IDR rates did not differ significantly between the two groups at 1 (20.6% vs. 10%, p = 0.307), 2 (25.9% vs. 25.9%, p = 0.999), or 5 years (49.9% vs. 53%, p = 0.838). Multivariable analysis showed that treatment type was not a significant factor for LTP or IDR. CONCLUSION The outcomes of TACE + RFA for HCC were similar to those of general US-guided RFA. Fluoroscopy-guided TACE + RFA may be an effective treatment when US-guided RFA is not feasible.
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Affiliation(s)
- Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; (D.I.C.); (W.K.J.); (H.R.)
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; (D.I.C.); (W.K.J.); (H.R.)
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; (D.I.C.); (W.K.J.); (H.R.)
| | - Soo Hyun Ahn
- Department of Mathematics, Ajou University, 206 World Cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea;
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; (D.I.C.); (W.K.J.); (H.R.)
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; (D.I.C.); (W.K.J.); (H.R.)
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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17
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Shah IA, Seol HY, Cho Y, Ji W, Seo J, Lee C, Chon MK, Shin D, Kim JH, Choo KS, Park J, Kim J, Yoo H, Kim JH. Conversion of the bronchial tree into a conforming electrode to ablate the lung nodule in a porcine model. COMMUNICATIONS MEDICINE 2023; 3:129. [PMID: 37775526 PMCID: PMC10541426 DOI: 10.1038/s43856-023-00362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is one of the treatment options for lung nodules. However, the need for exact delivery of the rigid metal electrode into the center of the target mass often leads to complications or suboptimal results. To overcome these limitations, a concept of conforming electrodes using a flexible material has been tested in this study. METHODS A bronchoscopy-guided RFA (CAROL) under a temperature-controlled mode was tested in in-vivo and ex-vivo porcine lungs. Gallium-based liquid metal was used for turning the bronchial tree into temporary RF electrodes. A customized bronchoscopy-guided balloon-tipped guiding catheter (CAROL catheter) was used to make the procedure feasible under fluoroscopy imaging guidance. The computer simulation was also performed to gain further insight into the ablation results. Safety was also assessed including the liquid metal remaining in the body. RESULTS The bronchial electrode injected from the CAROL catheter was able to turn the target site bronchial air pipe into a temporally multi-tined RF electrode. The mean volume of Gallium for each effective CAROL was 0.46 ± 0.47 ml. The ablation results showed highly efficacious and consistent results, especially in the peripheral lung. Most bronchial electrodes were also retrieved by either bronchoscopic suction immediately after the procedure or by natural expectoration thereafter. The liquid metal used in these experiments did not have any significant safety issues. Computer simulation also supports these results. CONCLUSION The CAROL ablation was very effective and safe in porcine lungs showing encouraging potential to overcome the conventional approaches.
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Affiliation(s)
- Izaz Ali Shah
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Hee Yun Seol
- Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea
| | - Youngdae Cho
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaeyoung Seo
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Cheolmin Lee
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Min-Ku Chon
- Department of Cardiology, School of Medicine & Cardiovascular center, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Donghoon Shin
- Department of Pathology, School of Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Justin H Kim
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Ki-Seok Choo
- Department of Radiology, School of Medicine & Medical Research Institute, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Junhui Park
- Major of Human Bioconvergence, College of Information Technology and Convergence, Pukyong National University, Busan, Republic of Korea
| | - Juhyung Kim
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Hyoungsuk Yoo
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea.
| | - June-Hong Kim
- Department of Cardiology, School of Medicine & Cardiovascular center, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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18
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Iezzi R, Posa A, Contegiacomo A, Lee IJ, Bale R, Tanzilli A, Tenore L, Giuliante F, Gasbarrini A, Goldberg SN, Jakobs T, Pompili M, Bargellini I, Sala E, Kim HC. Early-Stage HCC Percutaneous Locoregional Management: East versus West Perspectives. Cancers (Basel) 2023; 15:3988. [PMID: 37568804 PMCID: PMC10416919 DOI: 10.3390/cancers15153988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Hepatocellular carcinoma represents an important cause of death worldwide. Early-stage hepatocellular carcinoma patients not suitable for surgery can be treated with a variety of minimally invasive locoregional interventional oncology techniques. Various guidelines in different countries address the treatment of hepatocellular carcinoma, but the actual treatment is usually discussed by a multidisciplinary tumor board in a personalized manner, leading to potential treatment differences based on Western and Eastern perspectives. The aim of this paper is to integrate literature evidence with the eminent experiences collected during a focused session at the Mediterranean Interventional Oncology (MIO) Live Congress 2023.
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Affiliation(s)
- Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
| | - Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - Andrea Contegiacomo
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Reto Bale
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | | | - Lorenzo Tenore
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - Felice Giuliante
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Hepatobiliary Surgery Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Internal Medicine and Gastroenterology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Shraga Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Tobias Jakobs
- Clinic of Interventional Radiology, Hospital Barmherzige Brueder, 93049 Munich, Germany;
| | - Maurizio Pompili
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Internal Medicine and Gastroenterology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | | | - Evis Sala
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
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19
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Han S, Lee MW, Lee YJ, Hong HP, Lee DH, Lee JM. No-Touch Radiofrequency Ablation for Early Hepatocellular Carcinoma: 2023 Korean Society of Image-Guided Tumor Ablation Guidelines. Korean J Radiol 2023; 24:719-728. [PMID: 37500573 PMCID: PMC10400366 DOI: 10.3348/kjr.2023.0423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 07/29/2023] Open
Abstract
Radiofrequency ablation (RFA) has been widely used to manage hepatocellular carcinomas (HCCs) equal to or smaller than 3 cm. No-touch RFA has gained attention and has recently been implemented in local ablation therapy for HCCs, despite its technical complexity, as it provides improved local tumor control compared to conventional tumor-puncturing RFA. This article presents the practice guidelines for performing no-touch RFA for HCCs, which have been endorsed by the Korean Society of Image-Guided Tumor Ablation (KSITA). The guidelines are primarily designed to assist interventional oncologists and address the limitations of conventional tumor-puncturing RFA with describing the fundamental principles, various energy delivery methods, and clinical outcomes of no-touch RFA. The clinical outcomes include technical feasibility, local tumor progression rates, survival outcomes, and potential complications.
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Affiliation(s)
- Seungchul Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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20
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Park J, Lee MW, Ahn SH, Han S, Min JH, Cha DI, Song KD, Kang TW, Rhim H. Treatment Outcomes of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinomas: Effects of the Electrode Type and Placement Method. Korean J Radiol 2023; 24:761-771. [PMID: 37500577 PMCID: PMC10400371 DOI: 10.3348/kjr.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/29/2023] [Accepted: 05/23/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To investigate the association among the electrode placement method, electrode type, and local tumor progression (LTP) following percutaneous radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) and to assess the risk factors for LTP. MATERIALS AND METHODS In this retrospective study, we enrolled 211 patients, including 150 males and 61 females, who had undergone ultrasound-guided RFA for a single HCC < 3 cm. Patients were divided into four combination groups of the electrode type and placement method: 1) tumor-puncturing with an internally cooled tip (ICT), 2) tumor-puncturing with an internally cooled wet tip (ICWT), 3) no-touch with ICT, and 4) no-touch with ICWT. Univariable and multivariable Cox proportional-hazards regression analyses were performed to evaluate the risk factors for LTP. The major RFA-related complications were assessed. RESULTS Overall, 83, 34, 80, and 14 patients were included in the ICT, ICWT, no-touch with ICT, and no-touch with ICWT groups, respectively. The cumulative LTP rates differed significantly among the four groups. Compared to tumor puncturing with ICT, tumor puncturing with ICWT was associated with a lower LTP risk (adjusted hazard ratio [aHR] = 0.11, 95% confidence interval [CI] = 0-0.88, P = 0.034). However, the cumulative LTP rate did not differ significantly between tumor-puncturing with ICT and no-touch RFA with ICT (aHR = 0.34, 95% CI = 0.03-1.62, P = 0.188) or ICWT (aHR = 0.28, 95% CI = 0-2.28, P = 0.294). An insufficient ablative margin was a risk factor for LTP (aHR = 6.13, 95% CI = 1.41-22.49, P = 0.019). The major complication rates were 1.2%, 0%, 2.5%, and 21.4% in the ICT, ICWT, no-touch with ICT, and no-touch with ICWT groups, respectively. CONCLUSION ICWT was associated with a lower LTP rate compared to ICT when performing tumor-puncturing RFA. An insufficient ablation margin was a risk factor for LTP.
