Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma ≤4 cm

Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Gastroenterology (Impact Factor: 16.72). 01/2005; 127(6):1714-23. DOI: 10.1053/j.gastro.2004.09.003
Source: PubMed


The aim of this study was to compare the clinical outcome of percutaneous radiofrequency (RF) ablation, conventional percutaneous ethanol injection (PEI), and higher-dose PEI in treating hepatocellular carcinoma (HCC) 4 cm or less.
A total of 157 patients with 186 HCCs 4 cm or less were randomly assigned to 3 groups (52 patients in the conventional PEI group, 53 in the higher-dose PEI group, and 52 in the RF group). Clinical outcomes in terms of complete tumor necrosis, overall survival, local tumor progression, additional new tumors, and cancer-free survival were compared across 3 groups.
The rate of complete tumor necrosis was 88% in the conventional PEI group, 92% in the higher-dose PEI group, and 96% in the RF group. Significantly fewer sessions were required to achieve complete tumor necrosis in the RF group than in the other 2 groups (P < .01). The local tumor progression rate was lowest in the RF group (vs the conventional PEI group, P = .012; vs the higher-dose PEI group, P = .037). The overall survival rate was highest in the RF group (vs the conventional PEI group, P = .014; vs the higher-dose PEI group, P = .023). The cancer-free survival rate was highest in the RF group (vs the conventional PEI group, P = .019; vs the higher-dose PEI group, P = .024). Multivariate analysis determined that tumor size, tumor differentiation, and the method of treatment (RF vs both methods of PEI) were significant factors in relation to local tumor progression, overall survival, and cancer-free survival.
The results show that RF ablation yielded better clinical outcomes than conventional and higher-dose PEI in treating HCC 4 cm or less.

