<b>Radiofrequency Ablation in the Treatment of Small Hepatocellular Carcinomas:</b> Comparison of the Radiofrequency Effect With and Without Chemoembolization

Kitamoto, Mikiya; Imagawa, Masaru; Yamada, Hiroyasu; Watanabe, Chiho; Sumioka, Masaaki; Satoh, Osamu; Shimamoto, Masaru; Kodama, Makiko; Kimura, Shojiro; Kishimoto, Keiko; Okamoto, Yuzo; Fukuda, Yoshihiro; Dohi, Kiyohiko

doi:10.2214/ajr.181.4.1810997

Cited by 97 publications

(53 citation statements)

References 32 publications

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Section: Discussionmentioning

confidence: 72%

“…With the new strategy of PAA combined with RFA, the number of percutaneous punctures per HCC was reduced in group A to an average of 2.76 ± 1.12, which was significantly less than that in group B, 3.36 ± 1.60 (P = 0.001), thus injury to patients was reduced. Kitamoto et al [20] reported that the average duration between TACE and RFA was 18.2 d. In our study, RFA could be performed immediately after blocking of the major feeding artery with PAA, which could reduce hospital stay.In group A, 13 (17.33%) patients had a small amount of bleeding during PAA, most of which was detected at the first puncture, where the RFA needle punctured the area where the feeding artery entered the tumor. We supposed that the bleeding might have been caused by damage of the feeding vessels and incomplete ablation.…”

mentioning

confidence: 72%

“…TACE is one of the major interventional methods for HCC treatment, and when performed before RFA, it can increase therapeutic efficacy as a result of the decreased heat sink effect [17][18][19] . Kitamoto et al [20] have compared the therapeutic effects of RFA alone and in combination with TACE in 21 patients with 26 HCCs smaller than 3.0 cm. The size of the ablated necrotic area in the TACE/RFA group was significantly larger than that with RFA alone.…”

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confidence: 99%

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

Hou¹,

Chen²,

Yan³

et al. 2009

WJG

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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 ...

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Section: Discussionmentioning

confidence: 72%

mentioning

confidence: 72%

mentioning

confidence: 99%

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

Hou¹,

Chen²,

Yan³

et al. 2009

WJG

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“…In the case of RF ablation, these treatments include, in addition to liposome-encapsulated doxorubicin therapy, treatments with intravenous liposomal cisplatin ( 18 ), liposomal 5-fl uorouracil ( 18 ), arsenic trioxide ( 20 ), and hydralazine ( 24 ); intravenous and intratumoral Pluronic block copolymers ( 28 ); intratumoral ethanol ( 11,39 ) and unencapsulated doxorubicin ( 12 ); intraperitoneal arsenic trioxide ( 20 ); interstitially implanted 5-fl uorouracil-laden polymer rods ( 27 ); oral sorafenib ( 21 ); and transarterial chemoembolization ( 19,23 ). In human trials, the benefi ts of combined RF ablation-intratumoral ethanol therapy ( 30,40,41 ) and combined RF ablation-transarterial chemoembolization ( 15,22,25,29,31,42 ) have been shown. The synergistic effect of combined RF ablation-chemotherapy has been best established with intravenous liposomal doxorubicin.…”

Section: Discussionmentioning

confidence: 99%

Combination Radiofrequency Ablation and Intravenous Radiolabeled Liposomal Doxorubicin: Imaging and Quantification of Increased Drug Delivery to Tumors

Head¹,

Dodd²,

Bao³

et al. 2010

Radiology

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Purpose:To identify, with noninvasive imaging, the zone of radiopharmaceutical uptake after combination therapy with radiofrequency (RF) ablation and intravenous administration of technetium 99m ( 99m Tc) liposomal doxorubicin in a small-animal tumor model, and to quantify and correlate the uptake by using imaging and tissue counting of intratumoral doxorubicin accumulation. Materials and Methods:This study was approved by the animal care committee. Two phases of animal experiments were performed. In the fi rst experiment, a single human head-and-neck squamous cell carcinoma tumor was grown in each of 10 male nude rats. Seven of these animals were treated with intravenous 99m Tc-liposomal doxorubicin followed by RF tumor ablation at a mean temperature of 70°C 6 2 for 5 minutes, and three were treated with intravenous 99m Tc-liposomal doxorubicin only. Combination single photon emission computed tomography-computed tomography (SPECT/CT) was performed at 15 minutes, 4 hours, and 20 hours after therapy. In the second experiment, two tumors each were grown in 11 rats, but only one of the tumors was ablated after intravenous administration of 99m Tc-liposomal doxorubicin. SPECT/CT and planar scintigraphy were performed at the same posttreatment intervals applied in the fi rst experiment, with additional planar imaging performed at 44 hours. After imaging, tissue counting in the excised tumors was performed. Radiotracer uptake, as determined with imaging and tissue counting, was quantifi ed and compared. In a subset of three animals, intratumoral doxorubicin accumulation was determined with fl uorimetry and correlated with the imaging and tissue-counting data. Results:At both SPECT/CT and planar scintigraphy, increased uptake of Conclusion:Study results show that increased delivery of intravenous liposomal doxorubicin to tumors combined with RF ablation can be depicted and quantifi ed with noninvasive imaging.

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“…Therefore, the RFA technique could be further developed to improve the therapeutic effects of this treatment. To enhance the therapeutic effect of RFA, several treatment modalities have been applied in addition to local treatment [24][25][26][27][28][29] . As one of the optional combination therapies, we have developed a novel combination therapy of P-EI-RFA and showed that this combination therapy accurately enlarged the area of induced coagulated necrosis.…”

Section: Discussionmentioning

confidence: 99%

A combination therapy of ethanol injection and radiofrequency ablation under general anesthesia for the treatment of hepatocellular carcinoma

Kurokohchi¹,

Watanabe²,

Yoneyama³

et al. 2008

WJG

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AIM:To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thoracoscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC). METHODS:Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied energy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L). RESULTS:The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G. CONCLUSION:These results suggest that EI-RFA, under general anesthesia, may be effective for the treatment of HCC because a larger quantity of ethanol and

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Radiofrequency Ablation in the Treatment of Small Hepatocellular Carcinomas: Comparison of the Radiofrequency Effect With and Without Chemoembolization

Abstract: The combination of radiofrequency ablation and transcatheter arterial chemoembolization using doxorubicin markedly increased the extent of induced coagulation compared with radiofrequency alone, despite a small number of patients and the preliminary nature of this study.

Cited by 97 publications

References 32 publications

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

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

Combination Radiofrequency Ablation and Intravenous Radiolabeled Liposomal Doxorubicin: Imaging and Quantification of Increased Drug Delivery to Tumors

A combination therapy of ethanol injection and radiofrequency ablation under general anesthesia for the treatment of hepatocellular carcinoma

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