Factors predicting complete necrosis rate after ultrasound-guided percutaneous laser thermoablation of small hepatocellular carcinoma tumors in cirrhotic patients: a multivariate analysis

Abstract

The effectiveness of US-guided PLA for HCC tumors < or =4 cm turned out to be negatively affected by both operator-related (the beginning of the operator's experience with the technique) and tumor-related factors (non-naïve, infiltrating HCC tumors).

Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: A randomized trial

“…For the LA with the multifiber technique, the cons include the need of positioning multiple needles into the tumor. However, after a learning period of 3–6 months it is possible to have enough experience with this technique . Furthermore, the use of multiple thin needles may theoretically increase the applicability of thermal ablation: nodules irregularly shaped or located in difficult areas as behind large vessels may be treated more easily and safely using thin needles …”

Effectiveness, Safety, and Local Progression After Percutaneous Laser Ablation for Hepatocellular Carcinoma Nodules up to 4 cm Are Not Affected by Tumor Location

“…Over the past 20 years, we have developed and refined a laser ablation technique based on the use of fine needles to allow tiny optical fibers to reach target HCC nodules exclusively under ultrasound guidance [22,23,25,26]. The major finding of our study was that the location of HCC nodules had no negative impact on the initial complete response and did not increase the rates of major and minor complications or the risk of local tumor progression.…”

“…Percutaneous laser ablation is another hyperthermia-based ablative technique, and it too has been shown to achieve local tumor control in patients with HCC [22] with acceptable morbidity and complications and with a long-term outcome that compares favorably with the results of RFA [22][23][24][25][26]. We believe that the main advantage of laser ablation is the use of multiple fine needles, which are less traumatic in cirrhotic patients at risk of bleeding and may be handled more easily by the operator to reach difficult sites.…”

Percutaneous Laser Ablation of Small Hepatocellular Carcinoma

“…That HCC nodules treated during the first period of activity were less efficiently ablated than the nodules treated during the second period further underlines this point [15]. Such a kind of factor is likely to become more and more relevant, since the multifiber technique which has already been experienced with laser hyperthermia is now under consideration also for RF [19].…”

“…In another study by our group [15], two other factors turned out to affect achievement of complete ablation : a) naïve tumors (i.e. newly diagnosed HCC nodules never treated before) were more often completely eradicated (84.3%) than the non-naïve tumors (54.3%) (p <0.005): b) operator's learning curve: the year of treatment independently predicted the achievement of complete ablation; HCC nodules treated during the first two-year-period of activity were less efficiently ablated than the nodules treated during the second two-year-period.…”