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ABSTRACT: To retrospectively investigate the role of contrast-enhanced ultrasonography (CEUS) in percutaneous radiofrequency ablation (RFA) in patients with liver metastases and evaluate the therapeutic efficacy of RFA assisted by CEUS.
From May 2004 to September 2010, 136 patients with 219 liver metastatic lesions received CEUS examination 1 h before RFA (CEUS group), and other 126 patients with 216 lesions without CEUS examination in the earlier period were served as a historical control group. The mean tumor size was 3.2 cm and the mean tumor number was 1.6 in the CEUS group, while 3.4 cm and 1.7 in the control group, respectively (P>0.05). The clinical characteristics, recurrence results and survival outcomes were compared between two groups.
In the CEUS group, two isoechoic tumors were not demonstrated on unenhanced ultrasonography (US), and 63 (47%) of 134 tumors examined with CEUS were 0.3 cm larger than with unenhanced US. Furthermore, in 18.4% of 136 patients, additional 1-3 tumors were detected on CEUS. The CEUS group showed higher early tumor necrosis and lower intrahepatic recurrence than the control group. The 3-year overall survival (OS) rate and the 3-year local recurrence-free survival (LRFS) rate in the CEUS group were 50.1% and 38.3%, in contrast to 25.3% and 19.3% in the control group, respectively (P=0.002 and P<0.001).
CEUS provides important information for RFA treatment in patients with liver metastases and better therapeutic effect could be attained.
Chinese Journal of Cancer Research 04/2013; 25(2):143-154. · 0.18 Impact Factor
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ABSTRACT: Hepatocellular carcinoma (HCC) often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast-enhanced ultrasound (CEUS) and to correlate patterns of enhancement at CEUS with the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard.
Ninety-three cirrhotic patients with indeterminate hepatocellular nodules at ultrasound, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules (RNs), dysplastic nodules (DNs), or DNs with focus of HCC (DN-HCC), were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns: type I, isoenhancement to hepatic parenchyma at all phases; type II, hypoenhancement in the arterial phase, and isoenhancement in the portal venous phase and late phase; type III, iso-to-hypoenhancement in arterial and portal venous phase, and hypoenhancement in the late phase (washout); type IV, slight hyperenhancement in the arterial and portal venous phase and hypoenhancement in the late phase (washout); and type V, partial hyperenhancement in the arterial phase and hypoenhancement in the late phase; and another partial iso-to-hypoenhancement in the arterial and portal venous phase and hypoenhancement in the late phase (washout). The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed by the chi-squared test.
Totally 132 lesions were examined with CEUS in 93 patients. Pathologic diagnoses included 45 DN, 68 RN, and 19 DN-HCC. The enhancement patterns observed were as follows: type I, 49 (37.1%); type II, 27 (20.5%); type III, 28 (21.2%); type IV, 9 (6.8%); type V, 19 (14.4%). Nodules with type I enhancement showed dysplasia in 5 (10.2%) cases; nodules with type II were dysplastic in 11 (40.7%) of cases; nodules with type III enhancement pattern were dysplastic in 22 (78.6%), and those with type IV enhancement contained dysplasia in 7 (77.8%) of cases. Type V enhancement corresponded to DN-HCC in 19 (100%) of cases. CEUS enhancement pattern was correlated with likelihood of dysplasia at pathologic analysis (Trend chi-square test, P < 0.001). Pathological diagnosis was HCC in the enhanced area and hepatocyte dysplasia in the un-enhanced area in the 19 DN-HCC.
Pattern of enhancement at CEUS correlates with the pathologic diagnosis of hepatocellular nodules in liver cirrhosis, and may be helpful in predicting the progress from RN to HCC nodules.
Chinese medical journal 09/2012; 125(17):3104-9. · 0.86 Impact Factor
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ABSTRACT: To evaluate the efficacy of radiofrequency (RF) ablation for treatment of unresectable intrahepatic cholangiocarcinoma (ICC) and to explore the impact of prognostic variables on outcomes.
