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Kulkarni CB, Pullara SK, C S R, Moorthy S. Complications of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Acad Radiol 2024; 31:2987-3003. [PMID: 38092590 DOI: 10.1016/j.acra.2023.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 07/21/2024]
Abstract
Radiofrequency ablation (RFA) is a potentially curative treatment option for early Hepatocellular carcinoma. The RFA is considered safe with a relatively low incidence of complications ranging from 2%-7.9%. Though most of the complications are self-limiting, sometimes they can be life-threatening. The occurrence of the particular complication depends on various factors like tumour location and morphology, underlying disease and ablation technique. A detailed understanding of potential complications along with the associated risk factors will help to employ strategies to prevent them, identify them early and manage them when they occur. This article demonstrates various radiofrequency ablation-related complications and discusses the risk factors and technical strategies to minimise them and achieve complete ablation of the tumour.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India.
| | - Sreekumar Karumathil Pullara
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Rajsekar C S
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
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Luo L, Yan R, Zeng Q, Long Y, He X, Li K, Xu E. Radiofrequency Ablation of Hepatocellular Carcinomas Adjacent to the Gallbladder Without Isolation Under Contrast-Enhanced Ultrasound Monitoring: A Comparative Study with Long Term Follow-Up. J Hepatocell Carcinoma 2023; 10:631-642. [PMID: 37077303 PMCID: PMC10108906 DOI: 10.2147/jhc.s388738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/20/2023] [Indexed: 04/21/2023] Open
Abstract
Objective This study intends to compare the efficacy and safety between patients undergoing invasive isolation or monitoring measures and patients undergoing intra-operative contrast-enhanced ultrasound (CEUS) monitoring who underwent radiofrequency ablation (RFA) of hepatocellular carcinomas (HCC) adjacent to the gallbladder (GB). Methods We retrospectively assessed patients with HCC adjacent to the GB who underwent ultrasound-guided RFA. They were divided into two groups: group A was monitored under intra-operative CEUS, while group B was assisted by invasive auxiliary means. The efficacy, complications and survival were followed up and compared. Results Thirty-eight patients with 39 HCCs were enrolled into group A and 31 patients with 35 HCCs were enrolled into group B. The technique efficacy rates were both 100% in the two groups. There were no significant differences of the cumulative 1-, 3-, and 5-year local tumor progression, tumor-free survival and overall survival between the two groups (P = 0.851, 0.081 and 0.700, respectively). There were no significant differences of major and minor complications rates between the two groups (P = 1.000, 0.994, respectively). More importantly, no GB related complications occurred in group A. Conclusion Intra-operative CEUS monitoring without protective isolation of the GB might be also a potentially safe and effective method for the RFA of HCC adjacent to the GB, when compared with those assisted with invasive auxiliary means.
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Affiliation(s)
- Liping Luo
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, People’s Republic of China
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Ronghua Yan
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Qingjing Zeng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yinglin Long
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xuqi He
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Kai Li
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Kai Li, Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People’s Republic of China, Email
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, People’s Republic of China
- Correspondence: Erjiao Xu, Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, People’s Republic of China, Email
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Efficacy and Safety of Angioplasty Balloon Interposition in CT-Guided Percutaneous Thermal Ablation of Hepatic Malignancies to Protect Adjacent Organs. Cardiovasc Intervent Radiol 2022; 45:1401-1407. [PMID: 35794280 PMCID: PMC9458570 DOI: 10.1007/s00270-022-03184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/21/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of placing angioplasty balloons between the liver surface and adjacent organs in CT-guided thermal ablation of subcapsular liver malignancies in case of inadequate success of conventional dissection techniques. MATERIALS AND METHODS A retrospective, single-centre database query identified 327 hepatic malignancies in 153 patients treated in 215 sessions from 2016 to 2018 by thermal ablation. Demographic data, tumour size, distance to adjacent structures, complications and long-term outcomes were assessed when ancillary procedures were performed to protect adjacent organs. RESULTS In 21 of 327 (6.4%) ablations, thermal protection was necessary. Balloon interposition was successfully performed in 9 cases in 8 patients after hydrodissection or gas insufflation failed to separate adherent organs. Median pre- and post-balloon insertion distance was 0 mm [0-2 mm] and 17 mm [8-20 mm]. No balloons were damaged, ruptured or slid away from their initial position. Technical success of MWA and protection of adherent structures were achieved in all procedures. In a median follow-up of 11.5 months [0-49 months], the local control rate was 88.9% as 1 patient was treated twice with an interval of 3 months for local recurrence. Three non-process-related major complications and 1 minor complication occurred. CONCLUSION Balloon interposition is a safe and feasible method to enable thermal ablation to a greater number of patients, even after established thermo-protective techniques fail to separate the colon or stomach from the liver surface.