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Affiliation(s)
- Jiyeon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
| | - Soo Hyun Ahn
- Department of Mathematics, Ajou University, Suwon, Republic of Korea
| | - Seungchul Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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21
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Wang H, Wu Z, Cui D, Shi Y, Zhai B. Radiofrequency ablation of hepatocellular carcinoma: Current status, challenges, and prospects. LIVER RESEARCH 2023; 7:108-115. [PMID: 39958948 PMCID: PMC11791925 DOI: 10.1016/j.livres.2023.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/13/2022] [Accepted: 05/25/2023] [Indexed: 02/18/2025]
Abstract
Local ablation technologies, such as radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation, have become a standard treatment option for hepatocellular carcinoma (HCC) less than 5 cm in size, particularly in individuals who are not candidates for hepatectomy. Except for equivalent prognosis and efficiency, RFA has various advantages over surgical excision, including a lower rate of complications, a cheaper cost, more normal tissue preservation, and a shorter hospital stay. However, the rate of tumor recurrence and/or distant metastasis after RFA therapy is still high. RFA has been widely employed in multiple cancers, large cancer, and lesion identified at "high-risk" sites in recent years, with the advancement of ablation types and operating techniques, particularly the combined use of many technologies. The real value of RFA technology has been more fully reflected. We will examine the status, progress, and problems of RFA in the treatment of HCC in this review.
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Affiliation(s)
- Hongye Wang
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaorong Wu
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Cui
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaoping Shi
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Zou YW, Ren ZG, Sun Y, Liu ZG, Hu XB, Wang HY, Yu ZJ. The latest research progress on minimally invasive treatments for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2023; 22:54-63. [PMID: 36041973 DOI: 10.1016/j.hbpd.2022.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. Due to the high prevalence of hepatitis B virus (HBV) infection in China, the incidence of HCC in China is high, and liver cirrhosis caused by chronic hepatitis also brings great challenges to treatment. This paper reviewed the latest research progress on minimally invasive treatments for HCC, including percutaneous thermal ablation and new nonthermal ablation techniques, and introduced the principles, advantages, and clinical applications of various therapeutic methods in detail. DATA SOURCES The data of treatments for HCC were systematically collected from the PubMed, ScienceDirect, American Chemical Society and Web of Science databases published in English, using "minimally invasive" and "hepatocellular carcinoma" or "liver cancer" as the keywords. RESULTS Percutaneous thermal ablation is still a first-line strategy for the minimally invasive treatment of HCC. The effect of microwave ablation (MWA) on downgrading treatment before liver transplantation is better than that of radiofrequency ablation (RFA), while RFA is more widely used in the clinical practice. High-intensity focused ultrasound (HIFU) is mainly used for the palliative treatment of advanced liver cancer. Electrochemotherapy (ECT) delivers chemotherapeutic drugs to the target cells while reducing the blood supply around HCC. Irreversible electroporation (IRE) uses a microsecond-pulsed electric field that induces apoptosis and necrosis and triggers a systemic immune response. The nanosecond pulsed electric field (nsPEF) has achieved a good response in the ablation of mice with HCC, but it has not been reported in China for the treatment of human HCC. CONCLUSIONS A variety of minimally invasive treatments provide a sufficient survival advantage for HCC patients. Nonthermal ablation will lead to a new wave with its unique advantage of antitumor recurrence and metastasis.
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Affiliation(s)
- Ya-Wen Zou
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhi-Gang Ren
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ying Sun
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhen-Guo Liu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiao-Bo Hu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hai-Yu Wang
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zu-Jiang Yu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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23
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Jo MG, Lee MW, Ahn S, Kang TW, Song KD, Cha DI, Min JH, Rhim H. Percutaneous radiofrequency ablation of hepatocellular carcinoma in a recent cohort at a tertiary cancer center: incidence and factors associated with major complications and unexpected hospitalization events. Ultrasonography 2023; 42:41-53. [PMID: 36353791 PMCID: PMC9816693 DOI: 10.14366/usg.22041] [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: 03/12/2022] [Accepted: 05/23/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE This study aimed to assess the incidence of and factors associated with major complications, delayed discharge, and emergency room (ER) visits or readmission after percutaneous radiofrequency ablation (RFA) for single hepatocellular carcinoma (HCC) <3 cm in a recent cohort at a tertiary cancer center. METHODS A total of 188 patients with treatment-naïve single HCCs <3 cm who underwent RFA between January 2018 and April 2021 were included in the analysis. Univariable and multivariable logistic regression analyses were performed to identify the factors associated with major complications, delayed discharge, and ER visits or readmission. Local tumor progression (LTP) and overall survival were estimated using the Kaplan-Meier method and Cox proportional-hazards regression analysis. RESULTS Major complications occurred in 3.2% (6/188) of the patients. The longest diameter of the ablation zone was significantly larger in patients with major complications (P=0.023). Delayed discharge occurred in 5.8% (9/188) of the patients, for which albumin-bilirubin grade 3 was identified as an important determinant. No variables other than major complications were significantly associated with ER visits or readmission, which occurred in 7.0% (13/188) of the patients. Major complications, delayed discharge, and ER visits or readmission were not substantially related to the post-treatment outcomes of LTP and overall survival. CONCLUSION This study confirmed RFA as a highly safe procedure for single HCCs <3 cm, despite the rapidly changing RFA techniques in the most recent cohort. A large ablation zone and poor liver function were predictors of major complications and delayed discharge, respectively.
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Affiliation(s)
- Min Geun Jo
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea,Correspondence to: Min Woo Lee, MD, PhD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel. +82-2-3410-2518 Fax. +82-2-3410-2559 E-mail:
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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24
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Du F, Zhang L, Zhang Y, Fan H, Ren L. Efficacy and safety of no-touch radiofrequency ablation for small hepatocellular carcinoma-a systematic review and single-arm meta-analysis. Clin Res Hepatol Gastroenterol 2023; 47:102069. [PMID: 36513251 DOI: 10.1016/j.clinre.2022.102069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to report the efficacy and safety of no-touch radiofrequency ablation (NT-RFA) in the treatment of small hepatocellular carcinoma (HCC). METHODS We systematically searched for eligible studies in PubMed, Embase and Cochrane library until June 1, 2022. Random effect model was applied to synthesize the pooled proportions of local tumor progression-free survival (LTP), recurrence-free survival (RFS) and overall survival (OS) respectively, as well as adverse events, for small HCC treated by NT-RFA. RESULTS Of the 10 included studies, 3 of them reported local tumor recurrence. One reported local tumor recurrence at 19 months (range, 12-24), and 2 studies had no tumor recurrence with 24-months of follow-up. The 1- and 2-year LTP pooled proportions were 99.3% (95%CI, 97.5-100) and 97.8% (95%CI, 94.6-99.6) respectively, and two studies reported a 3-year LTP rate of 96.4% (204/212, 36/37). The 1-yearRFS rates was 91.3% (95%CI, 84.1-98.4), 2-year was 86.4% (95%CI, 75.3-97.5). The 1-, 2- and 3- year OS rates were 92.4% (95%CI, 82.8-92.7), 84.1% (95%CI, 74.7-93.6) and 81.8% (116/181, 33/36) respectively, and only one study reported a 5-year OS rate of 47.0% (85/181). The ablative success rate of the HCC nodules was 96.6% (95%CI, 91.3-99.5) and the proportions of mild and severe adverse events following ablation were 18.3% (95%CI, 8.1-41.6) and 5.0%, respectively. CONCLUSION NT-RFA provides safely very high rate of sustained local control for the treatment of HCC up to 5 cm.
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Affiliation(s)
- Fei Du
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China
| | - Lingkai Zhang
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China; Graduate School of Qinghai University, Xining 810000, China
| | - Yongxuan Zhang
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China; Graduate School of Qinghai University, Xining 810000, China
| | - Haining Fan
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China
| | - Li Ren
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China.