From 2000-2010, 17 patients with 26 ICCs underwent RF ablation at a single institution. None of the patients were surgery candidates. Seven patients had 15 primary ICCs, and 10 patients had 11 recurrent ICCs. The median largest diameter was 4.4 cm (range 2.1-6.8 cm). A percutaneous approach was used in 15 patients, and an open approach was used in 2 patients. Early tumor necrosis, recurrence-free survival, and overall survival were analyzed. Univariate analysis was performed to evaluate 12 clinicopathologic and treatment-related variables associated with recurrence-free survival and overall survival.
Early tumor necrosis was 96.2% (25 of 26 tumors). The median follow-up period after RF ablation was 29 months. The median recurrence-free survival and overall survival were 17 months and 33 months. The 1-year, 3-year, and 5-year survival rates were 84.6%, 43.3%, and 28.9%, with an overall complication rate of 3.6% (1 of 28 sessions). Three variables were found to be closely associated with recurrence-free survival: lymph node metastases (P = .023), tumor differentiation (P = .034), and tumor number (P = .035). The only variable significantly associated with overall survival was tumor differentiation (P = .033).
Preliminary results showed that RF ablation may be an effective treatment for ICC because it achieved an acceptable survival rate in a small population. Prognostic factors might allow better patient selection and outcomes.
Journal of vascular and interventional radiology: JVIR 05/2012; 23(5):642-9. · 1.81 Impact Factor
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ABSTRACT: To retrospectively investigate the feasibility of radiofrequency ablation (RFA) in treating advanced hepatocellular carcinoma (HCC) using standard ultrasound-guided percutaneous RFA.
A total of 655 patients with unresectable advanced HCC underwent ultrasound-guided percutaneous RFA therapy at our institution between July 2000 to September 2001. Ninety-two of those patients, representing 136 tumors, were selected for analysis based on the following criteria: presence of UICC/AJCC-TNM (6th edition) stage III and IV advanced HCC, (III: n=82 patients, with 126 tumors; IV: n=10 patients, with 10 tumors); extensive portal vein or inferior vena cava tumor thrombus; extrahepatic metastasis after surgical resection; and complete follow-up data. Follow-up consisted of enhanced computed tomography (CT) performed at one month post-RFA treatment, then every three months. Contrast-enhanced ultrasound (CEUS) was performed in 51 (55.4%) patients before RFA. The standard treatment using optimal strategies were applied in (72.8%) 67 patients. The established strategies included: (1) select RFA indications based on CEUS results; (2) design radical protocols based on invasive range showed by CEUS; (3) multiple overlapping ablations based on mathematical protocols; (4) two or three bipolar RFA electrodes with three-dimensional localization; (5) color ultrasound-guided percutaneous ablation of tumor feeding artery (PAA)/transcatheter arterial chemoembolization (TACE) + RFA for HCC with rich supply. The other 25 patients (27.2 %) were treated with conventional RFA protocols. The ablation procedure was considered a success if no abnormal enhancement or wash-out was detected in the treated area on the CT scan at one month. All patients had received liver protection treatments following RFA. Chi-squared test or Fisher's exact test were used to compare the early complete tumor necrosis rates and the local recurrence rates. Survival was estimated by Kaplan-Meier analysis and log-rank test. P less than 0.05 was considered statistically significant.
The RFA-treated tumors ranged in size from 1.5 to 7.0 cm (average: 4.5 cm). Fifty-nine patients had solitary tumor, and the remaining 33 had multiple tumors (2 to 4 tumors). Patients were classified by Child-Pugh score as A (n=58), B (n=32) and C (n=2). Early complete tumor necrosis rate after initial RFA was 90.4% (123/136 tumors). Serious complications developed in two patients (2.2%). No treatment-related death occurred. Follow-up ranged from 3-134 months. Local recurrence rate was 16.9% (23/136 tumors). The 1-, 3- and 5-year overall survival rates were 83.3%, 48.3% and 21.9%, respectively, and the median survival time was 35 months. Stratification analysis indicated the early complete tumor necrosis rate was higher in groups of patients with Child-Pugh A score (98.3%) , CEUS administration (98.0%), and standard treatment (97.0%). The local recurrence rate was lower in groups of patients with tumors less than or equal to 3.0 cm (5.9%), CEUS administration (11.8%), and standard treatment (16.4%). The 5-year survival was significantly higher in patients with Child-Pugh A, tumors less than or equal to 3.0 cm, CEUS administration, and standard treatment (all, P less than 0.05).