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Tsurugai Y, Takeda A, Eriguchi T, Sanuki N, Aoki Y. Hypofractionated radiotherapy for hepatocellular carcinomas adjacent to the gastrointestinal tract. Hepatol Res 2021; 51:294-302. [PMID: 33201542 DOI: 10.1111/hepr.13590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/21/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
AIM Decisions regarding therapeutic plans for inoperable patients with hepatocellular carcinoma (HCC) adjacent to the gastrointestinal (GI) tract are challenging because radiofrequency ablation has the potential risk of thermal injury. Moreover, the response rate of transcatheter arterial chemoembolization is relatively low and stereotactic body radiotherapy (SBRT) is believed to be too toxic. We have applied hypofractionated radiotherapy (HFRT) for such lesions. This study investigated the outcomes and toxicities of this treatment. METHODS Among consecutive HCC patients treated with radiotherapy with curative intent at our institution between 2015 and 2019, we retrospectively extracted those outside of the indication for SBRT due to exceeding the constraint of the GI tract and who were treated using HFRT with a prescription dose of 42 Gy in 14 fractions and prophylactic proton pump inhibitor administration for 6 months. The oncological outcomes and toxicities were investigated. RESULTS A total of 66 patients with 73 lesions were eligible. The median follow-up period was 24.0 months. The local recurrence, intrahepatic recurrence, liver-related death, and overall survival rates at 2 years were 11.3%, 50.6%, 15.9%, and 60.4%, respectively. Six (9.1%) patients experienced Child-Pugh score deterioration ≥2 within 6 months following treatment. Two and one patient developed grades 2 and 3 gastroduodenal bleeding, respectively. CONCLUSIONS HFRT can achieve good local control in patients with HCC adjacent to the GI tract, with low GI toxicity incidence. Our study demonstrated that HFRT can be a potentially curative treatment option for lesions.
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Affiliation(s)
- Yuichiro Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Naosko Sanuki
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Yousuke Aoki
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
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Reducing Pain by Artificial Ascites Infusion During Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2021; 44:565-573. [PMID: 33388866 DOI: 10.1007/s00270-020-02723-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/19/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate therapeutic effects of artificial ascites (AA) infusion in patients with subcapsular hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) and to determine whether this infusion can reduce pain. METHODS AND MATERIALS From 2011 to 2016, 123 patients with treatment-naïve single subcapsular HCC (≤ 2.5 cm) who underwent RFA were retrospectively included. Patients were divided into two groups according to AA infusion. After RFA, medical records were used to analyze pain scores during a 24-h period and to determine the opioid used that compared using Mann-Whitney U test. We also conducted subgroup analysis of the patients with HCCs located adjacent to parietal peritoneum. After follow-up period, we analyzed local tumor progression (LTP) and recurrence-free survival using Kaplan-Meier method. RESULTS AA was infused in 76 patients (61.8%, 76/123). Pain score using numeric rating scale (NRS) was significantly lower in AA infusion group than in control group (2.54 ± 2.8 vs. 3.66 ± 3.2, p = 0.048). Dose of opioids used was not significantly different between two groups (1.62 ± 3.4 mg vs. 1.66 ± 3 mg, p = 0.698). However, in subgroup analysis (N = 45), NRS score and dose of opioids used were significantly lower in AA infusion group (p = 0.03, p = 0.032, respectively). LTP rate was not significantly different between two groups (p = 0.673). CONCLUSION AA infusion was an effective and safe way to reduce pain when performing RFA for subcapsular HCC. In particular, in patients with subcapsular HCC adjacent to parietal peritoneum, dose of opioid to use pain control was significantly lower with AA infusion.
