Percutaneous radiofrequency ablation therapy for hepatocellular carcinoma: a proposed new grading system for the ablative margin and prediction of local tumor progression and its validation

Nishikawa, Hiroki; Inuzuka, Tadashi; Takeda, Haruhiko; Nakajima, Jun; Sakamoto, Azusa; Henmi, Sinichiro; Matsuda, Fumihiko; Eso, Yuji; Ishikawa, Tetsuro; Saito, Sumio; Kita, Ryuichi; Kimura, Tōru; Osaki, Yukio

doi:10.1007/s00535-011-0452-4

Cited by 66 publications

(51 citation statements)

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“…At Kagoshima University Medical and Dental Hospital, Kagoshima Teishin Hospital and Kagoshima City Hospital, RFA is often performed as a curative therapy following TACE in the tumor-bearing area. The main reasons for recommending RFA/TACE are as follows: When performing TACE in the tumor-bearing area, an antitumor effect is expected in the primary lesion as well as the surrounding area; lipiodol accumulates in the tumor, serving as a marker when performing the RFA, and the post-treatment identification of the ablation area is easier (21); expansion of the ablation area is expected in areas in which lipiodol accumulates following TACE, making it appropriate for slightly larger HCC (22); and the combination of TACE and RFA results in improved local Figure 6. During the follow-up period, the tumor-free survival rate of patients treated with RFA/TACE was significantly improved compared with that of patients treated with RFA alone.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, they reported that among 149 metastatic lesions, the distance from the primary tumor was ≤10 mm in 118 (79.2%) cases. Furthermore, Nishikawa et al (21) proposed a method for grading HCC based on ablative margins and its use in predicting local recurrence. For Grade A (absolutely curative) tumors the ablative margin around the tumor was >5 mm, for Grade B (relatively curative) the margin was <5 mm, for Grade C (relatively non-curative) there was no complete ablative margin although no residual tumor was apparent, and for Grade D (absolutely non-curative) the tumor had not been entirely ablated.…”

Section: Univariate Multivariate ------------------------------------mentioning

confidence: 99%

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Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

et al. 2017

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Abstract. Percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) is an effective, standard therapy against small hepatocellular carcinoma (HCC). However, there is debate regarding the effectiveness of RFA combined with TACE (RFA/TACE) compared with RFA alone. These two approaches were compared for the treatment of early HCC. The present study examined 83 HCC tumors in 83 patients treated with RFA between April 2007 and August 2014 at three medical institutions. All HCCs were single hypervascular tumors, with a median diameter of 16 mm (range, 6-30 mm). The overall survival (OS) rate of all patients (n=83) was 97.5% at 1 year, 82.8% at 3 years and 48.6% at 5 years, and the local recurrence rate of all patients was 14.3% at 1 year, 32.3% at 3 years and 36.5% at 5 years. The tumor-free survival (TFS) rate of all patients was 95.1% at 1 year, 56.3% at 3 years and 23.4% at 5 years. Compared with RFA alone, RFA/TACE significantly improved OS (P<0.001), intrahepatic distant recurrence (IDR; P=0.038) and TFS (P=0.010). A univariate analysis of prognostic indicators revealed that age <70 years (P=0.008), aspartate transaminase <40 IU/l (P=0.003), alanine aminotransferase <40 IU/l (P=0.006) and platelet count >10x10 4 /µl (P=0.05) were associated with a high survival rate. Multivariate analysis identified RFA/TACE [hazard ratio (HR), 0.108; P=0.001] as an independent prognostic indicator. RFA/TACE was identified as the only independent indicator of IDR (HR: 0.467; P=0.042) and TFS (HR: 0.452; P=0.012). RFA/TACE improved OS rate, IDR and TFS compared with RFA alone. The data suggested that RFA/TACE should be considered for the treatment of single hypervascular HCC.

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Section: Discussionmentioning

confidence: 99%

Section: Univariate Multivariate ------------------------------------mentioning

confidence: 99%

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

et al. 2017

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“…The ablative margin can be shown as the boundary between the high-density area of Lipiodol accumulation in HCC and the enhanced area of surrounding normal liver parenchyma. Therefore, the safety margin can be easily evaluated only by post-RFA dynamic CT images in HCC patients treated by RFA combined with TACE [41].…”

Section: Radiofrequency Ablationmentioning

confidence: 99%

Imaging Modalities for Assessment of Treatment Response to Nonsurgical Hepatocellular Carcinoma Therapy: Contrast-Enhanced US, CT, and MRI