RFA treatment of patients with advanced HCC, tumors less than 7.0 cm, and without thrombosis in the main vessels was efficacious. The RFA treatment strategy and subsequent liver protection therapy in RFA may improve survival.
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 04/2012; 20(4):256-60.
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ABSTRACT: To evaluate the effect of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treating advanced hepatocellular carcinoma (HCC) and to analyze the prognostic factors.
A total of 90 patients with unresectablely advanced HCC underwent percuatenous RFA therapy between July 2000 and June 2011 were enrolled into the study. According to the 6th UICC/AJCC-TNM system, 80 and 10 patients were in stage III and IV, respectively.78 patients were men and 12 patients were women. Ages ranged from 24 to 87 years old (mean ± SD, 59 ± 12 years). The tumor size ranged from 1.5 to 8.0 cm (mean ± SD, 4.5 ± 1.4 cm). The maximum tumor of 73 patients (81.1%) was larger than 3.0 cm. 31 patients (34.4%) had 2-4 tumors. The Child-Pugh classification of B and C were 32 patients (35.6%) altogether. By regular follow-up, enhanced CT combined with AFP was used to evaluate the effect after RFA. Kaplan-Meier model and Log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival. P < 0.05 was considered statistically significant difference.
Complete tumor necrosis rate after initial RFA was 90.9% (120/132 tumors). Serious complications were developed in two patients (2.2%) and no treatment-related death occurred. 3 - 129 months were followed up. Local recurrence rate was 15.2% (20/132 tumors). The 1-, 3-, 5-year overall survival rates were 83.3%, 48.3%, 21.9%, respectively, and the median survival time was 35 months. The univariate analyses showed that patients with Child-Pugh classification of A, tumor less than 3.0 cm, applying CEUS, using standard treatment protocols, achieving complete tumor necrosis and without tumor recurrence survived longer (P < 0.05). Child-Pugh classification and the standard treatment protocols were identified as independent prognostic factors for survival by multivariate model (P = 0.001, P < 0.001).
Paying attention to the following factors of CEUS, standard treatment protocols, initially complete tumor necrosis and liver protection therapy for patients with advanced HCC is helpful to improve the patients' survival.
Zhonghua yi xue za zhi 03/2012; 92(11):735-8.
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ABSTRACT: To investigate the application of contrast enhanced ultrasound (CEUS) in planning and guiding for radiofrequency ablation (RFA) for metastatic liver carcinoma (MLC).
One hundred and thirty-five patients with clinically and pathologically diagnosed MLC (from gastrointestinal tumors) were included in the present study, and 104 of them had received CEUS prior to RFA to assess the number, size, shape, infiltration, location and enhancing features of the lesions. Among the 104 patients, 21 (20.1%) were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS. The remaining 83 patients with 147 lesions underwent RFA (group A). During the same period, other 31 patients with 102 lesions serving as control group were treated based on findings of conventional ultrasound without contrast (group B). The patients underwent follow-up enhanced CT at the 1st month, and then every 3-6 months after RFA. The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 1st month.
In group A, 72 of 147 MLC lesions (48.9%) showed increased sizes on CEUS. Among them, 48 lesions (66.6%) appeared enlarged in arterial phase, and 24 (33.3%) showed enlarged hypoechoic area in parenchymal phase. CEUS showed total 61 additional lesions in 35 patients (42.1%) (ranged from 8 to 15 mm) compared with conventional ultrasound (US), and 42 (68.8%) of them were visualized in parenchymal phase only. There were total 208 lesions in group A underwent RFA with CEUS planning, and the tumor necrosis rate was 94.2% (196/208). In this group, local recurrence was found in 16 lesions (7.7%) during 3-42 months' following up, and new metastases were seen in 30 cases (36.1%). For group B, the tumor necrosis rate was 86.3% (88/102), local recurrence in 17 lesions (16.7%), and new metastases in 13 cases (41.9%). Tumor early necrosis and recurrence rates were significantly different between the two groups (P=0.018, P=0.016, respectively).
CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.
Chinese Journal of Cancer Research 03/2012; 24(1):44-51. · 0.18 Impact Factor
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ABSTRACT: Most recurrent intrahepatic cholangiocarcinoma (RICC) lost the opportunity of radical resection while most nonsurgical management failed to prolong patients' survival. The efficacy and safety of radiofrequency ablation (RFA) as a local treatment for recurrent hepatocellular carcinoma have been confirmed by many clinical studies. The purpose of this study was to evaluate the efficacy, long-term survival and complications of RFA for RICC.