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Wu G, Li J, Li C, Ou X, Feng K, Xia F, Chen Z, Zhang L, Ma K. Long‐term efficacy of no‐touch radiofrequency ablation in the treatment of single small hepatocellular carcinoma: A single center long‐term follow‐up study. Cancer Med 2022; 12:6571-6582. [PMID: 36444873 PMCID: PMC10067076 DOI: 10.1002/cam4.5428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/01/2022] [Accepted: 10/23/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the long-term efficacy of no-touch radiofrequency ablation (NT-RFA) for treating single hepatocellular carcinoma (HCC) less than 3 cm. METHODS A total of 331 patients with HCC less than 3 cm undergoing RFA in Southwest Hospital from 2015 to 2020 were analyzed retrospectively. All patients were divided into NT-RFA group (n = 113) and conventional RFA (C-RFA) group (n = 218). The survival rate, local tumor progression (LTP) and intrahepatic distant recurrence (IDR) of the two groups were calculated and compared. RESULTS A significant difference was observed in ablation range (p = 0.000) and safety margin (p = 0.000) between the two groups. The 1-, 2-, 3-, 4-and 5-year overall survival (OS) rates in NT-RFA and C-RFA group were 99.12%, 93.73%, 76.18%, 57.00%, 45.17% and 99.08%, 89.91%, 71.26%, 54.28%, 41.77%, respectively. There was no significant difference between the two groups (p = 0.281). The 1-, 2-, 3-, 4-and 5-year recurrence-free survival (RFS) rates in NT-RFA and C-RFA group were 78.51%, 52.59%, 41.02%, 34.36%, 30.92% and 68.81%, 44.95%, 30.88%, 23.73%, 22.88%, respectively. The two groups differed significantly (p = 0.044). The 1-, 3-and 5-year LTP-free survival rates in NT-RFA and C-RFA group were 87.12%, 74.99%, 72.32% and 75.75%, 65.52%, 65.52%, respectively. The two groups also differed significantly (p = 0.024). Furthermore, the RFS rates of D ≤ 2 cm subgroups in NT-RFA and C-RFA groups differed significantly (p = 0.037), while the RFS rates of 2 cm < D ≤ 3 cm subgroups in two groups showed no significant difference (p = 0.578). CONCLUSIONS The RFS rates of single HCC less than 3 cm treated by NT-RFA was significantly higher than that of C-RFA. Due to a larger ablation range and safety margin, NT-RFA could significantly reduce LTP and improve RFS. Dual-electrode NT-RFA can significantly improve the RFS rate of patients with HCC less than 2 cm, but there is no obvious advantage compared with C-RFA in the treatment of HCC over 2 cm.
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Affiliation(s)
- Guodong Wu
- Institute of Hepatobiliary Surgery Southwest Hospital, Army Medical University Chongqing China
- Department of Hepatobiliary Surgery The 958th Hospital of the PLA Army Chongqing China
| | - Jing Li
- Department of Hepatobiliary Surgery The 958th Hospital of the PLA Army Chongqing China
| | - Changfeng Li
- Institute of Hepatobiliary Surgery Southwest Hospital, Army Medical University Chongqing China
| | - Xia Ou
- Institute of Hepatobiliary Surgery Southwest Hospital, Army Medical University Chongqing China
| | - Kai Feng
- Institute of Hepatobiliary Surgery Southwest Hospital, Army Medical University Chongqing China
| | - Feng Xia
- Institute of Hepatobiliary Surgery Southwest Hospital, Army Medical University Chongqing China
| | - Zhiyu Chen
- Institute of Hepatobiliary Surgery Southwest Hospital, Army Medical University Chongqing China
| | - Leida Zhang
- Institute of Hepatobiliary Surgery Southwest Hospital, Army Medical University Chongqing China
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery Southwest Hospital, Army Medical University Chongqing China
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Imaging and histological features of tumor biopsy sample predict aggressive intrasegmental recurrence of hepatocellular carcinoma after radiofrequency ablation. Sci Rep 2022; 12:18712. [PMID: 36333426 PMCID: PMC9636258 DOI: 10.1038/s41598-022-23315-5] [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] [Received: 04/23/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Aggressive intrasegmental recurrence (AIR) is a form of local recurrence associated with a dismal prognosis and defined by multiple nodules or by an infiltrative mass with a tumor thrombus, occurring in the treated segment, after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). We aimed to identify radiological and/or histological characteristics of tumor biopsy predictive of AIR. We retrospectively analyzed patients treated by No-Touch multi-bipolar RFA (mbpRFA) for a first HCC with a systematic per-procedural tumor biopsy positive for diagnosis of HCC. The first recurrence was classified as non-aggressive local recurrence, AIR or intrahepatic distant recurrence. 212 patients were included (168 men; mean age 67.1 years; mean tumor size 28.6 mm, 181 cirrhosis). AIR occurred in 21/212 patients (10%) and was associated with a higher risk of death (57% in patients with AIR vs 30% without AIR, p = 0.0001). Non-smooth tumor margins, observed in 21% of the patients and macro-trabecular massive histological subtype, observed in 12% of the patients were independently related to a higher risk of AIR (HR: 3.7[1.57;9.06], p = 0.002 and HR:3.8[2.47;10], p = 0.005 respectively). Non smooth margins at imaging and macro-trabecular massive histological subtype are associated with AIR and could be considered as aggressive features useful to stratify therapeutic strategy.
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27
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Sidali S, Trépo E, Sutter O, Nault J. New concepts in the treatment of hepatocellular carcinoma. United European Gastroenterol J 2022; 10:765-774. [PMID: 35975347 PMCID: PMC9486494 DOI: 10.1002/ueg2.12286] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/25/2022] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death and occurs mainly in the context of chronic liver disease at cirrhosis stage. The Barcelona Clinic Liver Cancer classification, first established in 1999, is the most commonly used staging system for HCC in Western countries that link tumor burden, liver function and performance status with prognosis and therapeutic management. Since the first publication of this classification, it has been implemented in several clinical guidelines and recent major therapeutic advances in the management of HCC have modified the therapeutic landscape of HCC. Accordingly, an updated version was recently published in 2022, incorporating an expert clinical decision-making component and the concept of treatment stage migration. This update also introduces the positive results of recent randomized clinical trials, and introduces atezolizumab/bevacizumab (A/B) as a first-line combination regimen for patients with advanced HCC. Finally, the complexity of the management of patients with HCC highlights the need for a multidisciplinary approach including input from hepatology, surgery, radiology, medical oncology, and radiation oncology.
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Affiliation(s)
- Sabrina Sidali
- Université de ParisHôpitaux de Paris, Hôpital BeaujonService D’HépatologieDMU DIGESTClichyFrance
- Centre de Recherche des CordeliersSorbonne UniversitéInsermUniversité de ParisFunctional Genomics of Solid TumorsEquipe Labellisée Ligue Nationale Contre le CancerLabex OncoImmunologyParisFrance
| | - Eric Trépo
- Department of Gastroenterology, Hepatopancreatology and Digestive OncologyCUB Hôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
- Laboratory of Experimental GastroenterologyUniversité Libre de BruxellesBrusselsBelgium
| | - Olivier Sutter
- Interventional Radiology UnitHôpital AvicenneHôpitaux Universitaires Paris‐Seine‐Saint‐DenisAssistance‐Publique Hôpitaux de ParisBobignyFrance
| | - Jean‐Charles Nault
- Centre de Recherche des CordeliersSorbonne UniversitéInsermUniversité de ParisFunctional Genomics of Solid TumorsEquipe Labellisée Ligue Nationale Contre le CancerLabex OncoImmunologyParisFrance
- Liver UnitHôpital AvicenneHôpitaux Universitaires Paris‐Seine‐Saint‐DenisAssistance‐Publique Hôpitaux de ParisBobignyFrance
- Unité de Formation et de Recherche Santé Médecine et Biologie HumaineUniversité Paris 13Communauté D’Universités et Etablissements Sorbonne Paris CitéParisFrance
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28
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Safety and feasibility of radiofrequency ablation using bipolar electrodes for aldosterone-producing adenoma: a multicentric prospective clinical study. Sci Rep 2022; 12:14090. [PMID: 35982148 PMCID: PMC9388631 DOI: 10.1038/s41598-022-18136-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/05/2022] [Indexed: 12/04/2022] Open
Abstract
Evaluation of feasibility and safety of percutaneous radiofrequency ablation using bipolar radiofrequency devices in a prospective multicenter cohort of patients with benign aldosterone-producing adenoma. A total of five institutions participated. CT-guided percutaneous RFA was performed for patients diagnosed as APA. The safety of the procedure was evaluated using the Common Terminology Criteria for Adverse Events. During the 84-day follow-up period, serial changes in plasma aldosterone concentration and plasma renin activity were measured. The percentage of patients with normalized hormonal activity after the procedure, was calculated with 95% confidence intervals. Forty patients were enrolled, and two patients were excluded for cerebral hemorrhage and no safe puncture root. In another patients, RFA was tried, but an intraprocedural intercostal arterial injury occurred. Consequently, RFA was completed in thirty-seven patients (20 men, 17 women; mean age, 50.4 ± 10.0 year). The tumor size was 14.8 ± 3.8 mm. The treatment success rate of the ablation was 94.6% (35/37), and a 2nd session was performed in 2.7% (1/37) patients. Grade 4 adverse events were observed in 4 out of 38 sessions (10.5%). The normalization of plasma aldosterone concentration or aldosterone-renin ratio was 86.5% (72.0–94.1: 95% confidence interval) on day 84. Percutaneous CT-guided RFA for APA using a bipolar radiofrequency system was safe and feasible with clinical success rate of 86.5% on day 84.