Minami

Kudo²

2015

Liver Cancer

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Tumor response and time to progression have been considered pivotal for surrogate assessment of treatment efficacy for patients with hepatocellular carcinoma (HCC). Recent advancements in imaging modalities such as contrast-enhanced ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are playing an important role in assessing the therapeutic effects of HCC treatments. According to some HCC clinical guidelines, post-therapeutic evaluation of HCC patients is based exclusively on contrast-enhanced dynamic imaging criteria. The recommended techniques are contrast-enhanced CT or contrast-enhanced MRI. Contrast-enhanced US is employed more in the positive diagnosis of HCC than in post-therapeutic monitoring. Although contrast enhancement is an important finding on imaging, enhancement does not necessarily depict the same phenomenon across modalities. We need to become well acquainted with the characteristics of each modality, including not only contrast-enhanced CT and MRI but also contrast-enhanced US. Many nonsurgical treatment options are now available for unresectable HCC, and accurate assessment of tumor response is essential to achieve favorable outcomes. For the assessment of successful radiofrequency ablation (RFA), the achievement of a sufficient ablation margin as well the absence of tumor vascular enhancement is essential. To evaluate the response to transcatheter arterial chemoembolization (TACE), enhanced tumor shrinkage is relied on as a measure of antitumor activity. Here, we give an overview of the current status of imaging assessment of HCC response to nonsurgical treatments including RFA and TACE.

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“…Arterial-and portal-phase dynamic CT images were obtained at ~30 and 120 sec, respectively, after the injection of the contrast material. When carrying out angiography, we also confirmed intermediatestage HCC using CT during hepatic arteriography (CTHA) and arterial-portography (CTAP) (22,23).…”

Section: Methodsmentioning

confidence: 71%

Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

et al. 2013

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Abstract. The aim of the present study was to compare clinical outcomes in patients with intermediate-stage hepatocellular carcinoma (HCC) who underwent the following treatments: transcatheter arterial chemoembolization (TACE) using an epirubicin-mitomycin-lipiodol (EML) emulsion at initial therapy (TACE group; n=145), and transcatheter chemotherapy infusion (TACI) using an EML emulsion at initial therapy (TACI group; n=81). Overall survival (OS) and treatment efficacy in the TACE and TACI groups were retrospectively compared. Prognostic factors associated with OS were examined using univariate and multivariate analyses. Treatment-related mortality was also calculated. The median observation periods were 1.8 years (range, 0.2-9.0 years) in the TACE group and 2.0 years (range, 0.2-8.7 years) in the TACI group. The median survival time and the 1-, 2-, 3-and 5-year cumulative OS rates were 2.68 years and 81.5, 63.4, 43.9 and 32.7%, respectively, in the TACE group, and 2.64 years and 85.0, 60.0, 43.2 and 26.0%, respectively, in the TACI group (P=0.691). The objective response rate was significantly higher in the TACE group compared to the TACI group (80.0 vs. 66.7%; P=0.009). Using multivariate analysis, the Child-Pugh classification (P= 0.017), tumor number ≤5 (P= 0.045) and des-γ-carboxy prothrombin level >100 mAU/ml (P=0.002) were found to be significant predictors linked to OS. In all subgroup analyses involving Child-Pugh classification, maximum tumor size and tumor distribution, the differences in the two groups did not reach statistical significance in terms of OS. Treatment mortality was 0% in the two groups. In conclusion, patients with intermediate-stage HCC had a comparable prognosis when treated with TACI or TACE. IntroductionHepatocellular carcinoma (HCC) is a major health problem; it is the fifth most common type of cancer worldwide and the third most common cause of cancer-related mortality (1-3). The prognosis for untreated HCC is generally poor and the curative treatments for this disease consist of surgical resection, radiofrequency ablation and liver transplantation (1-3). Non-curative therapies for HCC include transcatheter arterial chemoembolization (TACE), transcatheter arterial chemotherapy infusion (TACI), continuous arterial chemoinfusion therapy, radioembolization, molecular targeting therapies such as sorafenib and radiation therapy (1-12).TACE is a procedure whereby an embolic agent is injected into the tumor feeding artery to deprive it of its major nutrient source by means of embolization; this results in ischemic necrosis of the targeted tumor (11,12). The survival benefit of TACE for unresectable HCC was established in two randomized controlled trials (RCTs) and in one meta-analysis (13-15). Thus, TACE plays an important role in treating unresectable HCC. It is clearly defined as a first-line therapy with an improved 2-year survival rate as compared with conservative therapy (16).The Barcelona Clinic Liver Cancer (BCLC) classification is regarded as one of the most reliable staging an...

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Percutaneous radiofrequency ablation therapy for hepatocellular carcinoma: a proposed new grading system for the ablative margin and prediction of local tumor progression and its validation

Abstract: The proposed R grading method is a valid and useful method for assessing treatment efficacy, and for predicting local tumor progression after RFA.

Cited by 66 publications

References 27 publications

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

Imaging Modalities for Assessment of Treatment Response to Nonsurgical Hepatocellular Carcinoma Therapy: Contrast-Enhanced US, CT, and MRI

Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

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