A total of 12 patients with 19 RICCs after radical resection were included in this study. The tumors were 1.9-6.8 cm at the maximum diameter (median, 3.2±1.6 cm). All patients were treated with ultrasound guided RFA. There were two RFA approaches including percutaneous and open.
A total of 18 RFA treatment sessions were performed. Ablation was successful (evaluated by 1-month CT after the initial RFA procedure) in 18 (94.7%) of 19 tumors. By a median follow-up period of 29.9 months after RFA, 5 patients received repeated RFA because of intrahepatic lesion recurrence. The median local recurrence-free survival period and median event-free survival period after RFA were 21.0 months and 13.0 months, respectively. The median overall survival was 30 months, and the 1- and 3-year survival rates were 87.5% and 37.5%, respectively. The complication rate was 5.6% (1/18 sessions). The only one major complication was pleural effusion requiring thoracentesis.
This study showed RFA may effectively and safely manage RICC with 3-year survival of 37.5%. It provides a treatment option for these RICC patients who lost chance for surgery.
Chinese Journal of Cancer Research 12/2011; 23(4):295-300. · 0.18 Impact Factor
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ABSTRACT: Biliary injury after radiofrequency ablation can cause serious consequences including death. However, there are limited data regarding bile duct changes with or without complications associated with radiofrequency ablation of hepatic malignancies. This study aimed to assess the incidence, prognosis and risk factors of intrahepatic biliary injury associated with radiofrequency ablation.
Between June 2001 and January 2009, 638 patients with hepatic malignancies (405 with hepatocellular carcinoma, and 233 with liver metastasis) who had 955 treatment sessions were enrolled in this study. Imaging and laboratory data, the course of treatment, and patient outcomes were reviewed retrospectively. The risk factors of biliary injury and the impact on overall survival of patients were analyzed. The chi-square test, Fisher's exact test, Kaplan-Meier curves and stepwise Logistic regression model were used for statistical analysis where appropriate.
Biliary injury was observed in 17 patients after 17 ablation sessions based on imaging findings. The overall incidence of biliary injury was 1.8% (17/955) with an average onset time of 12 weeks (2-36 weeks). Mild, moderate and severe complications of biliary injury were identified in 9, 6 and 2 cases, respectively. The median survival time after detection of biliary injury was 40 months. There seemed no notable difference in overall survival between patients with and those without biliary injuries. By multivariate analysis, vessel infiltration (P = 0.034) and treatment session ≥ 4 times (P = 0.025) were independent risk factors for biliary injury of hepatocellular carcinoma; while tumor located centrally was the only independent risk factor in the metastasis group (P = 0.043).
The incidence of biliary injury was not frequent (1.8%). Through appropriate treatment, intrahepatic bile duct injuries seemed not affect the patients' long-term survival. Additionally, risk factors may be helpful for selecting radiofrequency ablation candidates and predicting biliary complications.
Chinese medical journal 07/2011; 124(13):1957-63. · 0.86 Impact Factor
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ABSTRACT: To investigate the efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) according to standardized treatment strategy and individualized protocol.
A total of 468 patients of HCC underwent ultrasound/Contrast-enhanced ultrasound guided RF ablation in our department according to individualized protocol for large tumors, hypervascular tumors and tumors located adjacent to important structures in our study, of which 22 HCCs having undergone palliative RF ablation were excluded because of huge size, diffusive multiple tumors or adjacent structures invasion. The remaining 446 HCCs (680 sessions) were included and followed-up regularly to assess treatment efficiency. Of the 446 patients, 367 were male and 79 were female. 828 lesions underwent RFA. The mean size of tumors was (3.6±1.4)cm. Regular follow-up was conducted for 3-119 months. In this study, long-term outcome of various refractory tumors were also investigated.