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29
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Deng Q, He M, Fu C, Feng K, Ma K, Zhang L. Radiofrequency ablation in the treatment of hepatocellular carcinoma. Int J Hyperthermia 2022; 39:1052-1063. [PMID: 35944905 DOI: 10.1080/02656736.2022.2059581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this article is to discuss the use, comparative efficacy, and research progress of radiofrequency ablation (RFA), alone or in combination with other therapies, for the treatment of hepatocellular carcinoma (HCC). METHOD To search and summarize the basic and clinical studies of RFA in recent years. RESULTS RFA is one of the radical treatment methods listed in the guidelines for the diagnosis and treatment of HCC. It has the characteristics of being minimally invasive and safe and can obtain good local tumor control, and it can improve the local immune ability, improve the tumor microenvironment and enhance the efficacy of chemotherapy drugs. It is commonly used for HCC treatment before liver transplantation and combined ALPPS and hepatectomy for HCC. In addition, the technology of RFA is constantly developing. The birth of noninvasive, no-touch RFA technology and equipment and the precise RFA concept have improved the therapeutic effect of RFA. CONCLUSION RFA has good local tumor control ability, is minimally invasive, is safe and has other beneficial characteristics. It plays an increasingly important role in the comprehensive treatment strategy of HCC. Whether RFA alone or combined with other technologies expands the surgical indications of patients with HCC and provides more benefits for HCC patients needs to be determined.
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Affiliation(s)
- Qingsong Deng
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Minglian He
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunchuan Fu
- Department of Hepatobiliary Surgery, Xuanhan County People's Hospital, Xuanhan, China
| | - Kai Feng
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Kuansheng Ma
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Leida Zhang
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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30
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Su TH, Hsu SJ, Kao JH. Paradigm shift in the treatment options of hepatocellular carcinoma. Liver Int 2022; 42:2067-2079. [PMID: 34515412 DOI: 10.1111/liv.15052] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 01/27/2023]
Abstract
Hepatocellular carcinoma (HCC) is prevalent worldwide with suboptimal therapeutic outcomes. The advancement of therapeutic options and the development of new systemic therapies expand the armamentarium to tackle HCC. Treatment options should be provided based on the hierarchy of efficacy in a multidisciplinary perspective, instead of the traditional stage-guided scheme. In advanced HCC, lenvatinib has a comparable efficacy as sorafenib for the first-line therapy of HCC; while regorafenib, cabozantinib, and ramucirumab have been approved as second-line therapy after the failure of sorafenib. Immune checkpoint inhibitor therapy prolongs response rate and survival and enables long-term cure. Atezolizumab plus bevacizumab is superior to sorafenib as the first-line therapy for advanced HCC. Several emerging regimens by the combination of various systemic therapies are currently under clinical trials. Systemic therapy may be used in the neoadjuvant, adjuvant or even as initial therapy for intermediate-stage HCC. The paradigm shift of HCC treatment will improve patient outcomes.
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Affiliation(s)
- Tung-Hung Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Jer Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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31
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Can "no-touch" radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol 2022; 33:545-554. [PMID: 35907024 DOI: 10.1007/s00330-022-08991-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Percutaneous radiofrequency ablation (RFA) is one of the curative treatments for hepatocellular carcinoma (HCC), but local tumor progression (LTP) has been a main limitation of RFA. This study aims to evaluate the LTP of percutaneous no-touch RFA (NtRFA) for HCC ≤ 5 cm and compare with conventional RFA (intratumoral puncture) through a systematic review and meta-analysis. METHODS MEDLINE, EMBASE, and Cochrane Library were searched for studies on percutaneous NtRFA for HCC ≤ 5 cm. The pooled proportions of the overall and cumulative incidence rates at 1, 2, and 3 years for LTP after NtRFA were assessed using a random-effects model. For studies comparing NtRFA with conventional RFA, relative risks (RR) and hazard ratios (HR) were meta-analytically pooled with LTP as the outcome. RESULTS Twelve studies with 900 patients were included. The pooled overall rate of LTP after NtRFA was 6% (95% CI, 4-8%). The pooled 1-, 2-, and 3-year cumulative incidence rates of LTP were 3% (95% CI, 2-5%), 5% (95% CI, 3- 9%), and 8% (95% CI, 6-11%), respectively. Compared to conventional RFA, the pooled RR and HR of LTP were 0.26 (95% CI, 0.16-0.41) and 0.28 (95% CI, 0.11-0.70), respectively (both p < 0.01). Subgroup analysis including only randomized controlled studies also showed better local tumor control of NtRFA with HR of 0.13 (95% CI, 0.14-0.42). CONCLUSIONS Percutaneous NtRFA is an effective treatment for HCC ≤ 5 cm with an overall LTP rate of 6% and provides lower LTP compared with conventional RFA. KEY POINTS • The pooled 1-, 2-, and 3-year cumulative incidence rates of local tumor progression after no-touch radiofrequency ablation for HCC ≤ 5 cm were 3% (95% CI, 2-5%), 5% (95% CI, 3-9%), and 8% (95% CI, 6-11%). • No-touch radiofrequency ablation had significantly lower rates of local tumor progression compared to conventional radiofrequency ablation (hazard ratio, 0.28; 95% CI, 0.11-0.70; relative risk, 0.26; 95% CI, 0.16-0.41; p < 0.01, respectively).
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Li K, Long Y, He X, Wu Y, Xu J, Ye H, Xu E, Zeng Q, Chen J, Yuan L, Zheng R. Comparison of anatomical thermal ablation and routine thermal ablation for hepatocellular carcinoma≤50 mm: A propensity score matching. Hepatol Res 2022; 52:641-651. [PMID: 35506633 DOI: 10.1111/hepr.13772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/27/2022] [Accepted: 04/17/2022] [Indexed: 02/08/2023]
Abstract
AIM The present study was to evaluated the clinical value of anatomical thermal ablation to treat hepatocellular carcinoma compared with routine thermal ablation. METHODS Hepatocellular carcinoma patients with tumor diameter ≤50 mm treated by thermal ablation at our center were retrospectively enrolled from October 2015 to December 2018. Enrolled patients were grouped into the anatomical ablation group and routine ablation group, respectively. To minimize the effects of potential confounders from selection bias, a propensity score matching was carried out. Technical efficacy, recurrence and survivals rates were compared. RESULTS Altogether 101 patients (119 lesions) were grouped into the anatomical ablation group and 101 patients (131 lesions) into the routine ablation group. The ablation zone volume of the anatomical ablation group was 36.8 (2.5-176.9) ml, significantly larger than that of the routine ablation group (28.5 [28.5 (2.8-184.3) ml] (p = 0.005)). Adjusted with propensity score matching, The 1-, 2-, and 3-year local recurrence rates were 0.0%, 0.0%, and 0.0% for the anatomical ablation group and 6.9%, 10.1%, and 10.1% for the routine ablation group, respectively (p = 0.013). The cumulative 1-, 2-, and 3-year progression-free survival rates were 93.4%, 82.7%, and 79.0% for the anatomical ablation group, 74.2%, 56.9%, and 51.6% for the routine ablation group (p = 0.001). CONCLUSIONS Anatomical ablation could be a favorable ablation strategy to improve therapeutic effect of thermal ablation for HCC with visible feeding vessels and reserved liver function.
