Percutaneous Sonographically Guided Saline-Enhanced Radiofrequency Ablation of Hepatocellular Carcinoma

Giorgio, Antonio; Tarantino, L.; Stefano, G. de; Scala, Vincenzo; Liorre, G.; Scarano, Ferdinando; Perrotta, A.; Farella, Nunzia; Aloisio, Vincenza; Mariniello, N.; Coppola, Carmine; Francica, Giampiero; Ferraioli, Giovanna

doi:10.2214/ajr.181.2.1810479

Cited by 58 publications

(30 citation statements)

References 35 publications

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“…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 cause incomplete ablation or recurrence [10] .…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…In all cases, HCC tumor thrombus was diagnosed by means of US guided fine-needle biopsy (21G needle; HS, Tokyo, Japan). RF ablation was performed under general anesthesia using a 1.7 or 2.0 mm perfused electrode needle (Integra HITT, Tuttingen, Germany) as reported in the literature [12].…”

Section: Methodsmentioning

confidence: 99%

Radiofrequency ablation of hepatocellular carcinoma extended into the portal vein: Preliminary results

Giorgio

Stefano

Sarno

et al. 2009

Journal of Ultrasound

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Introduction: We report our preliminary results of radiofrequency (RF) ablation of hepatocellular carcinoma (HCC) and neoplastic portal thrombus (NPT) in cirrhotic patients. Methods: Ten patients (7 males and 3 females; mean age 68 yrs) with 10 HCC nodules (37e49 mm) extended into the main portal vein (MPV) underwent RF ablation. Diagnosis of NPT was achieved by fine-needle biopsy. RF ablation was performed firstly on the NPT and then on the HCC. RF ablation was considered successful when complete necrosis of the HCC and complete recanalization of the MPV were achieved. HCC necrosis was evaluated using contrast-enhanced CT. Recanalization of the portal vessels (PV) was analyzed using Color Doppler (CD). RF ablation was performed under ultrasonographic (US) guidance using a perfused electrode needle. Results: Complete necrosis of the HCC with complete recanalization of the PV was observed in 7 patients (success rate: 70%). In the remaining 3, necrosis of the HCC ranged from 70% to 95%, and recanalization of the PV was not complete. No major complications occurred. In 2 cases, mild ascites and increased aspartate aminotransferase/alanine aminotransferase (AST/ALT) values were observed. The follow-up ranged from 4 to 24 months; 1 and 2-year survival rates were 77% and 77%, respectively. At the last follow-up, the 7 successful patients were alive and the portal system was still patent. The 3 unsuccessful patients died within 5 months due to progressive disease. Conclusion: RF ablation can destroy HCC and NPT achieving a high rate of efficacy and low rate of complications. However, to confirm these results a control group and a longer follow-up are required.Sommario Scopo: In questo studio riportiamo i dati relativi all'ablazione percutanea con Radiofrequenza (RF) di HCC e trombosi neoplastica dei vasi portali. Pazienti e metodi: Dieci pazienti (pz) cirrotici, 7 maschi e 3 femmine, età media 68 anni, con 10 noduli di HCC e trombosi neoplastica dei vasi portali sono stati sottoposti ad ablazione percutanea con RF del trombo neoplastico e dell'HCC. La RF veniva ritenuta efficace quando alla TC con mdc si osservava la necrosi completa dell'HCC e al Color Doppler si osservava la ricanalizzazione completa dei vasi portali. Risultati: La necrosi completa dell'HCC e la ricanalizzazione completa dei vasi portali si osservava in 7 (70%) dei 10 pazienti. Nei rimanenti 3 (30%) la necrosi dell'HCC e la ricanalizzazione dei vasi portali non risultavano complete. Non si osservavano complicanze maggiori. Tutti i pazienti venivano dimessi il giorno dopo la procedura. Follow-up 4e24 mesi. Le percentuali di sopravvivenza sono dell'80% ad 1 anno e del 70% a 2 anni. I 3 pazienti nei quali la procedura non è stata completamente efficace sono deceduti entro 5 mesi dalla procedura per progressione della patologia neoplastica. Nei 7 pazienti nei quali la procedura è stata efficace il sistema portale è a tutt'oggi completamente ricanalizzato. Conclusioni: Questi primi risultati evidenziano che la RF è in grado di determinare necrosi...

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“…Against such backgrounds, percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) were developed, and they are now widely used in clinical practice as minimally invasive methods, 102-107 as a first-line, favored approach that has an efficient therapeutic effect on HCC. [108][109][110][111][112][113][114] Percutaneous needle puncture under US guidance is frequently performed for biopsy, as well as for the treatment of patients with liver diseases. 6,115,116 Although detection of the needle shaft or at least the needle tip on the sonogram is required for the technique, in practice this is not always easily to achieve.…”

Section: Application Of Us For the Treatment Of Hccmentioning

confidence: 99%

Recent applications of ultrasound: diagnosis and treatment of hepatocellular carcinoma

Maruyama

Ebara

2006

Int J Clin Oncol

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Ultrasound (US) has the advantages of real-time observation, simple technique, and a noninvasive procedure compared to other imaging modalities. The recent development of digital technologies has enabled the observation of sonograms with improved signal-to-noise ratio, penetration, and spatial and contrast resolutions. Furthermore, microbubble contrast agents have increased the diagnostic ability of US examination, and the use of three-dimensional sonograms is now not unusual. These advances have furthered the usefulness of US for liver tumors in clinical practice. This article reviews the recent applications of US in the diagnosis and treatment of hepatocellular carcinoma.

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Percutaneous Sonographically Guided Saline-Enhanced Radiofrequency Ablation of Hepatocellular Carcinoma

Cited by 58 publications

References 35 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

Radiofrequency ablation of hepatocellular carcinoma extended into the portal vein: Preliminary results

Recent applications of ultrasound: diagnosis and treatment of hepatocellular carcinoma

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