Radiofrequency and microwave ablation in combination with transarterial chemoembolization induce equivalent histopathologic coagulation necrosis in hepatocellular carcinoma patients bridged to liver transplantation

Vasnani, Raj; Ginsburg, M.; Ahmed, Osman; Doshi, Taral; Hart, John; Te, Helen S.; Ha, Thuong G. Van

doi:10.21037/hbsn.2016.01.05

Cited by 28 publications

(23 citation statements)

References 32 publications

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“…There was no statistical difference in complication rates (3% vs. 2%) . In contrast to Thornton et al , Vasnani also compared the efficacy of RFA and MWA in combination with transarterial chemoembolization (DEB‐TACE), demonstrating that both RFA and MWA in sequential combination with DEB‐TACE are equally efficacious at inducing HCC tumor coagulation . The authors assessed 42 patients who underwent combined therapy: 11 tumors (2.9 cm; range, 1.8–4.3) treated with DEB‐TACE/RFA and 40 tumors (mean, 2.4 cm; range, 1.1–5.4) with DEB‐TACE/MWA.…”

Section: Discussionmentioning

confidence: 99%

“…Among all 51 tumors, mean tumor coagulation of 95.8% was found on the 36 complete response on imaging at liver transplantation (LT). No correlation was reported between tumor coagulation and initial tumor size or time interval to LT. No tumor seeding was demonstrated along the ablation tracts . Abdelaziz et al demonstrated that TACE‐MWA obtained better response rates than TACE‐RFA with tumor size of 3–5 cm, with no difference in survival rates .…”

Section: Discussionmentioning

confidence: 99%

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Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update

et al. 2019

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This article provides an overview of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of primary liver tumors and hepatic metastasis. Only studies reporting RFA and MWA safety and efficacy on liver were retained. We found 40 clinical studies that satisfied the inclusion criteria. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive to treat hepatic tumors. According to the literature, the overall survival, local recurrence, complication rates, disease‐free survival, and mortality in patients with hepatocellular carcinoma (HCC) treated with RFA vary between 53.2 ± 3.0 months and 66 months, between 59.8% and 63.1%, between 2% and 10.5%, between 22.0 ± 2.6 months and 39 months, and between 0% and 1.2%, respectively. According to the literature, overall survival, local recurrence, complication rates, disease‐free survival, and mortality in patients with HCC treated with MWA (compared with RFA) vary between 22 months for focal lesion >3 cm (vs. 21 months) and 50 months for focal lesion ≤3 cm (vs. 27 months), between 5% (vs. 46.6%) and 17.8% (vs. 18.2%), between 2.2% (vs. 0%) and 61.5% (vs. 45.4%), between 14 months (vs. 10.5 months) and 22 months (vs. no data reported), and between 0% (vs. 0%) and 15% (vs. 36%), respectively. According to the literature, the overall survival, local recurrence, complication rates, and mortality in liver metastases patients treated with RFA (vs. MWA) are not statistically different for both the survival times from primary tumor diagnosis and survival times from ablation, between 10% (vs. 6%) and 35.7% (vs. 39.6), between 1.1% (vs. 3.1%) and 24% (vs. 27%), and between 0% (vs. 0%) and 2% (vs. 0.3%). MWA should be considered the technique of choice in selected patients, when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size. Implications for Practice Although technical features of the radiofrequency ablation (RFA) and microwave ablation (MWA) are similar, the differences arise from the physical phenomenon used to generate heat. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive than RFA to treat hepatic tumors. The benefits of MWA are an improved convection profile, higher constant intratumoral temperatures, faster ablation times, and the ability to use multiple probes to treat multiple lesions simultaneously. MWA should be considered the technique of choice when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update

et al. 2019

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“…However, treatment sequencing might be more variable in clinical practice as some patients are bridged or downstaged towards potentially curative treatments. Moreover, a deteriorating liver function and/ or rapid tumor progression during therapy may limit the use of subsequent treatment options …”