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Affiliation(s)
- Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yinglin Long
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuqi He
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuxuan Wu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianliang Xu
- Department of Liver Surgery, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huolin Ye
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Erjiao Xu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Ultrasound, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianning Chen
- Department of Pathology, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lianxiong Yuan
- Department of Science and Research, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Schullian P, Johnston E, Laimer G, Scharll Y, Putzer D, Eberle G, Kolbitsch C, Amann A, Stättner S, Bale R. Stereotactic radiofrequency ablation of tumors at the hepatic venous confluence. HPB (Oxford) 2022; 24:1044-1054. [PMID: 34887174 DOI: 10.1016/j.hpb.2021.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is subject to "heat-sink" effects, particularly for treatment of tumors adjacent to major vessels. METHODS In this retrospective study, 104 patients with 137 tumors (40 HCC, 10 ICC and 54 metastatic liver tumors) close to (≤1 cm from) the hepatic venous confluence underwent stereotactic RFA (SRFA) between June 2003 and June 2018. Median tumor size was 3.7 cm (1.4-8.5) for HCC, 6.4 cm (0.5-11) for ICC and 3.8 cm (0.5-13) for metastases. Endpoints comprised safety, local tumor control, overall and disease-free survival. RESULTS The overall major complication rate was 16.0% (20/125 ablations), where 8 (40%) were successfully treated by the interventional radiologist in the same anesthetic session and did not prolong hospital stay. 134/137 (97.8%) tumors were successfully ablated at initial SRFA. Local recurrence (LR) developed in 19/137 tumors (13.9%). The median and overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 51.5 months, 73.5%, 67.0%, and 49.7% for HCC, 14.6 months, 60.0%, 32.0% and 32.0% for ICC and 38.1 months, 91.4%, 56.5% and 27.9% for metastatic disease, respectively. CONCLUSION SRFA represents a viable alternative to hepatic resection for challenging tumors at the hepatic venous confluence.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Edward Johnston
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Christian Kolbitsch
- Department of Anesthesia, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Arno Amann
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, D.Wilhelm Bock Strasse 1, 4840, Vöcklabruck Austria; Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Marques F, Ghallab M, Vibert E, Boleslawski E, Soubrane O, Adam R, Farges O, Mabrut JY, Régimbeau JM, Cherqui D, Allard MA, Sa Cunha A, Samuel D, Pruvot FR, Golse N. Prognostic impact of surgical margins for hepatocellular carcinoma according to preoperative alpha-fetoprotein level. HPB (Oxford) 2022; 24:848-856. [PMID: 34785122 DOI: 10.1016/j.hpb.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND HCC are known to have satellite nodules and microvascular invasions requiring sufficient margins. An alpha-fetoprotein (AFP) level >100 ng/mL is associated with worse pathological features in HCC. In practice, large resection margins, particularly >1 cm, are infrequently retrieved on the specimens. METHODS 397 patients from 5 centres were included from 2012 to 2017. The primary endpoint was time-to-recurrence in relation to AFP level (> or <100 ng/ml) as well as surgical margins (> or <1 cm). The secondary endpoint was overall survival (OS). RESULTS The median follow-up was 25 months. In Low AFP group, median time to recurrence (TTR) for patients with margins <1 cm was 36 months and for patients with margins ≥1 cm was 34 months (p = 0.756), and overall survival (OS) was not significantly different according to margins (p = 0.079). In High-AFP group, patients with margins <1 cm had a higher recurrence rate than patients with margins ≥1 cm (p = 0.016): median TTR for patients with margins <1 cm was 8 months whereas it was not reached for patients with margins ≥1 cm. Patients with margins <1 cm had a significantly worse OS compared to the patients with margins ≥1 cm (p = 0.043). CONCLUSION Preoperative AFP level may help determine margins to effectively treat high AFP tumours. For low-AFP tumours, margins didn't have an impact on TTR or OS.
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Affiliation(s)
- Frédéric Marques
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France
| | - Mohammed Ghallab
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Eric Vibert
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France
| | - Emmanuel Boleslawski
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Université Paris Clichy, INSERM, Unit 776, Villejuif F-94800, France
| | - René Adam
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Univ Paris-Sud, UMR-S 776, Villejuif, 94800, France
| | - Olivier Farges
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Université Paris Clichy, INSERM, Unit 776, Villejuif F-94800, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Jean-Marc Régimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens, France
| | - Daniel Cherqui
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France
| | - Marc-Antoine Allard
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France
| | - Antonio Sa Cunha
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France
| | - Didier Samuel
- Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France; Department of Hepatology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France
| | - François-René Pruvot
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France
| | - Nicolas Golse
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France.
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Ramtohul T, Vilgrain V, Soubrane O, Bouattour M, Luciani A, Kobeiter H, Mule S, Tacher V, Laurent A, Amaddeo G, Regnault H, Bulsei J, Nault JC, Nahon P, Durand-Zaleski I, Seror O. Impact of Extended Use of Ablation Techniques in Cirrhotic Patients with Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. Cancers (Basel) 2022; 14:2634. [PMID: 35681618 PMCID: PMC9179352 DOI: 10.3390/cancers14112634] [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: 05/06/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To evaluate the cost-effectiveness of the extended use of ablation for the treatment of hepatocellular carcinoma (HCC) with cirrhosis in an expert ablation center when compared to the non-extended use of ablation in equivalent tertiary care centers. METHODS Consecutive cirrhotic patients with non-metastatic HCC, no prior treatment, and referred to three tertiary care centers between 2012 and 2016 were retrospectively identified. The Bondy group, including all of the patients treated at Jean Verdier Hospital, where the extended use of ablation is routinely performed, was compared to the standard of care (SOC) group, including all of the patients treated at the Beaujon and Mondor Hospitals, using propensity score matching. A cost-effectiveness analysis was carried out from the perspective of French health insurance using a Markov model on a lifetime horizon. RESULTS 532 patients were matched. The Bondy group led to incremental discounted lifetime effects of 0.8 life-years gained (LYG) (95% confidence interval: 0.4, 1.3) and a decrease in lifetime costs of EUR 7288 (USD 8016) (95% confidence interval: EUR 5730 [USD 6303], EUR 10,620 [USD 11,682]) per patient, compared with the SOC group, resulting in a dominant mean incremental cost-effectiveness ratio (ICER). A compliance with the Barcelona Clinic Liver Classification (BCLC) guidelines for earlier stage contributed to the greater part of the ICER. CONCLUSION The extended use of ablation in cirrhotic patients with HCC was more effective and less expensive than the non-extended use of the ablation strategy.
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Affiliation(s)
- Toulsie Ramtohul
- AP-HP, Health Economics Research Unit, 75004 Paris, France; (T.R.); (J.B.); (I.D.-Z.)
- AP-HP, Department of Radiology, Jean Verdier Hospital, 93140 Bondy, France
| | - Valérie Vilgrain
- AP-HP, Department of Radiology, Beaujon Hospital, 92110 Clichy, France;
- INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, 75018 Paris, France
| | - Olivier Soubrane
- AP-HP, Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, 92110 Clichy, France;
| | - Mohamed Bouattour
- AP-HP, Department of Digestive Oncology, Beaujon Hospital, 92110 Clichy, France;
| | - Alain Luciani
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Radiology, Henri Mondor Hospital, 94000 Créteil, France;
| | - Hicham Kobeiter
- AP-HP, Department of Radiology, Henri Mondor Hospital, 94000 Créteil, France;
| | - Sébastien Mule
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Radiology, Henri Mondor Hospital, 94000 Créteil, France;
| | - Vania Tacher
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Radiology, Henri Mondor Hospital, 94000 Créteil, France;
| | - Alexis Laurent
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Liver Surgery, Henri Mondor Hospital, 94000 Créteil, France
| | - Giuliana Amaddeo
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Hepatology, Henri Mondor Hospital, 94000 Créteil, France
| | - Hélène Regnault
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Hepatology, Henri Mondor Hospital, 94000 Créteil, France
| | - Julie Bulsei
- AP-HP, Health Economics Research Unit, 75004 Paris, France; (T.R.); (J.B.); (I.D.-Z.)
| | - Jean-Charles Nault
- AP-HP, Department of Hepatology, Jean Verdier Hospital, 93140 Bondy, France; (J.-C.N.); (P.N.)
