Percutaneous Radio-frequency Thermal Ablation of Nonresectable Hepatocellular Carcinoma after Occlusion of Tumor Blood Supply

Rossi, Sandro; Garbagnati, F; Lencioni, Riccardo; Allgaier, Hans-Peter; Marchianò, Alfonso; Fornari, Fabio; Quaretti, Pietro; Tolla, Giuseppe Di; Ambrosi, Claudia; Mazzaferro, Vincenzo; Blum, Hubert E.; Bartolozzi, Carlo

doi:10.1148/radiology.217.1.r00se02119

Cited by 470 publications

(242 citation statements)

References 30 publications

Supporting

Mentioning

224

Contrasting

Unclassified

Order By: Relevance

“…24 The blood supply to a classical HCC is primarily provided by the hepatic artery; therefore, the efficacy of RF-induced ablation can be enhanced by occlusion of the hepatic artery. Moreover, despite the fewer needle-insertion sessions in the TACE-RFA group, the larger coagulation area included regions of the surrounding nontumorous liver parenchyma.…”

Section: Discussionmentioning

confidence: 99%

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Morimoto

Numata

Kondou

et al. 2010

Cancer

290

View full text Add to dashboard Cite

BACKGROUND:To improve the efficacy of radiofrequency ablation (RFA) for the treatment of intermediate-sized hepatocellular carcinomas (HCCs), the authors compared RFA combined with transcatheter arterial chemoembolization (TACE) to RFA alone. METHODS: The authors randomly assigned 37 patients with solitary HCCs (diameter, 3.1-5.0 cm in the greatest dimension) to 2 groups: the TACE-RFA group, in which the patients received TACE followed by RFA on the same day, and the RFA group, in which the patients received only RFA. RESULTS: Technical success was achieved after 1.4 AE 0.5 RFA sessions in the RFA group and after 1.1 AE 0.2 RFA sessions in the TACE-RFA group (P < .01). The mean diameters of the longer and shorter axes of the RFA-induced ablated areas were 50 AE 8.0 mm and 41 AE 7.1 mm, respectively, in the RFA group and 58 AE 13.2 mm and 50 AE 11.3 mm, respectively, in the TACE-RFA group; the mean diameters of the shorter axes were significantly different (P ¼ .012). The rates of local tumor progression at the end of the third year in the RFA and TACE-RFA groups were 39% and 6%, respectively (P ¼ .012). The 3-year survival rates of the patients in the RFA and TACE-RFA groups were 80% and 93%, respectively (P ¼ .369). CONCLUSIONS: In patients with intermediate-sized HCCs, RFA combined with TACE is more effective than RFA alone for extending the ablated area in fewer treatment sessions and for decreasing the local tumor progression rate. Cancer 2010;116:5452-60.

show abstract

Section: Discussionmentioning

confidence: 99%

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Morimoto

Numata

Kondou

et al. 2010

Cancer

290

View full text Add to dashboard Cite

show abstract

“…Each system included expandabletip electrodes capable of creating thermal lesions 2.5-3.5 cm in diameter. The electrodes (14-to 19-gauge) had a stainless steel shaft (15-25 cm long) insulated with a 0.1-mm-thick layer of plastic and an exposed tip (1.0 cm long) with lateral deployable hooks (4 to 10) 27,28 or spirals (1 to 3). 29 Electrode choice was tailored to tumor size and location.…”

Section: Methodsmentioning

confidence: 99%

“…The session ended when the hyperechoic ablation area was at least as large as the tumor itself. 6,27 Laparoscopic RFA under general anesthesia was reserved for HCCs that were exophytic; located on the diaphragmatic surface of liver segments III, IV, V; or adherent to gallbladder or gastrointestinal loops. Electrodes were inserted under direct vision and 1-3 thermal lesions were produced with each insertion.…”

Section: Methodsmentioning

confidence: 99%

“…6 angiography, and chest or site-specific roentgenography, CT/MRI). 6,27 Nonlocal recurrences comprised all intrahepatic regrowth >2.0 cm from the ablation zone and extrahepatic metastases. They were diagnosed by imaging modalities and AFP assay; US-guided biopsies were used when ambiguous findings emerged.…”

Section: Assessment Of Complications and Treatmentmentioning

confidence: 99%

“…They were diagnosed by imaging modalities and AFP assay; US-guided biopsies were used when ambiguous findings emerged. 6,[10][11][12]27 Patients with nonlocal recurrences were classified as having limited disease (reflected by a tumor that still met the study's inclusion criteria) or advanced disease, i.e., intrahepatic HCC that was large (1-2 nodules >3.5 cm in diameter), massive (occupying an entire lobe or more), multifocal (!3 nodules, any size), or neoplastic vein thrombosis, or extrahepatic metastases.…”

Section: Assessment Of Complications and Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: A long-term cohort study

et al. 2011

Self Cite

View full text Add to dashboard Cite

In most patients with cirrhosis, successful percutaneous ablation or surgical resection of hepatocellular carcinoma (HCC) is followed by recurrence. Radiofrequency ablation (RFA) has proven effective for treating HCC nodules, but its repeatability in managing recurrences and the impact of this approach on survival has not been evaluated. To this end, we retrospectively analyzed a prospective series of 706 patients with cirrhosis (ChildPugh class B7) who underwent RFA for 859 HCC 35 mm in diameter (1-2 per patient). The results of RFA were classified as complete responses (CRs) or treatment failures. CRs were obtained in 849 nodules (98.8%) and 696 patients (98.5%). During follow-up (median, 29 months), 465 (66.8%) of the 696 patients with CRs experienced a first recurrence at an incidence rate of 41 per 100 person-years (local recurrence 6.2; nonlocal 35). Cumulative incidences of first recurrence at 3 and 5 years were 70.8% and 81.7%, respectively. RFA was repeated in 323 (69.4%) of the 465 patients with first recurrence, restoring disease-free status in 318 (98.4%) cases. Subsequently, RFA was repeated in 147 (65.9%) of the 223 patients who developed a second recurrence after CR of the first, restoring disease-free status in 145 (98.6%) cases. Overall, there were 877 episodes of recurrence (1-8 per patient); 577 (65.8%) of these underwent RFA that achieved CRs in 557 (96.5%) cases. No procedure-related deaths occurred in 1,921 RFA sessions. Estimated 3-and 5-year overall and disease-free (after repeated RFAs) survival rates were 67.0% and 40.1% and 68.0 and 38.0%, respectively. Conclusion: RFA is safe and effective for managing HCC in patients with cirrhosis, and its high repeatability makes it particularly valuable for controlling intrahepatic recurrences. (HEPATOLOGY 2011;53:136-147)

show abstract