The overall ablation success rate was 97%(803/828) 1 month after RFA. The recurrent rate was 7.2% (60/828). Base on Kaplan-Meier method, the 1-, 3- and 5-year overall survival rates after RF ablation were 85.3%, 61.3% and 47.0%, respectively. The ablation success rate of tumors larger than 3.5 cm was 90.8% (275/303). The 5-year survival rates of patients who had HCC for 3.1-5 cm and >5 cm were 45.1% and 35.9%, respectively. In this study, there were 40.3% (334/828) tumors located adjacent to important structures. The ablation success rates of these tumors located adjacent to gallbladder, diaphragm, bowel and major vessels were 93.5% (58/62), 92.5% (123/133), 92.4% (61/66) and 93.2% (68/73), respectively. The incidence of major complications was 3.1% (21/680), which included 5 intraperitoneal hemorrhages, 4 biliary injuries, 2 hemopleural effusions, 3 bowel perforations and 7 needle tract seedings. Treatment-related death occurred in 1 case of bowel perforation.
In RF ablation of refractory HCC, application of standardized treatment strategy and individualized protocol plays important roles in improving ablation success rate and minimizing potential complications. It could extend the indications of RF ablation for HCC in China.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 12/2010; 42(6):716-21.
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ABSTRACT: Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation (RFA) in treating hepatocellular carcinoma (HCC) patients with poor liver function (Child-Pugh class C), who are not suitable for surgery or hepatic artery chemo-embolization.
Thirteen HCC patients (the number of tumors was 17) with liver function of Child-Pugh C (scores: 10.2 +/- 0.4) were included in the study. Among the patients, 8 were male and 5 were female with the average age of (61.6 +/- 10.9) years old. The average size of HCC was (3.8 +/- 1.0) cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors (2 - 3 tumors). All the patients were treated with RFA.
There were 22 RFA sessions (1 - 4 sessions per patient) in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients (69.2%), in 7 of them, the liver enzyme returned to pre-RFA level in 1 - 3 months. One month after RFA, the Child-Pugh grading was 10.3 +/- 0.8 (Child-Pugh C), while that of pre-RFA was 10.2 +/- 0.4 (Child-Pugh C), with no significant difference. Computer tomography (CT) one month after RFA showed that the tumor necrosis rate was 88.2% (15/17). Five patients had 2 - 4 repeated RFA due to HCC recurrence. During the follow-up of 2- 69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% (3/22 sessions), including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function failure.
Minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to the required extended treatment region, special attention should be paid to the possibility of acute liver failure.
Chinese medical journal 08/2010; 123(15):1967-72. · 0.86 Impact Factor
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ABSTRACT: 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.
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.
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).
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.
World Journal of Gastroenterology 07/2009; 15(21):2638-43. · 2.47 Impact Factor
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ABSTRACT: Aim: To assess the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (HCC) after hepatectomy and to compare its outcome with a single modality. Method: We retrospectively studied 103 patients with recurrent HCCs after hepatectomy who were excluded from repeat hepatectomy. Of them, 81 patients were male and 22 were female (mean age 55.8 +/- 10.7 years; range, 30-80 years). According to treatment modality, these patients were divided into three groups: RFA was used as the sole first-line anticancer treatment in 37 patients (RFA group); TACE was used as the sole first-line anticancer treatment in 35 patients (TACE group). RFA followed by TACE was performed in 31 patients (combination group). There was no significant difference in clinical material between the three groups. Indices including treatment success rate, intrahepatic recurrence rate and survival were obtained for analysis and comparison. Results: The treatment success rate of the combination group was significantly higher than that of the TACE group (93.5 vs. 68.6%, P = 0.011). The intrahepatic recurrence rate of the combination group was significantly lower than that of the TACE group (20.7 vs 57.1%, P = 0.002) and the RFA group (20.7 vs 43.2%, P = 0.036). The overall 1-, 3- and 5-year survival rates were 73.9, 51.1 and 28.0% respectively in the RFA group; 65.8, 38.9 and 19.5% respectively in the TACE group; and 88.5, 64.6 and 44.3% respectively in the combination group. There was a significant difference in survival between the combination group and the TACE group (P = 0.028). Conclusion: RFA combined with TACE was more effective in treating recurrent HCC after hepatectomy compared to single RFA or TACE treatment. This combination therapy can thus be a valuable choice of treatment for recurrent HCC.
Hepatology Research 12/2008; 39(3):231-40. · 2.20 Impact Factor
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ABSTRACT: To explore the feasibility and outcome of radiofrequency ablation (RFA) in blocking feeding vessels of hypervascular hepatocellular carcinoma (HCC).