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, 75010 Paris, France
| | - Pierre Nahon
- AP-HP, Department of Hepatology, Jean Verdier Hospital, 93140 Bondy, France; (J.-C.N.); (P.N.)
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, 75010 Paris, France
- French League Against Cancer, Education and Research in Health Medicine and Human Biology, University Paris 13, Sorbonne Paris Cité, 75005 Paris, France
| | - Isabelle Durand-Zaleski
- AP-HP, Health Economics Research Unit, 75004 Paris, France; (T.R.); (J.B.); (I.D.-Z.)
- ECEVE, UMRS 1123, French National Institute of Health and Medical Research, 75010 Paris, France
- AP-HP, Department of Public Health, Henri Mondor Hospital, 94000 Creteil, France
| | - Olivier Seror
- AP-HP, Department of Radiology, Jean Verdier Hospital, 93140 Bondy, France
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, 75010 Paris, France
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ABDOMEN/BECKEN – No-Touch-Radiofrequenzablation überzeugt bei kleinen hepatozellulären Karzinomen. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/a-1692-1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hatzidakis A, Müller L, Krokidis M, Kloeckner R. Local and Regional Therapies for Hepatocellular Carcinoma and Future Combinations. Cancers (Basel) 2022; 14:cancers14102469. [PMID: 35626073 PMCID: PMC9139740 DOI: 10.3390/cancers14102469] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Percutaneous interventional radiological techniques offer many alternatives for treatment of Hepatocellular Carcinoma (HCC) using local anesthesia and sedation. These methods aim to destroy the malignant tumors locally without affecting the non-malignant liver. In this way, complications are kept low and patient recovery is quick. Indications depend on tumor size, type and stage, as well as patient’s condition, liver function and co-morbidities. In recent years, a lot of research has been made in combining such approaches with immune therapy, but there is still much work to be done. This manuscript tries to analyze where we stand today and explain, using a comprehensive algorithm, the treatment options for each different clinical condition. Abstract Background: Hepatocellular carcinoma (HCC) can be treated by local and regional methods of percutaneous interventional radiological techniques. Indications depend on tumor size, type and stage, as well as patient’s condition, liver function and co-morbidities. According to international classification systems such as Barcelona Clinic Liver Cancer (BCLC) classification, very early, early or intermediate staged tumors can be treated either with ablative methods or with transarterial chemoembolization (TACE), depending on tumor characteristics. The combination of both allows for individualized forms of treatment with the ultimate goal of improving response and survival. In recent years, a lot of research has been carried out in combining locoregional approaches with immune therapy. Although recent developments in systemic treatment, especially immunotherapy, seem quite promising and have expanded possible combined treatment options, there is still not enough evidence in their favor. The aim of this review is to provide a comprehensive up-to-date overview of all these techniques, explaining indications, contraindications, technical problems, outcomes, results and complications. Moreover, combinations of percutaneous treatment with each other or with immunotherapy and future options will be discussed. Use of all those methods as down-staging or bridging solutions until surgery or transplantation are taken into consideration will also be reviewed. Conclusion: Local and regional therapies remain a mainstay of curative and palliative treatment of patients with HCC. Currently, evidence on potential combination of the local and regional treatment options with each other as well as with other treatment modalities is growing and has the potential to further individualize HCC therapy. To identify the most suitable treatment option out of these new various options, a repeated interdisciplinary discussion of each case by the tumor board is of utmost importance.
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Affiliation(s)
- Adam Hatzidakis
- Department of Radiology, AHEPA University Hospital of Thessaloniki, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence:
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (R.K.)
| | - Miltiadis Krokidis
- 1st Department of Radiology, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (R.K.)
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38
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Chan KS, Shelat VG. Clinical Utility of Advances in Radiofrequency Ablation for Small Hepatocellular Carcinoma. J INVEST SURG 2022; 35:888-890. [PMID: 34240665 DOI: 10.1080/08941939.2021.1944404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Nguyen N, Rode A, Trillaud H, Aubé C, Manichon AF, Hocquelet A, Paisant A, Dao T, Nahon P, Ganne-Carrié N, Blaise L, Cauchy F, Sutter O, Séror O, Nault JC. Percutaneous radiofrequency ablation for hepatocellular carcinoma developed on non-alcoholic fatty liver disease. Liver Int 2022; 42:905-917. [PMID: 34894060 DOI: 10.1111/liv.15129] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/26/2021] [Accepted: 12/01/2021] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Long-term outcomes after percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD) have been poorly studied. We aim to determine the outcomes after multibipolar RFA in these patients compared to other aetiologies as well as the prognostic impact of metabolic syndrome (MS). METHODS Patients who underwent multibipolar RFA as the first treatment for HCC within Milan criteria (2008-2018) were enrolled in this multicentre retrospective cohort from four tertiary centres in France. The association of MS and NAFLD with adverse events and outcomes after percutaneous RFA were assessed using Kaplan Meier method, log-rank test and uni/multivariate analysis with the Cox models. RESULTS Among 520 patients, 390 patients (75%) had at least one component of MS including obesity (30%) and 95% had cirrhosis. Sixty-two patients (12.6%) had NAFLD-HCC, 225 (45.5%) had alcohol-related-HCC, 36 (7.3%) had HBV-HCC and 171 (34.6%) had HCV-HCC. Patients with NAFLD-HCC were significantly older (median age 72.6 years, P < .001), more obese (median BMI 30.3 kg/m2 , P < .001) and had more components of MS. Patients with NAFLD-HCC achieved a median overall survival (OS) of 79 months (1-year, 3-year and 5-year OS of 90%, 71% and 59%). There were no differences in morbidity, tumour recurrence and OS among patients with NAFLD-HCC vs other aetiologies as well as no prognostic impact of metabolic components. CONCLUSIONS Percutaneous multibipolar RFA is an efficient treatment in HCC patients with NAFLD or metabolic syndrome and achieved similar long-term oncological outcomes compared to other aetiologies.
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Affiliation(s)
- Nga Nguyen
- Hepatogastroenterology Department, Caen University Hospital, Avenue de la Côte de Nacre, Caen, France
| | - Agnès Rode
- Radiology Department, Hospices Civils de Lyon, Lyon, France
| | - Hervé Trillaud
- Radiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Christophe Aubé
- Radiology Department, Angers University Hospital, Angers, France.,Univ Angers, HIFIH, SFR ICAT, Angers, France
| | | | - Arnaud Hocquelet
- Radiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Anita Paisant
- Radiology Department, Angers University Hospital, Angers, France
| | - Thong Dao
- Hepatogastroenterology Department, Caen University Hospital, Avenue de la Côte de Nacre, Caen, France
| | - Pierre Nahon
- Hepatology Department, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, Paris, France
| | - Nathalie Ganne-Carrié
- Hepatology Department, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, Paris, France
| | - Lorraine Blaise
- Hepatology Department, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - François Cauchy
- Hepatobiliary and Digestive Surgery Department, APHP, Beaujon Hospital, Clichy, France
| | - Olivier Sutter
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Interventional Radiology Department, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - Olivier Séror
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, Paris, France.,Interventional Radiology Department, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - Jean-Charles Nault
- Hepatology Department, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, Paris, France
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40
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Lee MW, Rhim H. Research Highlight: How to Use Technical and Oncologic Outcomes of Image-Guided Tumor Ablation According to Guidelines by Society of Interventional Oncology and DATECAN? Korean J Radiol 2022; 23:385-388. [PMID: 35345060 PMCID: PMC8961014 DOI: 10.3348/kjr.2021.0982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/08/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.
