Efficacy of percutaneous radiofrequency ablation of hepatic malignant tumors using a perfused-cooled electrode

ArticleinJournal of the Medical Association of Thailand = Chotmaihet thangphaet 96(1):77-82 · May 2013with11 Reads
Source: PubMed
Abstract
Evaluate the efficacy of percutaneous radiofrequency ablation ofhepatic malignant tumors. An ultrasound-guided percutaneous radiofrequency ablation using a 17-gauge single needle perfusedcooled electrode (Cool-tip) RF ablation system was performed on 30 hepatic tumors in 26 patients between January 2009 and September 2010. The medical records, CT scan, and MRI results were assessed at one and three months after the procedure was completed. Primary technical success, local tumor progression, and complication were also evaluated. Twenty-six hepatic lesions in 23 patients were primarily hepatocellular carcinoma. Only four lesions in three patients were metastasized. Three of them were from colorectal cancer whilst another one was from malignant melanoma. At 1-month follow-up imaging post percutaneous radiofrequency ablation, complete ablation rate was 86.7%. Local tumor progression at 3-month follow-up imaging was 4.2%. The rate for minor complication was 3.8%. No major complication was found Complete ablation rate was found to increase signiJicantly in tumors size of less than 2 cm compared to those diameter larger than 2 cm (p < 0.05). Percutaneous radiofrequency ablation is one of the most effective and invulnerable therapeutic modality in treatment of hepatic malignant tumor. Size is the key factor of technical success as the smaller the size of tumor the better the outcome achieved.
    • "Together, these make the technique easier to perform. C-RFA has been used to successfully treat cardiac arrhythmia212223 and solid tumors [24, 25]. More recently introduced for chronic pain indications, a number of studies have demonstrated improved pain and functional outcomes when C-RFA is used to treat chronic sacroiliac joint pain26272829. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: While cooled radiofrequency ablation (C-RFA) appears to be a promising technology for joint denervation, outcomes of this technique for the treatment of lumbar facet syndrome have not been described. We report clinical outcomes in a case series of patients treated with C-RFA for lumbar facet syndrome. Methods: Consecutive patients aged 18-60 years diagnosed with lumbar facet syndrome, confirmed by ≥75% symptom relief with at least one set of diagnostic medial branch nerve blocks, who underwent C-RFA between January 2007 and December 2013 in an urban academic pain center were included. The respective proportions of participants who reported ≥50% improvement in pain and in function were calculated. Change in median NRS score, daily morphine equivalent consumption (DME), and medication quantification scale III (MQS III) score were measured. Results: Twelve patients underwent C-RFA; three were lost to follow-up. The median and 25%-75% interquartile range (IQR) for age was 44 years (35, 54). The median duration of follow-up was 34 months, IQR (21, 55). The percentage and 95% confidence interval (CI) of patients who reported ≥50% improvement in pain was 33% CI (12%, 64%) and in function was 78%, CI (41%, 96%). There was no significant change in DME or MSQ III score. Approximately 50% of patients sought additional healthcare by long-term follow-up. No complications were reported. Conclusions: This case series suggests that C-RFA may improve function and to a lesser degree pain at long-term follow-up. A randomized, controlled trial is warranted.
    Full-text · Article · Dec 2014 · Journal of the Medical Association of Thailand = Chotmaihet thangphaet
  • [Show abstract] [Hide abstract] ABSTRACT: To evaluate complication, rate of residual, and tumor recurrence in high-risk location compared to non-high-risk location in hepatocellular carcinoma patients. Radiofrequency ablation was performed on 409 tumors in Siriraj Hospital between October 2009 and May 2012. Eighty-eight nodules in 78 atients were treated by RF ablation, which divided into high risk and non-high-risk location. Complete ablation rate, residual tumor recurrent tumor, and complication were retrospectively reviewed. HCC nodules were in non-high-risk location 34 nodules (38.6%) and in high-risk location 54 nodules (61.4%). Complete tumor ablations were done in 34 nodules (100%) of non-high-risk location group and 50 nodules (92.6%) of high-risk location group. All residual tumors were four nodules (7.2%), which located in subcapsular location. Recurrent tumors were found in six nodules (6.8%), and mean time to recurrence were 210.2 days. Early complication was 10.2% and late complication was 4.5%. The recurrent tumor and complication were not significantly different between two groups. Radiofrequency ablation is effective treatment of hepatocellular carcinoma in high-risk location tumor There is no significant difference in complication and tumor recurrent rate between high-risk and non-high-risk group. However incidence of residual tumor is significantly increased in subcapsular location tumor
    Full-text · Article · Apr 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Objective: The aim of the study was to investigate the performance of dynamic 3-dimensional contrast-enhanced ultrasound (3D-CEUS) on assessment of efficacy of local ablation therapy of hepatocellular carcinoma (HCC) with contrast-enhanced computed tomography (CT) as reference standard. Methods: Eighty-nine HCC lesions from 75 patients undergoing ultrasound-guided percutaneous thermal ablation or chemical ablation were studied by both dynamic 3D-CEUS and contrast-enhanced CT 1 month after ablation. Imaging results from two imaging modalities were evaluated independently by experienced readers to determine whether the treated lesions were ablated incompletely (residual unablated tumor) or completely. Sensitivity, specificity, positive and negative predictive values, and accuracy to identify incomplete ablation were calculated for dynamic 3D-CEUS imaging with contrast-enhanced CT as reference standard. Results: Contrast-enhanced CT reported that 80.9% (72/89) of all the treated lesions were completely ablated and 19.1% (17/89) were incompletely ablated. The dynamic 3D-CEUS identified 82.0% (73/89) and 18.0% (16/89) of lesions as completely and incompletely ablated, respectively. With contrast-enhanced CT as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of dynamic 3D-CEUS for identifying residual unablated tumor were 88.2% (15/17), 98.6% (71/72), 93.8% (15/16), 97.3% (71/73), and 96.6% (86/89), respectively. The Kappa value for identifying residual unablated tumor between contrast-enhanced CT and dynamic 3D-CEUS was 0.89. Conclusions: Dynamic 3D-CEUS is highly consistent with contrast-enhanced CT in assessment of efficacy of HCC ablation and has potential to serve as an alternative to contrast-enhanced CT in the follow-up assessment after HCC ablation.
    Article · Dec 2015 · Journal of the Medical Association of Thailand = Chotmaihet thangphaet

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