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    • "Radiofrequency ablation (RFA) is an effective and safe curative therapy used to treat small hepatocellular carcinoma (HCC) [1] [2]. However, a higher local recurrence rate than surgical resection and the risk of tumor seeding after ablation are major drawbacks of this procedure [3]. "
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    ABSTRACT: Background Conventional monopolar radiofrequency ablation (RFA) bears the risks of incomplete ablation and tumor seeding. This study aimed to evaluate the effectiveness and safety of multipolar RFA with non-touch technique for hepatocellular carcinoma (HCC) ≤ 3 cm. Methods Fifteen cirrhotic patients (9 men, 6 women; age 51–83 years, mean 64.4 years, Child-Pugh score: A = 10 and B = 5) with 17 HCCs of ≤ 3 cm (mean: 26 mm), which were diagnosed based on typical radiologic findings were enrolled. Two or three Celon Prosurge Bipolar electrodes with 3-cm active tip were deployed with non-touch technique via percutaneous approach under ultrasound guidance. Results Complete ablation was achieved in all 17 lesions. This is defined as no enhanced part around the ablated index tumors according to dynamic computed tomography or magnetic resonance imaging at least 1 month after ablation. No local tumor progression was detected at follow-up (range, 3–21.5 months; mean, 10 months). No track seeding was observed. There was one distant recurrence 15.4 months after ablation. One patient had procedure-related biliary stricture and died of pneumonia 3.5 months after tumor ablation. Conclusion Multipolar RFA with non-touch technique is an effective method to achieve complete tumor ablation and an adequate safety margin. This method has low complication rate and bears minimal risk of tumor seeding.
    Full-text · Article · Sep 2014
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    • "The mechanisms of local recurrent or residual tumor tissues after RFA and the strategies for decreasing local recurrent or residual tumor tissues were as follows: first, all the local recurrent or residual viable tumors were located at the periphery of RFA, so the location of the probe should be accurately guided by US or CT, and the area of RFA should be larger than that of the tumor, the current ablation strategy attempted to destroy a peripheral 0.5- to 1.0-cm rim of apparently normal tissue surrounding the tumor margin [19]; second, in this study, we found 8 RFA lesions had intact portal venous surrounded by necrosis, with patent hepatic arterial and/or portal venous branches extending into the RFA lesions, in 1 lesion, microscopic viable tumor was adjacent to intact portal venous within necrotic RFA lesion [21]–[24]. The pathophysiology mechanism was that the temperature surrounding the vessel decreased by the flowing blood during RFA [25]–[27], on the other hand, the time of RFA in this study was shorter than that of the clinical application [28], [29]. Granulation tissues were seen in all lesions surrounding the area of the RFA 7–10 d after RFA, but granulation tissues disappeared after 1 month in 2 rabbits of control group. "
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    ABSTRACT: Purpose To evaluate the value of DWI in detecting the lesions of pre- and post-radiofrequency ablation (RFA) of the rabbit liver VX2 tumors. Materials and Methods Twenty-two New Zealand White rabbits were tested. The protocol was approved by the Committee on the Ethics of Animal Experiments. Twenty separate tumor fragments were implanted into the livers of 20 rabbits, the liver was exposed by performing midline laparotomy. 3.0T MR DWI (b = 0, 200, 400, 600, 800,1000 s/mm2) were performed 14–21 days after tumor implantation (mean, 17 days) in the 18 tumor-bearing animals. Then RFA was performed in the 18 tumor-bearing animals and in the two healthy animals. 3.0T MR DWI was performed 7–10 days after RFA (mean, 8 days). Pathology exam was performed immediately after the completion of post- RFA MR imaging. Analyzing the features of MRI and ADC values in the pre- and post- RFA lesions of the VX2 tumors, and histopathologic results were compared with imaging findings. Results The difference of ADC value between viable tumor and normal liver parenchyma was significant (P<.001). After RFA, when b = 200, 400, 600, 800, 1000 s/mm2, the differences of ADC values of viable tumor, granulation tissue, necrosis, normal liver parenchyma were significant (P<.001). At the time the animals were sacrificed after RFA and MR imaging, histopathologic results of local viable tumors were found in 9 (50%) of the 18 treated tumors. Macroscopic viable tumors were found at the RFA sites in 3 (17%), all 3 macroscopic viable tumors were visualized at the periphery of the RFA areas. Conclusions 3.0T MR DWI can be used to follow up the progress of the RFA lesion, it is useful in detecting different tissues after RFA, and it is valuable in the further clinical research.
    Full-text · Article · Aug 2014 · PLoS ONE
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    • "Surgical resection is the standard treatment for HCC, but approximately 80% of cases are unresectable, generally because of preexisting hepatic dysfunction associated with cirrhosis or the multifocality of its presentation [3]. Transcatheter arterial chemoembolization (TACE), percutaneous ablation [4,5], and radiation therapy (RT) [6,7] have been used for patients with unresectable HCC, but the standard treatment modality for primary HCC has not yet been established. Only TACE has been proven to provide a survival benefit in a phase III study of advanced-stage disease [8]. "
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    ABSTRACT: Purpose To evaluate and compare the risks of secondary cancers from therapeutic doses received by patients with hepatocellular carcinoma (HCC) during intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT), and tomotherapy (TOMO). Methods Treatments for five patients with hepatocellular carcinoma (HCC) were planned using IMRT, VMAT, and TOMO. Based on the Biological Effects of Ionizing Radiation VII method, the excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) were evaluated from therapeutic doses, which were measured using radiophotoluminescence glass dosimeters (RPLGDs) for each organ inside a humanoid phantom. Results The average organ equivalent doses (OEDs) of 5 patients were measured as 0.23, 1.18, 0.91, 0.95, 0.97, 0.24, and 0.20 Gy for the thyroid, lung, stomach, liver, small intestine, prostate (or ovary), and rectum, respectively. From the OED measurements, LAR incidence were calculated as 83, 46, 22, 30, 2 and 6 per 104 person for the lung, stomach, normal liver, small intestine, prostate (or ovary), and rectum. Conclusions We estimated the secondary cancer risks at various organs for patients with HCC who received different treatment modalities. We found that HCC treatment is associated with a high secondary cancer risk in the lung and stomach.
    Full-text · Article · May 2014 · Radiation Oncology
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