Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

Abstract

AIM:To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA. METHODS:A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 ± 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 ± 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo. RESULTS:In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04).CONCLUSION: PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC. INTRODUCTIONHepatocellular carcinoma (HCC) is the fifth most common cancer in the world (564 000 cases per year) and the third most frequent cause of cancer-related death [1] . Surgical resection is considered to be potentially curative therapy. However, only about 20% of HCC patients are eligible for resection [1,2] ; the remainder are ineligible because of multifocal tumors, advanced tumors, tumor location precluding complete resection, or poor hepatic functional reserve. Therefore, a variety of imaging-guided tumor ablation therapies such as ethanol injection, microwave coagulation, percutaneous radiofrequency ablation (RFA) and laser ablation are often considered as alternative options [3][4][5][6] . Among them, RFA has been used increasingly as a safe technique for treating hepatic tumors [7][8][9] . However, for hypervascular HCC, RFA appears less effective because of a blood-flow-induced heat sink effect, which might BRIEF ARTICLESwww.wjgnet.com cause incomplete ablation or recurrence [10] . Transcatheter arterial chemoembolization (TACE) can reduce blood supply of HCC by occlusion of tumor arteries, and the efficacy of combination TACE and RFA has been confirmed [11,12] . Treatment difficulty remains for those patients who cannot tolerate or are ineligible for TACE because of liver cirrhosis or difficulty in manipulation of vessels with abnormal curvature that have resulted from surgical resection and liver ...

Bilirubin: An Endogenous Molecule with Antiviral Activity in vitro

“…Biliverdin-IX-alpha was shown to inhibit the replication of HCV, HHV-6, and HIV (Mori et al, 1991; Nakagami et al, 1992; Lehmann et al, 2010; Zhu et al, 2010), CO reduced the growth of E. coli , P. aeruginosa , and S. aureus (Nobre et al, 2007, 2009; Davidge et al, 2009; Desmard et al, 2012) and iron almost completely decreased HCV core mRNA and protein (Hou et al, 2009). The results shown in this paper provided original evidence about the antiviral role of BR, the formation of which requires the concerted action of both HO and BVR, thus expanding the cytoprotective role of this linear tetrapyrrole.…”

“…With regard to the by-products of the HO system involved in this antiviral activity, BV was shown to interfere with human hepatitis C virus (HCV) and human herpes virus (HHV)-6 replication as well as to reduce the cytopathic effect of human immunodeficiency type 1 virus (HIV) in Huh or MT-4 cells (Mori et al, 1991; Nakagami et al, 1992; Lehmann et al, 2010; Zhu et al, 2010). In addition, CO inhibited the growth of enterovirus, E. coli , P. aeruginosa as well as S. aureus (Nobre et al, 2007; Tung et al, 2011; Desmard et al, 2012) and iron almost completely decreased HCV core mRNA and protein (Hou et al, 2009). Taken together these results underlined a major role for HO in antiviral and antibacterial defense.…”

Percutaneous radiofrequency ablation of tumor feeding artery before target tumor ablation may reduce local tumor progression in hepatocellular carcinoma

“…Most HCC is a hypervascular tumor with its blood supply majorly from hepatic artery. Many factors including intra-tumoral or peri-tumoral heat-sink effect, insufficient ablative margin or the presence of satellite around the target tumor are associated with incomplete ablation and local tumor progression (LTP) [5] , [6] , [7] , [8] , [9] , [10] , [11] .To overcome these limitations, many novel algorithms have been accepted [5] , [6] , [7] , [8] , [9] , [10] , [11] but only one study reported that feeding artery ablation (FAA) before target tumor ablation in HCC >3 cm could reduce LTP [12] .To our knowledge, the effects of FAA for HCC <3 cm or for HCC at difficult-to-ablate location remain unknown. Therefore, the aim of our study is to compare the outcomes between patient with and without FAA before target tumor ablation.…”

Application of oxytocin in ultrasound-guided percutaneous microwave ablation for treatment of hypervascular uterine fibroids: a preliminary report

“…At present, there are physical and chemical methods for blocking the nourishing vessels of tumors. Intravascular interventional embolization is the commonly used physical method for treatment of malignant liver tumors [26]. Intravenous infusion of vasoconstrictor drugs is used as a chemical method, and the commonly used drugs are pituitary vasopressin, adrenaline and oxytocin [24].…”