Totally 101 patients pathologically confirmed hypervascular HCC were included in the study. In percutaneous arterial ablation (PAA) + RFA group, 71 patients with 74 HCC underwent PAA before classical RFA of the other regions of the tumors, while in the RFA group, another 83 patients with 102 HCC were treated with RFA directly. For another 30 patients who responded poorly to transcatheter arterial chemoembolization were treated with percutaneous arterial embolization (PAE), followed by RFA; another 23 patients were treated with RFA alone were regarded as the control group. Contrast-enhanced CT and magnetic resonance imaging were used as post-RFA imaging follow-up at 1, 3, and 6 month.
In PAA + RFA group, post-PAA imaging showed blocked blood flow in 65 (87.8%) HCC. There were average 2.76 +/- 1.12 ablated foci per HCC in PAA + RFA group and 3.36 +/- 1.60 ablated foci per HCC in control group (P = 0.01). The tumor necrosis rate at 1 month after RFA was 90. 5% (67/74) in PAA + RFA group and 90.2% (92/102) in control group. HCC recurrence rate at 6 month after RFA was 17.6% (13/74) in PAA + RFA group and 31.4% (32/102) in control group (P = 0.038). In PAE + RFA group, 88.6% of the main feeding vessels were blocked. The tumor necrosis rate at 1 and 6 month after FRA was 92.6% (25/27) and 85.2% (23/27) in PAA + RFA group and 65.2% (15/ 23) (P = 0.030) and 56.5% (13/23) (P = 0.024) in control group.
PAA and PAE can block the feeding vessels of HCC, enhance the ablated necrosis in the tumor, decrease post-RFA recurrence, and therefore provides a safe and feasible method for treating hypervascular HCC.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 09/2008; 30(4):448-54.
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ABSTRACT: To investigate the efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC), and the prognostic factors for post-RFA survival rate.
From 1999 to 2006, 266 patients with 392 HCCs underwent ultrasound guided RFA treatment. They were 216 males and 50 females, average age 59.4+/-15.4 years (24-87 years). The HCC were 1.2-6.7 cm in diameters (average 3.9+1.3 cm). There were 158 patients with single tumor, and the rest had multiple (2-5) tumors. Univariate and multivariate analysis with 19 potential variables were examined to identify prognostic factors for post-RFA survival rate.
The overall post-RFA survival rates at 1st, 3rd, and 5th year were 82.9%, 57.9% and 42.9%, respectively. In the 60 patients with stage I HCC (AJCC staging), the 1-, 3-, 5-year survival rate were 94.8%, 76.4% and 71.6%, significantly higher than the 148 patients with stage II-IV tumors (81.8%, 57.6% and 41.2%, P=0.006). For the 58 patients with post-surgery recurrent HCC, the survival rates were 73.2%, 41.9% and 38.2% at the 1st, 3rd, and 5th year, which were significantly lower than those of stage I HCC (P=0.005). Nine potential factors were found with significant effects on survival rate, and they were number of tumors, location of tumors, pre-RFA liver function enzymes, Child-Pugh classification, AJCC staging, primary or recurrent HCC, tumor pathological grading, using mathematical protocol in RFA procedure and tumor necrosis 1 month after RFA. After multivariate analysis, three factors were identified as independent prognostic factors for survival rate, and they were Child-Pugh classification, AJCC staging and using mathematical protocol.
Identifying prognostic factors provides important information for HCC patient management before, during and after RFA. This long-term follow-up study on a large group of HCC patients confirmed that RFA could not only achieve favorable outcome on stage I HCC, but also be an effective therapy for stage II-IV or recurrent HCC.
European Journal of Radiology 09/2008; 67(2):336-47. · 2.61 Impact Factor
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ABSTRACT: To evaluate the effectiveness of a tailored approach to radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).
Ultrasound-guided percutaneous RFA was performed in 274 tumors of 228 patients located at liver periphery, including 59 near the bowel, 115 near the diaphragm, 54 near the gallbladder, and 46 near the liver surface. The tumor sizes ranged 1.2-7.0 cm [mean (3.7 +/- 1.2) cm]. A tailored treatment strategy was established for tumors in different locations. Contrast-enhanced CT was performed one month later to evaluate the early necrosis rate of the treated tumors.
