Combined Percutaneous Radiofrequency Ablation and Ethanol Injection for Hepatocellular Carcinoma in High-Risk Locations

Wong, Stephen N.; Lin, Ching-Yu; Lin, Ching‐Long; Chen, Wei‐Ting; Y., Ian Homer; Lin, Shi‐Ming

doi:10.2214/ajr.07.2537

Cited by 84 publications

(95 citation statements)

References 30 publications

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“…32,33 In these studies, the principal role of ethanol was to induce a larger necrotic area and to minimize complications. 34,35 To our knowledge, the present study is the first to examine the efficacy of the combination of these 2 modalities in treating predominantly cystic thyroid nodules. The present study has several limitations.…”

Section: Initialmentioning

confidence: 95%

Combination Therapy Consisting of Ethanol and Radiofrequency Ablation for Predominantly Cystic Thyroid Nodules

Yoon

Baek

Lee

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY:Predominantly cystic thyroid nodules are often aspirated before radiofrequency ablation to enhance its efficacy; however internal bleeding during the aspiration is a problem. We evaluated the feasibility and safety of ethanol ablation to control internal bleeding that occurred during preparatory aspiration. Between September 2010 and August 2011, 11 of 40 predominantly cystic nodules bled internally during fluid aspiration before radiofrequency ablation. To control the bleeding, 99% ethanol was injected. The efficacy of ethanol in controlling bleeding, final nodule volume and complications were assessed. Control of the bleeding by ethanol ablation and subsequent radiofrequency ablation was feasible in all patients. Ninety-one percent (10/11) could be treated in 1 session. The mean nodule volume dropped from 17.1 to 4.3 mL (P Ͻ .018). There were no major complications. Ethanol ablation and radiofrequency ablation combination therapy is a feasible and safe technique for treating predominantly cystic thyroid nodules that exhibit internal bleeding during preparatory aspiration. ABBREVIATIONS:EA ϭ ethanol ablation; RF ϭ radio-frequency; US ϭ ultrasound

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Section: Initialmentioning

confidence: 95%

Combination Therapy Consisting of Ethanol and Radiofrequency Ablation for Predominantly Cystic Thyroid Nodules

Yoon

Baek

Lee

et al. 2013

AJNR Am J Neuroradiol

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“…Incomplete ablation of tumours after the local treatment is independently associated with tumour progression [21,22]. Our results showed that, despite using lower RF power, the complete ablation and primary effectiveness of index tumours was achieved similarly between both groups.…”

Section: T C Macatula C-c Lin C-j Lin Et Almentioning

confidence: 51%

Radiofrequency ablation for hepatocellular carcinoma: use of lowvsmaximal radiofrequency power

Tc¹,

Cc²,

Lin³

et al. 2012

BJR

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Objectives: To investigate whether radiofrequency (RF) ablation with low power (LP) or maximal power (MP) for hepatocellular carcinoma (HCC) can achieve optimal ablation and fewer adverse effects. Methods: RF ablation was performed with MP in 101 patients (129 tumours) and with LP in 46 patients (61 tumours). MP RF ablation used power of .120 W. RF power below this was designated as LP. Clinical outcomes were also analysed in subgroups of highrisk tumours near the bile duct and blood vessels. Results: Primary effectiveness was achieved in 91.8% in the LP group and 89.9% in the MP group (p50.795). 1 and 2-year local tumour progression rates were 28% and 30%, respectively, in the LP group, and 24% and 29%, respectively, in the MP group (p50.70). 1 and 2-year survival rates were 98% and 98%, respectively, in the LP group, and 93% and 90%, respectively, in the MP group (p50.216). The MP group had more adverse effects, with post-RF ablation syndrome, asymptomatic pleural effusion and ascites, than the LP group (20% vs 39% in the MP group; p50.027); however, there was no significant difference in major complication rates (6% in the MP and LP groups; p50.497). Among the patients with high-risk tumours, RF ablation using MP vs LP was comparable in primary effectiveness (91.7% vs 95.2%; p50.618), local tumour progression (42.9% vs 29.2%; p50.304) and overall complications (5% vs 8%; p50.618). Conclusion: RF ablation with LP and MP are comparable in clinical outcomes but considerably fewer adverse effects were encountered in the LP group.

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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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Combined Percutaneous Radiofrequency Ablation and Ethanol Injection for Hepatocellular Carcinoma in High-Risk Locations

Abstract: The combination of radiofrequency ablation and PEI in the management of HCC in high-risk locations has a slightly higher primary effectiveness rate than does radiofrequency ablation alone. A randomized controlled study is warranted.

Cited by 84 publications

References 30 publications

Combination Therapy Consisting of Ethanol and Radiofrequency Ablation for Predominantly Cystic Thyroid Nodules

Combination Therapy Consisting of Ethanol and Radiofrequency Ablation for Predominantly Cystic Thyroid Nodules

Radiofrequency ablation for hepatocellular carcinoma: use of lowvsmaximal radiofrequency power

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

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