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41
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Schullian P, Laimer G, Johnston E, Putzer D, Eberle G, Scharll Y, Widmann G, Kolbitsch C, Bale R. Technical efficacy and local recurrence after stereotactic radiofrequency ablation of 2653 liver tumors: a 15-year single-center experience with evaluation of prognostic factors. Int J Hyperthermia 2022; 39:421-430. [PMID: 35227136 DOI: 10.1080/02656736.2022.2044522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To assess the technical outcome and local tumor control of multi-probe stereotactic radiofrequency ablation (SRFA) in a large series of patients. Furthermore, to determine factors accounting for adverse outcomes. MATERIAL AND METHODS Between 2003 and 2018, 865 patients were treated by SRFA for 2653 primary and metastatic liver tumors with a median tumor size of 2.0 cm (0.5 - 19 cm). Primary technical efficacy (PTE) and local recurrence (LR) were evaluated, and possible predictors for adverse events analyzed using uni- and multi-variable binary logistic regression. RESULTS Overall, 2553 of 2653 tumors were successfully ablated at initial SRFA resulting in a PTE rate of 96.2%. Predictors of lower PTE rates were age > 70 years, tumor size > 5 cm, number of probes, location close to liver capsule/organs and segment II. LR occurred in 220 of 2653 tumors (8.3%) with the following predictors: age, tumor type/size, conglomerates, segments I/IVa/IVb, number of probes and location close to major vessels/bile duct. Multivariable analysis revealed tumor size > 5 cm (odds ratio [OR] 3.153), age > 70 years (OR 1.559), and location in segment II (OR 1.772) as independent prognostic factors for PTE, whereas tumor location close to major vessels (OR 1.653) and in segment IVb (OR 2.656) were identified as independent prognostic factors of LR. CONCLUSIONS Stereotactic RFA is an attractive option in the management of primary or metastatic liver tumors with good local tumor control, even in large tumors. The presented prognostic factors for adverse local oncological outcome might help to stratify unfavorable tumors for ablation.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kolbitsch
- Department of Anesthesia, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
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Duan L, Zhang BH, Zheng XH. No-Touch Radiofrequency Ablation for Small Hepatocellular Carcinoma. Radiology 2022; 303:E27. [PMID: 35230184 DOI: 10.1148/radiol.211994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Lei Duan
- Department of Radiology, The Sixth People's Hospital of Chengdu, 16 Jianshe South Street, Chenghua District, 610000 Chengdu, China
| | - Bo-Han Zhang
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, 37 Guoxue Lane, Wuhou District, 610000 Chengdu, China
| | - Xiao-Hua Zheng
- Department of Radiology, The Sixth People's Hospital of Chengdu, 16 Jianshe South Street, Chenghua District, 610000 Chengdu, China
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Takaura K, Kurosaki M, Inada K, Kirino S, Yamashita K, Muto T, Osawa L, Sekiguchi S, Hayakawa Y, Higuchi M, Kaneko S, Maeyashiki C, Tamaki N, Yasui Y, Itakura J, Tsuchiya K, Nakanishi H, Takahashi Y, Izumi N. The impact of background liver disease on the long-term prognosis of very-early-stage HCC after ablation therapy. PLoS One 2022; 17:e0264075. [PMID: 35196341 PMCID: PMC8865683 DOI: 10.1371/journal.pone.0264075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background and aim The long-term prognosis of hepatocellular carcinoma (HCC) treated at a very-early-stage (the Barcelona Clinical Liver Cancer (BCLC) classification stage 0) was unclear, especially in terms of background liver disease. Methods This single-center, retrospective study included 302 patients with BCLC stage 0 HCC treated with radiofrequency ablation (RFA) and followed for at least six months. We examined the impact of background liver disease on overall survival and recurrence. Results The median age was 72 (range; 36–91) years; the median tumor diameter was 15 (range; 8–20) mm. The etiologies of background liver disease were hepatitis B virus infection (HBV) in 24 cases, hepatitis C virus infection (HCV) in 195 cases, and non-viral (NBNC) in 83 cases. Among the patients with HCV, 63 had achieved sustained virological response (SVR) by antiviral therapy (HCV SVR) before developing HCC (n = 37) or after HCC treatment (n = 26), and 132 had active HCV infection (HCV non-SVR). The median overall survival was 85 (95% CI; 72–98) months, and the median recurrence-free survival was 26 (95% CI; 20–30) months. Active infection with hepatitis C virus negatively contributed to overall survival (HR 2.91, 95% CI 1.31–3.60, p = 0.003) and recurrence-free survival (HR 1.47, 95% CI 1.06–2.05, p = 0.011). Conclusions The prognosis of RFA treatment for very early-stage HCC was favorable. Achieving SVR in hepatitis C was important for further prognosis improvement.
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Affiliation(s)
- Kenta Takaura
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kento Inada
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Sakura Kirino
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kouji Yamashita
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Tomohiro Muto
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Leona Osawa
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Shuhei Sekiguchi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yuka Hayakawa
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Mayu Higuchi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Shun Kaneko
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Chiaki Maeyashiki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
- Division of Medicine, NAFLD Research Center, University of California, San Diego, La Jolla, California, United States of America
| | - Yutaka Yasui
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Jun Itakura
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kaoru Tsuchiya
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hiroyuki Nakanishi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yuka Takahashi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
- * E-mail:
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Seror O. No touch radiofrequency ablation for hepatocellular carcinoma: a conceptual approach rather than an iron law. Hepatobiliary Surg Nutr 2022; 11:132-135. [PMID: 35284526 PMCID: PMC8847878 DOI: 10.21037/hbsn-21-512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 07/29/2023]
Affiliation(s)
- Olivier Seror
- Unité de Radiologie Interventionnelle, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris 7, Paris, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d’Universités et Etablissements Sorbonne Paris Cité, Bobigny, France
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45
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Lu Y, Lu C, Xu D, Huang F, He Z, Lei J, Sun H, Zeng J. Computed Tomography-Guided Percutaneous Radiofrequency Ablation in Older Adults With Early-Stage Peripheral Lung Cancer: A Retrospective Cohort Study. Cancer Control 2022; 29:10732748211070702. [PMID: 35076322 PMCID: PMC8793422 DOI: 10.1177/10732748211070702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives To evaluate the feasibility, safety, and efficacy of computed tomography(CT)-guided percutaneous radiofrequency ablation (RFA) in medically inoperable older adults with clinical stage I non-small cell lung cancer (NSCLC). Patients and Methods We retrospectively reviewed the records of medically inoperable older adults (≥70 years) with clinical stage I NSCLC who underwent percutaneous multi-tined electrode RFA at our institution between January 2014 and December 2018. We analyzed the patients’ characteristics, therapy response, survival, as well as the procedure-related complications. Results Eighteen patients (10 men and 8 women) with a mean age of 75.9 (71−85) years were treated in during the study period. The median tumor size was 25 mm (range, 19−43 mm); 10 and 8 cases involved stage T1 and T2a disease, respectively. The median follow-up duration was 25 (11–45) months. RFA was technically successful for all 18 lesions, with no treatment-related mortality. The disease control rate was 83.3% (15/18 lesions). There were 6 cases of pneumothorax: one symptomatic case requiring thoracic drainage, and five requiring no treatment. Minor complications, including pulmonary infection, chest pain, fever, and cough, were treated within 4 days (range, 1−4 days). The progression-free survival rates were 83.3%, 64.9%, and 51.9% 1, 2, and 3 years, respectively. The corresponding overall survival rates were 92.2%, 81.5%, and 54.3%, respectively. Conclusions CT-guided percutaneous RFA is safe and effective in medically inoperable patients with stage I NSCLC and could be an alternative therapeutic strategy, particularly in older adults with early-stage peripheral lung cancer.