Early tumor necrosis rate was 91.6% of the peripherally located HCC, including 91.5% of the tumors near the bowel, 90.4% near the diaphragm, 92.6% near the gallbladder, and 93.5% near the liver surface. Local tumor recurrence rates were 8.5%, 9.6%, 7.4%, and 6.5% for tumors near the bowel, diaphragm, gallbladder, and liver surface, respectively. The 1-, 2-, and 3-year survival rate of this group were 82.3%, 62.9%, and 53.7%, respectively. Major complications occurred in 3.3% of the treatment sessions, including haemorrhage (n = 2), nearby structure injury (n = 6), and needle tract seeding (n = 4).
The tailored approach to RFA provides a promising treatment option for refractory peripherally located HCC with satisfactory tumor necrosis rate and low complication rate.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 03/2008; 30(1):15-21.
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ABSTRACT: The purpose of this study was to evaluate the use of contrast-enhanced ultrasonography (CEUS) in selecting patients with hepatocellular carcinoma (HCC) for radio frequency ablation (RFA).
One hundred seventy-nine patients with HCC were divided into 2 groups before receiving RFA: a CEUS group and a control group. The patients were concatenated and alternately apportioned into these 2 groups. In the CEUS group, 92 patients underwent pre-RFA CEUS using the contrast agent sulfur hexafluoride and enhanced computed tomography or magnetic resonance imaging before RFA for selecting suitable cases for RFA, and in the control group, conventional ultrasonography and enhanced computed tomography or magnetic resonance imaging were performed in 87 patients for selecting patients.
In the CEUS group, 9 patients (9.8%) were excluded for RFA therapy by CEUS. The other 83 patients (90.2%), with a total of 114 lesions, were treated by RFA. In the control group, 5 patients (5.7%) were excluded for RFA. The other 82 patients (94.3%), with a total of 107 lesions, were treated by RFA. During the follow-up period of 18 to 50 months, the primary technique effectiveness rates in the CEUS and control groups were 94.7% and 87.9%, respectively (P = .1182). The local tumor progression rate, the new HCC rate, and the repeated RFA rate of the CEUS group were significantly lower than those of the control group (P = .033, .004, and .001, respectively).
Pre-RFA CEUS provides important information for selecting suitable patients for RFA. The use of CEUS in selecting patients with HCC can decrease post-RFA local tumor progression and improve the efficacy of RFA therapy.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 09/2007; 26(8):1055-63. · 1.25 Impact Factor
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ABSTRACT: To evaluate whether contrast-enhanced ultrasound (CEUS) with SonoVue could differentiate malignant focal liver lesions (FLLs) from benign lesions and provide lesion type diagnoses.
Four hundred fifty-six patients with 554 FLLs were examined by CEUS with SonoVue using low mechanical index, nonlinear imaging techniques. Each lesion was characterized by 2 independent off-site readers as malignant or benign and given specific lesion type diagnosis, if possible, both at baseline ultrasound (US) and after SonoVue administration (CEUS). The final diagnosis was achieved by histopathology obtained from biopsy or surgical specimens, or by typical manifestation on contrast-enhanced CT or MRI.
The diagnostic accuracies of the 2 readers were 41.9% and 35.2% for baseline US, which improved significantly to 87.2% and 87.9% for CEUS (P < 0.05). Interreader agreement also increased with CEUS compared with baseline US (ê value changed from 0.49 to 0.77). The accuracy for lesion type diagnosis was 38.4% and 32.5% for baseline US, which increased to 77.6% and 78.0% for CEUS (P < 0.05).
CEUS with SonoVue improves differentiation between malignant and benign FLLs, and also provides improved lesion type (differential) diagnosis.
Investigative Radiology 09/2007; 42(8):596-603. · 4.59 Impact Factor
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ABSTRACT: To investigate the differential diagnosis of non-functional islet cell tumor (NFICT) and pancreatic ductal adenocarcinoma (pancreatic carcinoma) with clinical presentation and sonographic features.
Twenty cases of NFICT were investigated in the study, and 41 cases of pancreatic carcinoma were included as the control group. Among them, 5 NFICT and 32 pancreatic carcinomas underwent CEUS with SonoVue. Clinical presentation and sonographic characteristics were evaluated with Logistic regression analysis. Furthermore, the preliminary result of contrast enhanced ultrasound (CEUS) was analyzed.
