Radiofrequency Ablation Combined with Chemoembolization in Hepatocellular Carcinoma: Treatment Response Based on Tumor Size and Morphology

Yamakado, Koichiro; Nakatsuka, Atsuhiro; Ohmori, Shigeru; Shiraki, Katsuya; Nakano, Takeshi; Ikoma, Jiro; Adachi, Yukihiko; Takeda, Kan

doi:10.1016/s1051-0443(07)61969-1

Cited by 171 publications

(91 citation statements)

References 19 publications

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“…15,30,31 In contrast, in this study, we performed the combination therapy on the same day, and the resultant local tumor progression rates were significantly lower than those achieved with RFA monotherapy. Yu et al evaluated the biodistribution properties of the transarterial Lipiodol-based therapeutic regimens in HCC patients.…”

Section: Discussionmentioning

confidence: 78%

“…8,9 However, because of the limited coagulative necrosis induced by RFA alone, in larger HCCs, the percentage of cases showing complete necrosis varied between 29% and 70%. 10 To obtain a larger therapeutic region, RFA has been combined with adjuvant therapies such as percutaneous instillation of sodium chloride solution 11 or ethanol, 12 occlusion of the tumor blood supply, 13,14 and/or transcatheter arterial chemoembolization (TACE) [15][16][17] ; however, most of these studies were pilot or retrospective studies.…”

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confidence: 99%

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Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Morimoto

Numata

Kondou

et al. 2010

Cancer

290

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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.

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Section: Discussionmentioning

confidence: 78%

mentioning

confidence: 99%

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Morimoto

Numata

Kondou

et al. 2010

Cancer

290

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“…By contrast, ex vivo bovine liver was not perfused with blood flow (17)(18)(19). Previous studies have demonstrated that a reduction in blood supply, such as in transcatheter arterial chemoembolization, results in enlarged ablative volume (20)(21)(22). The cooling effect of the blood perfusion in the clinical cases may have disclosed the advantage of the CoAccess electrode masked in the ex vivo experiments.…”

Section: Discussionmentioning

confidence: 99%

Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study

Koda

Tokunaga

Matono

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. The purpose of the present study was to compare the size and configuration of the ablation zones created by SuperSlim and CoAccess electrodes, using various ablation algorithms in ex vivo bovine liver and in clinical cases. In the experimental study, we ablated explanted bovine liver using 2 types of electrodes and 4 ablation algorithms (combinations of incremental power supply, stepwise expansion and additional low-power ablation) and evaluated the ablation area and time.In the clinical study, we compared the ablation volume and the shape of the ablation zone between both electrodes in 23 hepatocellular carcinoma (HCC) cases with the best algorithm (incremental power supply, stepwise expansion and additional low-power ablation) as derived from the experimental study. In the experimental study, the ablation area and time by the CoAccess electrode were significantly greater compared to those by the SuperSlim electrode for the single-step (algorithm 1, p=0.0209 and 0.0325, respectively) and stepwise expansion algorithms (algorithm 2, p=0.0002 and <0.0001, respectively; algorithm 3, p= 0.006 and 0.0407, respectively). However, differences were not significant for the additional low-power ablation algorithm. In the clinical study, the ablation volume and time in the CoAccess group were significantly larger and longer, respectively, compared to those in the SuperSlim group (p=0.0242 and 0.009, respectively). Round ablation zones were acquired in 91.7% of the CoAccess group, while irregular ablation zones were obtained in 45.5% of the SuperSlim group (p= 0.0428). In conclusion, the CoAccess electrode achieves larger and more uniform ablation zones compared with the SuperSlim electrode, though it requires longer ablation times in experimental and clinical studies.

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“…The local recurrence rate after RFA in this study was considerably lower (3.5% at 5 years) compared to previous reports, even though 23 (21%) of patients had HCCs larger than 30 mm in diameter. Real-time CT guidance is very useful for ensuring precise positioning of electrode insertion into the HCC nodules even if the lesion is located in the subcapsular or subphrenic region, and it is thus useful for obtaining sufficient ablation margins (30). Despite good control of treated lesions, new tumors frequently occur in the different regions of the liver.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

Beppu

Sugimoto²,

Shiraki³

et al. 2010

Int J Mol Med

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Abstract. The aim of this study was to elucidate the importance of three tumor markers, ·-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3), and des-Á-carboxy prothrombin (DCP), for detecting and predicting the recurrence of hepatocellular carcinomas (HCCs). A total of 108 patients with initial non-advanced HCC who underwent curative radiofrequency ablation (RFA) in our hospital were enrolled in this study. The effectiveness of the three tumor markers for detecting recurrence and recurrence-free survival was analyzed. Positivity of these three makers was not markedly increased at the first or second recurrence. In addition, there was no significant correlation between the initial and recurrent levels of each tumor marker. The tumor marker that was positive at the time of initial HCC was not necessarily positive at recurrence. The tumor marker levels at recurrence were not correlated with pre-ablation levels. No significant correlation was found in the tumor marker values between pre-ablation and the time of recurrence. On multivariate analysis, high AFP-L3 levels (≥10%) were significantly predictive of recurrence-free survival. All three tumor markers should be routinely measured to detect recurrence during follow-up after RFA. Especially high AFP-L3 levels should be followed closely.

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Radiofrequency Ablation Combined with Chemoembolization in Hepatocellular Carcinoma: Treatment Response Based on Tumor Size and Morphology

Cited by 171 publications

References 19 publications

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

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