Influence of ablation technique on treatment failure for perivascular hepatocellular carcinoma

Mohkam, Kayvan; Rode, Agnès; Mabrut, Jean‐Yves

doi:10.1016/j.jhep.2018.04.027

Cited by 6 publications

(2 citation statements)

References 6 publications

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“…According to a previous multicenter study [ 27 ], NT-RFA showed better LTP than standard monopolar RFA for HCCs located near large vessels, because more homogenous and extensive tissue necrosis and ablation zones were achieved beyond the macroscopic tumor boundary by placing the needles away from the tumor periphery. Second, blockage of drainage vessels from the target tumor may have been achieved in the early period of the ablation procedure, which may have blocked the dispersal of tumor cells into the drainage portal bloodstream, and may also be less susceptible to the heat sink effect [ 17 , 28 ]. Third, the centripetal thermal conduction from the periphery to the center of the index tumor may provide a theoretical advantage of less elevation of intratumoral pressure compared to conventional RFA [ 13 17 ].…”

Section: Discussionmentioning

confidence: 99%

No-Touch vs. Conventional Radiofrequency Ablation Using Twin Internally Cooled Wet Electrodes for Small Hepatocellular Carcinomas: A Randomized Prospective Comparative Study

et al. 2021

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Objective This study aimed to compare the efficacy between no-touch (NT) radiofrequency ablation (RFA) and conventional RFA using twin internally cooled wet (TICW) electrodes in the bipolar mode for the treatment of small hepatocellular carcinomas (HCC). Materials and Methods In this single-center, two-arm, parallel-group, prospective randomized controlled study, we performed a 1:1 random allocation of eligible patients with HCCs to receive NT-RFA or conventional RFA between October 2016 and September 2018. The primary endpoint was the cumulative local tumor progression (LTP) rate after RFA. Secondary endpoints included technical conversion rates of NT-RFA, intrahepatic distance recurrence, extrahepatic metastasis, technical parameters, technical efficacy, and rates of complications. Cumulative LTP rates were analyzed using Kaplan-Meier analysis and the Cox proportional hazard regression model. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat and as-treated analyses were performed. Results Enrolled patients were randomly assigned to the NT-RFA group (37 patients with 38 HCCs) or the conventional RFA group (36 patients with 38 HCCs). Among the NT-RFA group patients, conversion to conventional RFA occurred in four patients (10.8%, 4/37). According to intention-to-treat analysis, both 1- and 3-year cumulative LTP rates were 5.6%, in the NT-RFA group, and they were 11.8% and 21.3%, respectively, in the conventional RFA group ( p = 0.073, log-rank). In the as-treated analysis, LTP rates at 1 year and 3 years were 0% and 0%, respectively, in the NT-RFA group sand 15.6% and 24.5%, respectively, in the conventional RFA group ( p = 0.004, log-rank). In as-treated analysis using multivariable Cox regression analysis, RFA type was the only significant predictive factor for LTP (hazard ratio = 0.061 with conventional RFA as the reference, 95% confidence interval = 0.000–0.497; p = 0.004). There were no significant differences in the procedure characteristics between the two groups. No procedure-related deaths or major complications were observed. Conclusion NT-RFA using TICW electrodes in bipolar mode demonstrated significantly lower cumulative LTP rates than conventional RFA for small HCCs, which warrants a larger study for further confirmation.

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Section: Discussionmentioning

confidence: 99%

No-Touch vs. Conventional Radiofrequency Ablation Using Twin Internally Cooled Wet Electrodes for Small Hepatocellular Carcinomas: A Randomized Prospective Comparative Study

et al. 2021

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“…The local tumour progression was 50.5% in monopolar RFA vs 16.3% in multi‐bipolar RFA 43 . Finally, a western monocentric study reported no difference in terms of local recurrence between liver resection and mbp‐RFA for the treatment of single perivascular HCC between 2 and 5 cm 41,44 . This data suggested that mbp‐RFA could be used to treat efficiently HCC closed to major vessels.…”

Section: Introductionmentioning

confidence: 89%

Percutaneous treatments of hepatocellular carcinoma: Improving efficacy, applicability and extending ablation criteria

Gigante

Nahon

Séror

et al. 2022

Liver Cancer International

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Hepatocellular carcinoma (HCC) is considered to be the sixth most common cancer worldwide and the fourth deadliest cancer accounting for 782 000 deaths/y. In 2018, the incidence rate of liver cancer was 9.3 per 100 000 person-years with a similar death rate. 1,2 However, several advances occurred in the management of patients with HCC including screening programs and the development of curative and palliative treatments. 3 The treatments considered as curative are liver resection, liver transplantation and percutaneous ablation with a 5-year survival rate ranging from 60% to 80%. 4 The most frequent techniques used in percutaneous treatments are radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA) and irreversible electroporation (IRE). 5,6 The first enlisted

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A novel nomogram to predict the local tumor progression after microwave ablation in patients with early‐stage hepatocellular carcinoma: A tool in prediction of successful ablation

Huang

et al. 2019

Cancer Medicine

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ObjectivesTo develop a nomogram for the local tumor progression (LTP) in patients with early‐stage hepatocellular carcinoma (HCC) after computed tomography‐guided percutaneous microwave ablation (CT‐PMWA) and to assess clinical‐pathologic risk factors for individual LTP estimation. Furthermore, we compared the prognostic predictive ability for LTP between the nomogram and the traditional staging systems.MethodsThis retrospective study was approved by the institutional review board. Five hundred and forty treatment‐naïve patients with HCC according to the Milan criteria, who subsequently underwent CT‐PMWA were reviewed from 2009 to 2019. Baseline characteristics were collected to identify the risk factors for the determination of LTP after CT‐PMWA. The multivariate Cox proportional‐hazards model based on significant prognostic factors of LTP was used to construct the nomogram, which was then assessed for its predictive accuracy using mainly the Harrell's C‐index and time‐dependent area under the curve (tAUC).ResultsAfter a median follow‐up time of 28.7 months, 6.5% (35/540) patients had LTP. The nomogram was developed based on the tumor size, tumor number, Child‐Turcotte‐Pugh (CTP) grade, platelet, and alanine aminotransferase (ALT). The nomogram had good calibration and discriminatory abilities in the training set, with C‐indexes of 0.799 (95% confidence interval (CI): 0.738, 0.860), and tAUCs of 0.844 (CI: 0.728, 0.895), that were greater than those of traditional staging systems. Internal validation with 1000 bootstrap resamples had a good C‐index of 0.735 (CI: 0.648, 0.816).ConclusionsThe nomogram model can be used to predict accurately LTP after CT‐PMWA for early‐stage HCC, as well as to assist physicians during the therapeutic decision‐making process.

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Influence of ablation technique on treatment failure for perivascular hepatocellular carcinoma

Cited by 6 publications

References 6 publications

No-Touch vs. Conventional Radiofrequency Ablation Using Twin Internally Cooled Wet Electrodes for Small Hepatocellular Carcinomas: A Randomized Prospective Comparative Study

No-Touch vs. Conventional Radiofrequency Ablation Using Twin Internally Cooled Wet Electrodes for Small Hepatocellular Carcinomas: A Randomized Prospective Comparative Study

Percutaneous treatments of hepatocellular carcinoma: Improving efficacy, applicability and extending ablation criteria

A novel nomogram to predict the local tumor progression after microwave ablation in patients with early‐stage hepatocellular carcinoma: A tool in prediction of successful ablation

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