Percutaneous thermal ablation of medium and large hepatocellular carcinoma: Long-term outcome and prognostic factors

Yin, Xiaoyu; Xie, Xian-Jin; Liu, Min; Xu, Hui‐Xiong; Xu, Zuo-Feng; Kuang, Ming; Guang, Liu; Liang, Jun; Lau, W. Y.

doi:10.1200/jco.2008.26.15_suppl.15572

Cited by 45 publications

(67 citation statements)

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“…Numerous studies have shown that the treatment modality is directly linked with the survival of patients with HCC. 8,17,23,33 Therefore, to reflect the true clinical scenario, the strategic approach to select an appropriate staging system for patients with favorable and unfavorable outcomes might be different. Interestingly, the CLIP staging system was further identified as an ideal model to stage patients undergoing either curative or noncurative treatment.…”

Section: Discussionmentioning

confidence: 99%

Selecting an optimal staging system for hepatocellular carcinoma

Hsu

Hsia

Huang

et al. 2010

Cancer

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BACKGROUND: Selecting an appropriate staging system is crucial to predict the outcome of patients with hepatocellular carcinoma (HCC). The optimal prognostic model for HCC is under intense debate. This study investigated the prognostic ability of the 5 currently used staging systems, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Japan Integrated Scoring (JIS) system, tumor-node-metastasis (TNM), and Tokyo score, for HCC. METHODS: Between 2002 and 2008, 1713 prospectively enrolled HCC patients were compared for their longterm survival by using the Akaike information criterion (AIC) according to the staging or scoring methods of these 5 models. RESULTS: The mean and median follow-up duration was 18 and 14 months, respectively. Among all patients, the CLIP staging system had the lowest AIC value in comparison with other systems in the Cox proportional hazards model, followed by the Tokyo score, JIS score, BCLC staging system, and TNM staging system. Patients undergoing curative treatment had a significantly better survival in comparison with patients undergoing noncurative treatment (P < .001). When the predictive accuracy of the staging systems was analyzed according to treatment strategy, the CLIP staging system had the lowest AIC value and remained the best prognostic model in patients undergoing curative (801 patients) and noncurative (912 patients) treatment. CONCLUSIONS: The CLIP staging system is the best long-term prognostic model for HCC in a cohort of patient with early to advanced stage of HCC. Its predictive accuracy is independent of the treatment strategy. Selecting an optimal staging system is helpful in improving the design of future clinical trials.

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Section: Discussionmentioning

confidence: 99%

Selecting an optimal staging system for hepatocellular carcinoma

Hsu

Hsia

Huang

et al. 2010

Cancer

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“…In clinical practice, the sequential technique is hampered by difficulty in precisely repositioning the antenna after previous ablations owing to obscuration of the tumor by gas bubbles, bleeding, tissue shrinkage, and charring. Despite these limitations, the sequential method appears to be in widespread clinical use (26)(27)(28)(29)(30). The primary advantage of the sequential technique appears to be a lower monetary cost for one antenna compared with multiple antennas.…”

Section: Two Versus Three Antennasmentioning

confidence: 99%

Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems

Harari¹,

Magagna²,

Bedoya³

et al. 2016

Radiology

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Purpose:To compare microwave ablation zones created by using sequential or simultaneous power delivery in ex vivo and in vivo liver tissue. Materials and Methods:All procedures were approved by the institutional animal care and use committee. Microwave ablations were performed in both ex vivo and in vivo liver models with a 2.45-GHz system capable of powering up to three antennas simultaneously. Two-and three-antenna arrays were evaluated in each model. Sequential and simultaneous ablations were created by delivering power (50 W ex vivo, 65 W in vivo) for 5 minutes per antenna (10 and 15 minutes total ablation time for sequential ablations, 5 minutes for simultaneous ablations). Thirty-two ablations were performed in ex vivo bovine livers (eight per group) and 28 in the livers of eight swine in vivo (seven per group). Ablation zone size and circularity metrics were determined from ablations excised postmortem. Mixed effects modeling was used to evaluate the influence of power delivery, number of antennas, and tissue type. Results:On average, ablations created by using the simultaneous power delivery technique were larger than those with the sequential technique (P , .05). Simultaneous ablations were also more circular than sequential ablations (P = .0001). Larger and more circular ablations were achieved with three antennas compared with two antennas (P , .05). Ablations were generally smaller in vivo compared with ex vivo. Conclusion:The use of multiple antennas and simultaneous power delivery creates larger, more confluent ablations with greater temperatures than those created with sequential power delivery.q RSNA, 2015

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“…Using RFA, treatment response has been found to correlate best with the size of the lesion; a complete response rate between 80%-90% in tumors up to 3 cm in diameter [24][25][26][27] , and 50%-70% in lesions between 3 and 5 cm in diameter [25,[28][29][30][31] . Five-year survival rates following RFA were reported as 48%-71% by some studies [32][33][34] .…”

Section: Rfamentioning

confidence: 99%

“…Like laser ablation, data for microwave ablation is also limited, but studies have indicated complete response rates between 89% and 95%, while three and five-year survival rates have been reported as 73% and 57% respectively [25,[54][55][56][57][58] . As seen in case of RFA, survival following microwave ablation was also affected by tumor size, number of nodules and Child-Pugh class.…”

Section: Microwave Ablationmentioning

confidence: 99%

“…While PEI has shown to be almost as equally effective as RFA for small tumours, and costs much less since it requires a minimal amount of equipment, its use has largely been restricted to situations where RFA might not be available or for lesions located near the gall bladder, hepatic hilum or major vessels, precluding thermal ablation [25] . Factors responsible for this may include peri-procedural pain and the need for multiple settings, both of which contribute to non-compliance, as well as higher local recurrence rates in comparison with RFA as observed by various randomized trials and meta-analyses [61] .…”

Section: Rfa Vs Peimentioning

confidence: 99%

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Ablative techniques in hepatocellular carcinoma treatment

Naeem¹,

Abid²

2018

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Hepatocellular carcinoma has been known to arise commonly in the setting of chronic liver disease. Due to its association with cirrhosis, patients with hepatocellular carcinoma often present with markedly diminished hepatic functional reserve, making them poor surgical candidates. For such patients, image-guided percutaneous ablative modalities have provided a viable alternate curative therapy. Although treatment allocation is a decision based on a number of factors, patients eligible for percutaneous ablation generally include those with early stage disease, hepatocellular carcinoma with disease limited to the liver and no extra-hepatic metastases. While percutaneous ethanol injection is the seminal technique, newer developments have led to it being replaced by percutaneous radiofrequency ablation as the most commonly employed procedure, due to a better efficacy as well as safety profile. Other ablative modalities including microwave ablation, laser ablation and cryotherapy are not as widely available. Furthermore, data comparing their effectiveness with well-established procedures like radiofrequency ablation is limited.

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Percutaneous thermal ablation of medium and large hepatocellular carcinoma: Long-term outcome and prognostic factors

Cited by 45 publications

References 0 publications

Selecting an optimal staging system for hepatocellular carcinoma

Selecting an optimal staging system for hepatocellular carcinoma

Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems

Ablative techniques in hepatocellular carcinoma treatment

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