Percutaneous Radiofrequency Tissue Ablation: Does Perfusion-mediated Tissue Cooling Limit Coagulation Necrosis?

Goldberg, S. Nahum; Hahn, Peter F.; Tanabe, Kenneth K.; Müeller, Peter R.; Schima, Wolfgang; Athanasoulis, Christos A.; Compton, Carolyn C.; Solbiati, Luigi; Gazelle, G. Scott

doi:10.1016/s1051-0443(98)70491-9

Cited by 530 publications

(292 citation statements)

References 17 publications

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“…www.wjgnet.com cause incomplete ablation or recurrence [10] . Transcatheter arterial chemoembolization (TACE) can reduce blood supply of HCC by occlusion of tumor arteries, and the efficacy of combination TACE and RFA has been confirmed [11,12] .…”

Section: Brief Articlesmentioning

confidence: 99%

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

Hou¹,

Chen²,

Yan³

et al. 2009

WJG

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AIM:To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA. METHODS:A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 ± 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 ± 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo. RESULTS:In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04).CONCLUSION: PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC. INTRODUCTIONHepatocellular carcinoma (HCC) is the fifth most common cancer in the world (564 000 cases per year) and the third most frequent cause of cancer-related death [1] . Surgical resection is considered to be potentially curative therapy. However, only about 20% of HCC patients are eligible for resection [1,2] ; the remainder are ineligible because of multifocal tumors, advanced tumors, tumor location precluding complete resection, or poor hepatic functional reserve. Therefore, a variety of imaging-guided tumor ablation therapies such as ethanol injection, microwave coagulation, percutaneous radiofrequency ablation (RFA) and laser ablation are often considered as alternative options [3][4][5][6] . Among them, RFA has been used increasingly as a safe technique for treating hepatic tumors [7][8][9] . However, for hypervascular HCC, RFA appears less effective because of a blood-flow-induced heat sink effect, which might BRIEF ARTICLESwww.wjgnet.com cause incomplete ablation or recurrence [10] . Transcatheter arterial chemoembolization (TACE) can reduce blood supply of HCC by occlusion of tumor arteries, and the efficacy of combination TACE and RFA has been confirmed [11,12] . Treatment difficulty remains for those patients who cannot tolerate or are ineligible for TACE because of liver cirrhosis or difficulty in manipulation of vessels with abnormal curvature that have resulted from surgical resection and liver ...

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Section: Brief Articlesmentioning

confidence: 99%

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

Hou¹,

Chen²,

Yan³

et al. 2009

WJG

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“…The iodine oil can fill up the portal vein surrounding the tumor through the communication branches connecting the arterial and portal veins [14,15] . Thus, it can decrease the blood flow volume of the portal vein, and alleviate the adverse cooling effect induced by abundant blood flow [16,17] . In addition, TACE can result in ischemia of the tumor tissue and inflammatory edema, which accelerates tumor necrosis and enhances the coagulation effect of microwaves [18] .…”

Section: Discussionmentioning

confidence: 99%

Combined therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation for small hepatocellular carcinoma

Weizhu¹,

Jiang²,

Huang³

et al. 2009

WJG

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AIM:To assess the efficacy of combined transcatheter arterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT) for small hepatocellular carcinoma (HCC). METHODS:Thirty-five patients with a total of 41 HCC nodules (≤ 3 cm in diameter) were treated with TACE followed by computed tomograghy (CT)-guided percutaneous microwave coagulation therapy (PMCT) within 1-3 wk. RESULTS:By biopsies and enhanced CT scans, complete necrosis of the tumor and 3-5 mm of the surrounding non-cancerous area were observed in 34 foci. In seven foci, incomplete necrosis of the surrounding parenchyma was observed. Serum alphafetoprotein (AFP) levels returned to normal 10 d after treatment in 25 patients who originally had high serum AFP levels. The follow-up period was 6-31 mo, and all patients remained alive. One patient had a recurrence in the subsegments of the liver, and another patient had a recurrence near the original lesion. CONCLUSION:Combined therapy with TACE and PMCT is a safe and effective treatment without severe complications for small HCC.

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“…However, remnant cancer cells were observed at the peripheral areas of the tumors; remnant malignant cells were particularly observed in broncho-vascular areas of the lung parenchyma surrounding the tumor. Some factor may limit the degree of ablation of the tumor; for example, previous studies carried out in hepatic neoplasms have shown that blood flow may cause heat loss and thereby limit the size of tumor ablation (11). The degree of tissue ablation may also depend on ventilatory conditions of the affected lung; ventilation of the air spaces of the lung may be the cause of incomplete RFA of lung tumors by acting as an air-cooled radiator (12).…”

Section: Discussionmentioning

confidence: 99%

Radiological and Pathological Correlation of Lung Malignant Tumors Treated with Percutaneous Radiofrequency Ablation

Hataji¹,

Yamakado

Nakatsuka

et al. 2005

Intern. Med.

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Percutaneous Radiofrequency Tissue Ablation: Does Perfusion-mediated Tissue Cooling Limit Coagulation Necrosis?

Cited by 530 publications

References 17 publications

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

Combined therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation for small hepatocellular carcinoma

Radiological and Pathological Correlation of Lung Malignant Tumors Treated with Percutaneous Radiofrequency Ablation

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