<p>Computed Tomography-Guided Percutaneous Cryoablation for ‎ Subcardiac Hepatocellular Carcinoma: Safety, Efficacy, Therapeutic Results and Risk Factors for Survival Outcomes</p>

Abstract

Objective: To investigate the clinical safety, efficacy, therapeutic outcomes and risk factors of computed tomography-guided percutaneous cryoablation (CT-PCRA) for subcardiac hepatocellular carcinoma (HCC). Patients and Methods: In this study, patients with single HCC nodules located on the left lobe who subsequently underwent CT-PCRA were reviewed from July 2012 to August 2016. According to the definition of subcardiac HCC, the patients were grouped into the subcardiac HCC group (n=33) and the non-subcardiac HCC group (n=40). The technical success rates, tumour response rates, oncological outcomes including overall survival (OS) and recurrencefree survival (RFS) and complications were compared. Multivariate analysis was performed on clinicopathological variables to identify factors affecting long-term outcomes. Results: Seventy-three patients with subcardiac HCC were included in this study. After a median follow-up time of 37.8 months, 27.4% (20/73) of the patients died. The technical success and complete response rates were not significantly different between the two groups (p = 1.000; p = 0.590). The cumulative OS and RFS of the subcardiac HCC group were comparable to those of the non-subcardiac HCC group (p =0.820, p =0.922). Two major complications, intra-abdominal bleeding and right pleural effusion, were found at 2.2 and 3.1 months in the subcardiac HCC group, which were comparable with those in the non-subcardiac HCC group (p = 0.683). The multivariate analysis results showed that older age (hazard ratio [HR]: 2.382, 95% confidence interval [CI]: 1.884-7.823; p = 0.038) and ALBI grade 2-3 (HR: 3.398, 95% CI: 1.950-6.058; p = 0.021) may be predictors of poor OS and that tumour size ≥3 cm in diameter (HR: 3.302, 95% CI: 2.232-8.293; p = 0.012) may be a predictor of poor RFS. Conclusion: CT-PCRA for subcardiac HCC can be performed safely and efficiently and contribute to improving survival prognosis.

Percutaneous Argon-Helium Cryoablation for Small Hepatocellular Carcinoma Located Adjacent to a Major Organ or Viscus: A Retrospective Study of 92 Patients at a Single Center

“…Cryoablation of HCC located adjacent to major organs or viscus is challenging because it can cause some complications. The HCC located adjacent to major organs or viscus was defined as the tumor in close vicinity to organs, such as the stomach, gallbladder, portal or hepatic vein, heart, intestine, and diaphragm, with a maximum distance of 1.0 cm [ 9 , 19 ]. The distance from the edge of the tumor to neighboring organs was independently analyzed by 2 radiologists on sagittal and coronal reconstruction computed tomography (CT) images or magnetic resonance imaging (MRI) of axial and coronal/sagittal scans before the procedure.…”

Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

“…Although some of these problems could be solved by resorting to the use of artificial ascites or by performing laparoscopic ablation, in some cases it is not feasible to safely conduct RFA in subcapsular tumors, especially in certain circumstances such as proximity to the gallbladder. Since CA generates ice balls whose formation can be monitored in real time via ultrasound, CT or MRI, and because the ablation area can be controlled, this procedure can be selected to treat tumors in the vicinity of the gallbladder, main bile ducts, diaphragm and other high-risk sites as sub-cardiac localization [ 96 , 97 , 98 ].…”

Role of modern radiotherapy in managing patients with hepatocellular carcinoma

“…Local therapy includes surgical resection, ablative therapies, and radiotherapy (RT). Ablative therapies include radiofrequency ablation (RFA)[ 5 - 7 ], percutaneous ethanol injection therapy[ 8 ], cryoablation[ 9 ], and microwave[ 10 ]; these modalities can be performed through percutaneous, laparoscopic, or open approaches. Local-regional or so-called arterially directed therapies include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE)[ 5 ], drug-eluting beads (DEB)-TACE[ 11 - 13 ], trans-arterial radioembolization (TARE) with yttrium 90[ 14 , 15 ], and hepatic arterial infusion chemotherapy (HAIC)[ 16 - 18 ].…”