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Affiliation(s)
- Yanda Lu
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Caiwei Lu
- Department of Rehabilitation Medicines, Hainan Medical University, Hainan, China
| | - Danni Xu
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Fen Huang
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Zhihui He
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Junhua Lei
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Huamao Sun
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Jiangzheng Zeng
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
- Jiangzheng Zeng, Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan 571199, China. E-mail:
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Hendriquez R, Keihanian T, Goyal J, Abraham RR, Mishra R, Girotra M. Radiofrequency ablation in the management of primary hepatic and biliary tumors. World J Gastrointest Oncol 2022; 14:203-215. [PMID: 35116111 PMCID: PMC8790419 DOI: 10.4251/wjgo.v14.i1.203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/15/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
In the United States, 80%-90% of primary hepatic tumors are hepatocellular carcinomas and 10%-15% are cholangiocarcinomas (CCA), both with high mortality rate, particularly CCA, which portends a worse prognosis. Traditional management with surgery has good outcomes in appropriately selected patients; however, novel ablative treatment options have emerged, such as radiofrequency ablation (RFA), which can improve the prognosis of both hepatic and biliary tumors. RFA is aimed to generate an area of necrosis within the targeted tissue by applying thermal therapy via an electrode, with a goal to completely eradicate the tumor while preserving surrounding healthy tissue. Role of RFA in management of hepatic and biliary tumors forms the focus of our current mini-review article.
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Affiliation(s)
- Richard Hendriquez
- Department of Internal Medicine, University of Central Florida, Orlando, FL 32816, United States
| | - Tara Keihanian
- Department of Gastroenterology and Hepatology, University of Miami, Miami, FL 33136, United States
| | - Jatinder Goyal
- Department of Gastroenterology and Hepatology, Wellspan Digestive Health - York Hospital, York, PA 17403, United States
| | - Rtika R Abraham
- Department of Endocrinology, Swedish Medical Center, Seattle, WA 98104, United States
| | - Rajnish Mishra
- Digestive Health Institute, Section of Gastroenterology and Interventional Endoscopy, Swedish Medical Center, Seattle, WA 98104, United States
| | - Mohit Girotra
- Digestive Health Institute, Section of Gastroenterology and Interventional Endoscopy, Swedish Medical Center, Seattle, WA 98104, United States
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Cha DI, Lee MW, Song KD, Ko SE, Rhim H. Ablative Outcomes of Various Energy Modes for No-Touch and Peripheral Tumor-Puncturing Radiofrequency Ablation: An Ex Vivo Simulation Study. Korean J Radiol 2022; 23:189-201. [PMID: 35029079 PMCID: PMC8814705 DOI: 10.3348/kjr.2021.0451] [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] [Received: 06/03/2021] [Revised: 08/13/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the outcomes of radiofrequency ablation (RFA) using dual switching monopolar (DSM), switching bipolar (SB), and combined DSM + SB modes at two different interelectrode distances (25 and 20 mm) in an ex vivo study, which simulated ablation of a 2.5-cm virtual hepatic tumor. MATERIALS AND METHODS A total of 132 ablation zones were created (22 ablation zones for each protocol) using three separable clustered electrodes. The performances of the DSM, SB, and combined DSM + SB ablation modes were compared by evaluating the following parameters of the RFA zones at two interelectrode distances: shape (circularity), size (diameter and volume), peritumoral ablative margins, and percentages of the white zone at the midpoint of the two electrodes (ablative margin at midpoint, AMm) and in the electrode path (ablative margin at electrode path, AMe). RESULTS At both distances, circularity was the highest in the SB mode, followed by the DSM + SB mode, and was the lowest in the DSM mode. The circularity of the ablation zone showed a significant difference among the three energy groups (p < 0.001 and p = 0.002 for 25-mm and 20-mm, respectively). All size measurements, AMm, and AMe were the greatest in the DSM mode, followed by the DSM + SB mode, and the lowest were with the SB mode (all statistically significant). The white zone proportion in AMm and AMe were the greatest in the SB mode, followed by the DSM + SB mode and DSM in general. CONCLUSION DSM and SB appear to be complementary in creating an ideal ablation zone. RFA with the SB mode can efficiently eradicate tumors and create a circular ablation zone, while DSM is required to create a sufficient ablative margin and a large ablation zone.
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Affiliation(s)
- Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Seong Eun Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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48
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Blaise L, Pereira H, Vilgrain V, Sutter O, Gigante E, Walter A, Ganne-Carrié N, Nahon P, Bouattour M, Dioguardi Burgio M, Grando V, Nkontchou G, Seror O, Nault JC. Percutaneous ablation for locally advanced hepatocellular carcinoma with tumor portal invasion. Clin Res Hepatol Gastroenterol 2021; 45:101731. [PMID: 34139320 DOI: 10.1016/j.clinre.2021.101731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We aim to assess the outcomes of percutaneous ablation of locally advanced HCC in a tertiary center, which is usually not indicated. We compared to sorafenib or trans-arterial radioembolization (TARE). METHODS We included 272 patients with HCC and tumor portal invasion treated by percutaneous ablation (n = 44) assessed retrospectively from one center compared to a control group from the SARAH trial including patients treated with sorafenib (n = 123) or TARE (n = 105). A propensity-score matching was performed in a subgroup of patients with similar baselines characteristics. RESULTS 84% of patients treated by ablation were male with a unique nodule (median size 50 mm) in 72.7% of the case. Complete tumor ablation was achieved in 75% of the patients with 20% Dindo-Clavien III-V adverse events including 6.8% of 90-days mortality. Sum of tumor size ≥70 mm was associated with incomplete ablation (p = 0.0239) and a higher risk of death (p = 0.0375). Patients in control group had a higher tumor burden, and more Vp3/4 compared to ablation group. Median overall survival was similar in the ablation and in the control group (16.4 and 14.0 months respectively, p = 0.48). The median progression-free survival was 6.6 months in ablation group compared to 4.2 months in the control group (p = 0.12). CONCLUSION Percutaneous ablation for locally advanced HCC was feasible and associated with similar long-term outcomes to sorafenib or TARE.
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Affiliation(s)
- Lorraine Blaise
- Service d'Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - Helena Pereira
- Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Valérie Vilgrain
- Service de Radiologie, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France; Université de Paris et CRI, INSERM 1149, F-75018, Paris, France
| | - Olivier Sutter
- Unité de Radiologie Interventionnelle, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - Elia Gigante
- Service d'Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - Aurélie Walter
- Service d'Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - Nathalie Ganne-Carrié
- Service d'Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Pierre Nahon
- Service d'Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Mohamed Bouattour
- Service d'Oncologie Digestive et Médicale, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Marco Dioguardi Burgio
- Service de Radiologie, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France; Université de Paris et CRI, INSERM 1149, F-75018, Paris, France
| | - Véronique Grando
- Service d'Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - Gisèle Nkontchou
- Service d'Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
| | - Olivier Seror
- Unité de Radiologie Interventionnelle, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France.
| | - Jean-Charles Nault
- Service d'Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France.
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Kuhaimi TA, Alenezi G, Alawaji A, Alshaikh M, Bauones S. Intra-articular hip joint osteoid osteoma: Challenging diagnosis and percutaneous radiofrequency ablation treatment. Radiol Case Rep 2021; 16:3315-3320. [PMID: 34484539 PMCID: PMC8403707 DOI: 10.1016/j.radcr.2021.07.072] [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] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023] Open
Abstract
Atypical intra-articular osteoid osteoma can be difficult to diagnose and challenging to treat. We report a case of a right acetabular subchondral intra-articular osteoid osteoma in a young male patient which was initially diagnosed as femoroacetabular impingement due to its atypical clinical and radiological presentations. After fully working up the patient the lesion was successfully treated with percutaneous CT-guided low-power bipolar radiofrequency ablation using several per procedural articular cartilage thermal protective measures including intra-articular thermocouple, and continuous per procedural joint space cooling with Dextrose 5% solution. A precise RFA electrode placement, using the No-touch technique, and applying different passive and active thermal protective measures were helpful in avoiding collateral damage of the hip joint articular cartilages. atypical intra-articular osteoid osteomas necessitate pertinent correlation between the clinical and radiological presentations. As far as intra-articular or subchondral nidus ablation is concerned, thermal protective measures should be considered.
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Affiliation(s)
- Talal Al Kuhaimi
- Department of Interventional Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Gaied Alenezi
- Department of Musculoskeletal Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Aliya Alawaji
- Department of Musculoskeletal Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshaikh
- Department of Interventional Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Salem Bauones
- Department of Musculoskeletal and Intervention Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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50
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Lee DH. Recent technical advances in radiofrequency ablations for hepatocellular carcinoma. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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