Statistic analysis showed four significant factors in differential diagnosis for NFICT and pancreatic carcinoma, including age (P<0.001), tumor size (P=0.006), tumor margin (P<0.001) and vascularity of tumor (P=0.004). Combined these four factors, the sensitivity, specificity and accuracy are 95.0%, 95.1% and 95.1%, respectively. When the patient is younger than 60 years, and tumor is smaller than 5 cm with well-defined margin and hypervascular, it would be most likely a NFICT other than pancreatic carcinoma. NFICT often shows early enhancement and more homogeneous infusion than pancreatic carcinoma on CEUS (P=0.005 and 0.008).
Sonography is able to provide useful differential information for NFICT, which is often misdiagnosed as pancreatic carcinoma.
European Journal of Radiology 07/2007; 62(3):342-51. · 2.61 Impact Factor
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ABSTRACT: Comprehensive studies are scarce with regard to the quality of life (QOL) of hepatocellular carcinoma (HCC) patients after transcatheter arterial chemoembolization (TACE) and/or radiofrequency ablation (RFA) treatment. The purpose of this study was to examine the impact of TACE alone and that of the TACE followed by RFA (TACE-RFA) on QOL in HCC patients.
QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G) (Version 4.0) questionnaire, translated into Chinese, as a measure of QOL among Chinese HCC patients. Prospectively, 83 patients in both TACE group (n = 40) and TACE-RFA group (n = 43) completed the questionnaire at baseline and 3 months after treatment, respectively.
The TACE-RFA group resulted in a significantly higher total QOL score, socio-family well-being score, and functional well-being score than that of TACE group, 3 months after respective treatment. Liver function, tumor recurrence and complication, age, income were the most important factors affecting the QOL of HCC patients after treatment. The logistic regression analyses showed that Child-Pugh Class and tumor recurrence after treatment were independent predictors of post-treatment QOL scores of HCC patients.
The overall QOL of HCC patients in TACE-RFA group was maintained at a relatively higher level than that of TACE group. TACE followed by RFA appeared to be more favorable than TACE alone with respect to QOL.
Quality of Life Research 05/2007; 16(3):389-97. · 2.30 Impact Factor
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ABSTRACT: To study the histopathologic characteristics of the enlarged enhancement area of hepatocellular carcinoma (HCC) at contrast-enhanced ultrasound (CEUS) during the arterial or portal phase and evaluate the value of CEUS in identifying the invasion range of HCC.
Fifty-two patients with fifty-two lesions confirmed as HCC pathologically (41 by surgery and 11 by needle biopsy) were included. The lesion size, margin and shape at fundamental ultrasonography (US) and CEUS were compared before surgery or needle biopsy. Lesions with a larger enhancement area and/or a more irregular shape during the arterial or portal phase at CEUS were classified as group A; lesions with unchanged size and shape were classified as group B. The tissues specimens of the tumor margin (peripheral tumor tissues) were obtained and the slides were stained with HE and CD34 immunohistochemistry, the histopathology and microvessels density (MVD) of group A and B were compared.
In group A, 75% (24/32 lesions) had vaguely demarcated margin at US compared with 40% (8/20 lesions) in Group B (P < 0.05). The largest average diameter of Group A was 6.1 +/- 2.9 cm compared with 4.4 +/- 2.1 cm in group B (P < 0.05). Of the 41 surgically resected HCC specimens, 88% of the 75 slides for the 25 lesions in Group A demonstrated cancer cells invasion in the peripheral tumor, much higher than the 56.3% (27/48 slides) of the 16 lesions in Group B (P < 0.001). The MVD in Group A by CD34 immunohistochemistry was significant higher than that in Group B (52.25 vs 36.82, P < 0.01).
The enlarged enhancement area of HCC at CEUS correlated with the sharpness of tumor margins. The cancer cells invasion and more microvessels generation in the enlarged enhancement area reflected the histopathologic characteristics of invasive growth pattern of HCC. CEUS is helpful in identifying the actual tumor size and invasion range, and might be helpful for HCC treatment.
Zhonghua yi xue za zhi 12/2006; 86(46):3294-8.