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Schullian P, Johnston E, Laimer G, Putzer D, Eberle G, Amann A, Effenberger M, Maglione M, Freund MC, Loizides A, Bale R. Frequency and risk factors for major complications after stereotactic radiofrequency ablation of liver tumors in 1235 ablation sessions: a 15-year experience. Eur Radiol 2020; 31:3042-3052. [PMID: 33125554 PMCID: PMC8043912 DOI: 10.1007/s00330-020-07409-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/27/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Objectives To assess the frequency of major complications after multi-probe stereotactic radiofrequency ablation (SRFA) in a large cohort of patients over 15 years and to elucidate risk factors for adverse events. Materials and methods A retrospective study was carried out between July 2003 and December 2018. Seven hundred ninety-three consecutive patients (median 65.0 years (0.3–88), 241 women and 552 men, were treated in 1235 SRFA sessions for 2475 primary and metastatic liver tumors with a median tumor size of 3.0 cm (0.5–18 cm). The frequency of major complications was evaluated according to SIR guidelines and putative predictors of adverse events analyzed using simple and multivariable logistic regression. Results Thirty-day mortality after SRFA was 0.5% (6/1235) with an overall major complication rate of 7.4% (91/1235). The major complication rate decreased from 11.5% (36/314) (before January 2011) to 6.0% (55/921) (p = 0.001). 50.5% (46/91) of major complications were successfully treated in the same anesthetic session by angiographic coiling for hemorrhage and chest tube insertion for pneumothorax. History of bile duct surgery/intervention, number of coaxial needles, and location of tumors in segment IVa or VIII were independent prognostic factors for major complications following multivariable logistic regression analysis. Simple logistic regression revealed the number of tumors, tumor size, location close to the diaphragm, tumor conglomerate, and segment VII as other significant predictors. Conclusion SRFA of liver tumors is safe and can extend the treatment spectrum of conventional RFA. Adaptations over time combined with increasing experience resulted in a significant decrease in complications. Key Points • In 1235 ablation sessions in 793 patients over 15 years, we found a mortality rate of 0.5% (6/1235) and an overall major complication rate of 7.4%, which fell from 11.5 (36/314) to 6.0% (55/921, p = 0.001) after January 2011, likely due to procedural adaptations. • History of bile duct surgery/intervention (p = 0.013, OR = 3.290), number of coaxial needles (p = 0.026, OR = 1.052), and location of tumors in segment IVa (p = 0.016, OR = 1.989) or VIII (p = 0.038, OR = 1.635) were found to be independent prognostic factors. • Simple logistic regression revealed that number of tumors, tumor size, location close to the diaphragm, tumor conglomerates, and segment VII were other significant predictors of major complications.
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Affiliation(s)
- Peter Schullian
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Edward Johnston
- The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Gregor Laimer
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Arno Amann
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Maria Effenberger
- Department of Internal Medicine I, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Martin C Freund
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Alexander Loizides
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Jiang B, Luo H, Yan K, Zhang Z, Li X, Wu W, Yang W, Chen M. Ten-Year Outcomes of Percutaneous Radiofrequency Ablation for Colorectal Cancer Liver Metastases in Perivascular vs. Non-Perivascular Locations: A Propensity-Score Matched Study. Front Oncol 2020; 10:553556. [PMID: 33178581 PMCID: PMC7596897 DOI: 10.3389/fonc.2020.553556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/25/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To compare long-term outcomes of percutaneous radiofrequency ablation for colorectal liver metastases in perivascular versus non-perivascular locations. Methods This retrospective study included 388 consecutive patients with colorectal liver metastases (246 men, 142 women; age range 27–86 years) who underwent percutaneous radiofrequency ablation between January 2006 and December 2018. Propensity-score matching was performed for groups with perivascular and non-perivascular colorectal liver metastases. Rates of accumulative local tumor progression, overall survival, intra/extrahepatic recurrence, and complications were compared between the two groups. Results We successfully matched 104 patients each in the perivascular and non-perivascular groups (mean age: 60.1 ± 11.5 and 60.1 ± 11.3 years, respectively). Cumulative local tumor progression rates at 6 months, 1 years, 3 years, and 5 years, respectively, were 8.8%,14.8%, 18.9%, and 18.9% in the perivascular group and 8.8%, 13.1%, 15.5%, and 15.5% in the non-perivascular group. The 1-, 3-, 5-, and 10-year overall survival rates, respectively, were 91.3%, 45.6%, 23.9%, and 18.7% in the perivascular group and 88.0%, 47.2%, 27.2%, and 22.6% in the non-perivascular group. No significant between-group differences were detected in cumulative local tumor progression (p=0.567, hazard ratio: 1.224) or overall survival (p = 0.801, hazard ratio: 1.047). The major complication rate was 1.0% (1/104, p > 0.999) in both groups. Tumor size was the only independent prognostic factor for local tumor progression (hazard ratio: 2.314; p = 0.002). On multivariate analysis for overall colorectal liver metastases, tumor diameter >3 cm, tumor location in the right colon, multiple tumors, and extrahepatic metastases before radiofrequency ablation (hazard ratios: 2.046, 1.920, 1.706, and 1.892, respectively; all p < 0.001) and intrahepatic recurrence (hazard ratio: 1.564; p = 0.002) were associated with poor overall survival. Conclusion Cumulative local tumor progression, overall survival, and major complications rates did not differ significantly between perivascular and non-perivascular colorectal liver metastases after percutaneous radiofrequency ablation. For perivascular colorectal liver metastases, percutaneous radiofrequency ablation is a safe and effective treatment option.