Section: Introductionmentioning

confidence: 99%

“…Moreover, a deteriorating liver function and/ or rapid tumor progression during therapy may limit the use of subsequent treatment options. 8,17,18 In this study, we characterized a large cohort of 2101 patients with HCC based on a 15-year experience from a large referral center-Hannover Medical School, Germany. The aim of this study was to analyze initial treatments and treatment sequencing in regard to tumor burden and liver function at first diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Patterns and challenges of treatment sequencing in patients with hepatocellular carcinoma: Experience from a German referral center

Kirstein

Schweitzer

Winter

et al. 2017

J of Gastro and Hepatol

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“…Studies have shown that the synergistic effect of DEB-TACE and RFA has a powerful anti-cancer effect[ 40 ]. It is demonstrated by the studies of patients with liver metastases from colorectal cancer from Lee et al[ 41 ] and Ahmed et al[ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Drug-eluting beads transarterial chemoembolization sequentially combined with radiofrequency ablation in the treatment of untreated and recurrent hepatocellular carcinoma

Zhang¹,

Zhang²,

Fan³

et al. 2020

WJGS

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BACKGROUND Drug-eluting beads transarterial chemoem-bolization (DEB-TACE) has the advantages of slow and steady release, high local concentration, and low incidence of adverse drug reactions compared to the traditional TACE. DEB-TACE combined with sequentially ultrasound-guided radiofrequency ablation (RFA) therapy has strong anti-cancer effects and little side effects, but there are fewer related long-term studies until now. AIM To explore the outcome of DEB-TACE sequentially combined with RFA for patients with primary hepatocellular carcinoma (HCC). METHODS Seventy-six patients with primary HCC who underwent DEB-TACE sequentially combined with RFA were recruited. Forty patients with untreated HCC were included in Group A, and 36 patients with recurrent HCC were included in Group B. In addition, 40 patients with untreated HCC who were treated with hepatectomy were included in Group C. The serological examination, preoperative magnetic resonance imaging examination, and post-treatment computed tomography enhanced examination were performed for all patients. The efficacy was graded as complete remission (CR), partial remission (PR), stable disease and progressive disease at the 3 rd , 6 th , and 9 th . All patients were followed up for 3 years and their overall survival (OS), disease-free survival (DFS) were assessed. RESULTS The efficacy of Group A and Group C was similar ( P > 0.05), but the alanine aminotransferase, aspartate aminotransferase and total bilirubin of Group A were lower than those of Group C (all P < 0.05). The proportions of CR (32.5%), PR (37.5%) were slightly higher than Group A (CR: 27.5%, PR: 35%), but the difference was not statistically significant ( χ 2 = 0.701, P = 0.873). No operational-related deaths occurred in Group A and Group C. The OS (97.5%, 84.7%, and 66.1%) and the DFS (75.0%, 51.7%, and 35.4%) of Group A at the 1 st , 2 nd , and 3 rd year after treatment were similar with those of Group C (OS: 90.0%, 79.7%, and 63.8%; DFS: 80.0%, 59.7%, and 48.6%; P > 0.05). The OS rates in Group A and Group B (90%, 82.3%, and 66.4%) were similar ( P > 0.05). The DFS rates in Group B (50%, 31.6%, and 17.2%) were lower than that of Group A ( P = 0.013). CONCLUSION The efficacy of DEA-TACE combined with RFA for untreated HCC is similar with hepatectomy. Patients with recurrent HCC could get a longer survival time through the combined treatment.

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Radiofrequency and microwave ablation in combination with transarterial chemoembolization induce equivalent histopathologic coagulation necrosis in hepatocellular carcinoma patients bridged to liver transplantation

Abstract: RFA and MWA in sequential combination with DEB-TACE, used as a bridge to LT, are equally efficacious at inducing HCC tumor coagulation.

Cited by 28 publications

References 32 publications

Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update

Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update

Patterns and challenges of treatment sequencing in patients with hepatocellular carcinoma: Experience from a German referral center

Drug-eluting beads transarterial chemoembolization sequentially combined with radiofrequency ablation in the treatment of untreated and recurrent hepatocellular carcinoma

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