Complications of Laser Ablation for Hepatocellular Carcinoma: A Multicenter Study

Arienti, Vincenzo; Pretolani, S.; Pacella, Claudio Maurizio; Magnolfi, Fabrizio; Caspani, B.; Francica, Giampiero; Megna, Angelo Salomone; Regine, R.; Sponza, Massimo; Antico, E; Lascio, F. Marta L. Di

doi:10.1148/radiol.2463070390

Cited by 62 publications

(40 citation statements)

References 29 publications

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“…In this group, 32 (61.44%) of 52 lesions treated were considered a therapeutic success. This apparently unsatisfactory result is in contrast with the data reported by various publications [9,15], and also with the results reported elsewhere by the same authors [16]: this seems to rule out an inadequate skill of the operators as a possible cause of the low success rate. Another reason for the discrepancy concerns the localization of the lesions: the more they are strictly in contact with risk structures, the more likely an incomplete necrosis after a percutaneous approach is to be expected.…”

Section: Discussioncontrasting

confidence: 68%

“…In a larger series, the same authors [16] reported a complete necrosis rate of 81.14% in 314 HCC nodules (diameter ≤3 cm) ( Table 3). We think this discrepancy can be explained just by analyzing the selection criteria of the nodules.…”

Section: Discussionmentioning

confidence: 89%

“…We compared the percentage of necrosis registered in nodules located in critical sites with that registered in noncritical lesions treated in our center and with the effectiveness of LTA treatment registered in the multicenter Italian study [16].…”

Section: Resultsmentioning

confidence: 99%

“…We compared the complications that occurred in our patients affected by HCCs treated with LTA localized in critical sites and those of HCCs localized in non-critical sites. Moreover we compared the complications of HCCs localized in critical sites treated in our center with the LTA total complications reported in an Italian multicenter study, in which 520 patients with a total of 1,004 lesions were included [16].…”

Section: Methodsmentioning

confidence: 99%

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Small nodular hepatocellular carcinoma treated by laser thermal ablation in high risk locations: preliminary results

et al. 2010

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Small nodular hepatocellular carcinoma treated by laser thermal ablation in high risk locations: preliminary results

et al. 2010

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“…A complete response rate of 78% was observed following laser ablation in a study of 432 patients, while the local recurrence rate was found to be 20%, with 3-and 5-year survival rates as high as 61% and 34% respectively [48][49][50] . The safety of laser ablation has also been found to be comparable with other percutaneous modalities like RFA with major and minor complication rates of 1.5% and 6.2% respectively, and a mortality rate of 0.8% as reported by an Italian study [51] . While these results may be encouraging, they do not provide evidence of greater efficacy or a better safety profile over alternate technology that is available at a much cheaper cost and hence, much more readily than percutaneous laser ablation [52] .…”

Section: Laser Ablationmentioning

confidence: 54%

Ablative techniques in hepatocellular carcinoma treatment

Naeem¹,

Abid²

2018

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Hepatocellular carcinoma has been known to arise commonly in the setting of chronic liver disease. Due to its association with cirrhosis, patients with hepatocellular carcinoma often present with markedly diminished hepatic functional reserve, making them poor surgical candidates. For such patients, image-guided percutaneous ablative modalities have provided a viable alternate curative therapy. Although treatment allocation is a decision based on a number of factors, patients eligible for percutaneous ablation generally include those with early stage disease, hepatocellular carcinoma with disease limited to the liver and no extra-hepatic metastases. While percutaneous ethanol injection is the seminal technique, newer developments have led to it being replaced by percutaneous radiofrequency ablation as the most commonly employed procedure, due to a better efficacy as well as safety profile. Other ablative modalities including microwave ablation, laser ablation and cryotherapy are not as widely available. Furthermore, data comparing their effectiveness with well-established procedures like radiofrequency ablation is limited.

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Heat stress induced cell death mechanisms in hepatocytes and hepatocellular carcinoma: In vitro and in vivo study

et al. 2014

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Background and Objective The aims of the present study were to investigate the thermal-dose dependent effect of heat stress on hepatocyte and HCC cell death mechanisms using clinically relevant experimental heat stress conditions in vitro and to investigate apoptotic cell death induced by laser thermal ablation in vivo. Study Design/Materials and Methods Institutional Animal Care and Use Committee approved all studies. Hepatocyte and HCC cell lines were heat stressed from 37°C to 60°C for 2 or 10 minutes and assessed for viability, cytotoxicity and caspase-3/7 activity at 6 and/or 24 hours post-treatment (N=3). Viability experiments were repeated with the RIPK1 inhibitor Necrostatin-1 to block necroptosis (N=3). Rats with orthotopic HCC tumors stably expressing luciferase (N1S1luc2) were randomized to US-guided laser ablation (3W-45s for an intentional partial ablation; N=6) or sham (N=6) and followed by post-ablation caspase-3/7 bioluminescence imaging at 6 and 24 hours and cleaved caspase-3 immunostaining. p<0.05 was considered statistically significant. Results Heat-stress induced apoptosis and necrosis in hepatocytes and HCC cells in a thermal dose and cell-type dependent manner. Inhibition of RIPIK1-mediated necroptosis induced a significant, differential increase in HCC cell viability under physiologic and hyperthermic heat stress (p<0.001). Intentional partial laser thermal ablation induced a significant increase in caspase-3/7 activity in the laser versus sham ablation groups at both 6 hours (10.1-fold, p<0.01) and 24 hours (16.7 fold, p<0.02). Immunohistochemistry confirmed increased cleaved caspase-3 staining at the tumor ablation margin 24 hours post-ablation. Conclusions Both regulated and non-regulated cell death mechanisms mediate heat stress-induced HCC cell killing and vary between hepatocytes and HCC subtypes. Apoptosis is a significant mechanism of cell death at the HCC tumor ablation margin.

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Complications of Laser Ablation for Hepatocellular Carcinoma: A Multicenter Study

Abstract: Percutaneous LA may be considered a safe treatment for small HCCs.

Cited by 62 publications

References 29 publications

Small nodular hepatocellular carcinoma treated by laser thermal ablation in high risk locations: preliminary results

Small nodular hepatocellular carcinoma treated by laser thermal ablation in high risk locations: preliminary results

Ablative techniques in hepatocellular carcinoma treatment

Heat stress induced cell death mechanisms in hepatocytes and hepatocellular carcinoma: In vitro and in vivo study

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