Hepatocellular Carcinoma: Long-term Results of Combined Treatment with Laser Thermal Ablation and Transcatheter Arterial Chemoembolization

Pacella, Claudio Maurizio; Bizzarri, Giancarlo; Cecconi, Pietro; Caspani, B.; Magnolfi, Fabrizio; Bianchini, A.; Anelli, Vincenzo; Pacella, Sara; Rossi, Z.

doi:10.1148/radiology.219.3.r01ma02669

Cited by 108 publications

(48 citation statements)

References 37 publications

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“…The common treatments for malignant liver tumors include surgery, transcatheter arterial chemoembolization (TACE), PEI, radiofrequency thermal ablation, microwave coagulation, laser thermal ablation therapy [1][2][3][4] . Although surgery is the most radical treatment, it is not indicative for patients with severe cirrhosis or in cases where tumors are very close to the major vessels.…”

Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Zuo¹,

Wang²,

Shao³

et al. 2004

WJG

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AIM:To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes. METHODS:CT-guided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and stylet, a disposable curved tip (25 G) and a fine stylet. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors, multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curved needle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle. RESULTS:All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRI) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors, respectively. Among the 8 tumors sizing up to 5 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases. In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3 times of PEI, all the foci treated were completely necrotic and smaller demonstrated by dynamic contrast-enhanced CT or MRI 3 months later.CONCLUSION: CT-guided PEI using a disposable curved needle is effective, time-saving and convenient, providing an alternative therapy for the treatment of malignant liver tumors and their retroperitoneal lymph node metastases.Zuo CJ, Wang PJ, Shao CW, Wang MJ, Tian JM, Xiao Y, Ren FY, Hao XY, Yuan M. CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes.

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Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Zuo¹,

Wang²,

Shao³

et al. 2004

WJG

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“…RFA and LITT are considered relatively safe techniques with the ability to accomplish local disease control [4,5,6,7]. Published long-term results after RFA and interstitial laser coagulation (ILC) seem to be promising with 5-year survival rates ranging from 30 to 40% and 15 to 35%, respectively [7,8,9,10,11,12,13,14]. However, we have to bear in mind that results in the literature are difficult to interpret due to patient selection.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Viable Tumour Tissue Attached to Needle Applicators after Local Ablation of Liver Tumours

et al. 2009

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Aim: Local recurrence and needle track seeding are serious complications after local ablation for liver malignancies and potentially affect long-term survival. The aim of this study was to assess the incidence of viable tissue adherent to the needle applicators after ablation to gain insight into the possible mechanisms of local recurrence and needle track seeding. Methods: A total of 40 consecutive patients underwent 59 local liver ablations. Cells and tissue attached to the needle applicators were analysed for morphology (HE, PAP and Giemsa staining) and viability (G6PD staining). Results: Macroscopic tissue adherence was visible following 31 of the ablative procedures, all with radiofrequency ablation. Four applications were performed percutaneously and 27 during an open procedure. Morphologically intact tumour cells could be identified in 8 patients (20%), and viable tumour cells in 5 patients (12.5%). Morphologically intact tumour cells or viable tumour cells could only be demonstrated when track ablation was not performed. Conclusion: Viable tumour cells adherent to the needle applicators were found in an alarming 12.5% of patients after local ablation. We recommend track ablation not only after the procedure but also during any shifting and (re-)positioning to prevent shedding of viable tumour cells during or after ablation.

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“…Surgical resection, liver transplantation and cryosurgery are regarded as potentially curative treatment for HCC [3][4][5] , but most patients are not suitable candidates [6][7][8][9] . Thus, the local interventional therapy of liver tumor has been rapidly evolving currently, which includes transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), laser-induced thermotherapy (LITT) and microwave coagulation therapy (MCT) [10][11][12][13][14][15][16][17][18][19] . TACE is one of the most common forms of interventional therapies and seems most effective against encapsulated small HCCs without extracapsular invasion, whereas in large HCCs, viable residual tumor cells remain and the tumor frequently recurs [20][21][22] .…”

Section: Introductionmentioning

confidence: 99%

Combined transarterial chemoembolization and arterial administration ofBletilla striatain treatment of liver tumor in rats

Qian

Vossoughi²,

Woitaschek³

et al. 2003

WJG

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Hepatocellular Carcinoma: Long-term Results of Combined Treatment with Laser Thermal Ablation and Transcatheter Arterial Chemoembolization

Abstract: LTA followed by TACE is an effective palliative therapy in treating large HCCS:

Cited by 108 publications

References 37 publications

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Assessment of Viable Tumour Tissue Attached to Needle Applicators after Local Ablation of Liver Tumours

Combined transarterial chemoembolization and arterial administration ofBletilla striatain treatment of liver tumor in rats

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