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Affiliation(s)
- Binbin Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongjie Luo
- Department of Hepatobiliary, Pancreatic and Minimally Invasive Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhongyi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Minhua Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
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Ziv O, Goldberg SN, Nissenbaum Y, Sosna J, Weiss N, Azhari H. In vivo noninvasive three-dimensional (3D) assessment of microwave thermal ablation zone using non-contrast-enhanced x-ray CT. Med Phys 2020; 47:4721-4734. [PMID: 32745257 DOI: 10.1002/mp.14428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To develop an image processing methodology for noninvasive three-dimensional (3D) quantification of microwave thermal ablation zones in vivo using x-ray computed tomography (CT) imaging without injection of a contrast enhancing material. METHODS Six microwave (MW) thermal ablation procedures were performed in three pigs. The ablations were performed with a constant heating duration of 8 min and power level of 30 W. During the procedure images from sixty 1 mm thick slices were acquired every 30 s. At the end of all ablation procedures for each pig, a contrast-enhanced scan was acquired for reference. Special algorithms for addressing challenges stemming from the 3D in vivo setup and processing the acquired images were prepared. The algorithms first rearranged the data to account for the oblique needle orientation and for breathing motion. Then, the gray level variance changes were analyzed, and optical flow analysis was applied to the treated volume in order to obtain the ablation contours and reconstruct the ablation zone in 3D. The analysis also included a special correction algorithm for eliminating artifacts caused by proximal major blood vessels and blood flow. Finally, 3D reference reconstructions from the contrast-enhanced scan were obtained for quantitative comparison. RESULTS For four ablations located >3 mm from a large blood vessel, the mean dice similarity coefficient (DSC) and the mean absolute radial discrepancy between the contours obtained from the reference contrast-enhanced images and the contours produced by the algorithm were 0.82 ± 0.03 and 1.92 ± 1.47 mm, respectively. In two cases of ablation adjacent to large blood vessels, the average DSC and discrepancy were: 0.67 ± 0.6 and 2.96 ± 2.15 mm, respectively. The addition of the special correction algorithm utilizing blood vessels mapping improved the mean DSC and the mean absolute discrepancy to 0.85 ± 0.02 and 1.19 ± 1.00 mm, respectively. CONCLUSIONS The developed algorithms provide highly accurate detailed contours in vivo (average error < 2.5 mm) and cope well with the challenges listed above. Clinical implementation of the developed methodology could potentially provide real time noninvasive 3D accurate monitoring of MW thermal ablation in-vivo, provided that the radiation dose can be reduced.
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Affiliation(s)
- Omri Ziv
- Department of Biomedical Engineering, Technion - IIT, Haifa, 32000, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Medical Center, Hebrew University, Jerusalem, 91120, Israel.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Yitzhak Nissenbaum
- Department of Radiology, Hadassah Medical Center, Hebrew University, Jerusalem, 91120, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University, Jerusalem, 91120, Israel.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Noam Weiss
- Department of Biomedical Engineering, Technion - IIT, Haifa, 32000, Israel
| | - Haim Azhari
- Department of Biomedical Engineering, Technion - IIT, Haifa, 32000, Israel
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Schullian P, Putzer D, Eberle G, Laimer G, Bale R. Simultaneous Stereotactic Radiofrequency Ablation of Multiple (≥ 4) Liver Tumors: Feasibility, Safety, and Efficacy. J Vasc Interv Radiol 2020; 31:943-952. [PMID: 32414570 DOI: 10.1016/j.jvir.2019.12.794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/15/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess feasibility, safety, and clinical outcome of simultaneous stereotactic radiofrequency (RF) ablation of multiple (≥ 4) primary and metastatic liver tumors. MATERIALS AND METHODS This retrospective observational study included 92 patients (29 women, 62 men), 35 with ≥ 4 hepatocellular carcinomas (HCCs) and 57 with ≥ 4 metastatic liver tumors at initial stereotactic RF ablation between 2005 and 2018. The median size of 178 HCCs and 371 metastases was 2.2 cm (range, 1.0-8.5 cm) and 3.0 cm (range, 0.5-13 cm), respectively. At initial stereotactic RF ablation, 17 (48.6%) patients with HCC and 19 (33.3%) with metastases had 4 liver tumors, 11 (31.4%) and 19 (33.3%) had 5 tumors, and 7 (20%) and 19 (33.3%) had ≥ 6 tumors. RESULTS Major complications occurred in 2 of 35 ablations (5.4%) in patients with HCCs and in 7 of 63 (10%) with metastases. The primary technical efficacy rate (ie, successful initial ablation) was 100% (178/178) in HCCs and 98.8% (363/371) in metastases. Local recurrence was observed in 4 of 178 (2.2%) HCCs and in 17 of 371 (4.6%) metastases. Overall survival (OS) rates at 1, 3, and 5 years from the date of the first stereotactic RF ablation were 88.0%, 54.0%, and 30.4% for patients with HCCs with a median OS of 38.2 months and 86.1%, 53.1%, and 37.3% for patients with metastases with a median OS of 37.4 months. CONCLUSIONS Stereotactic RF ablation is a feasible, safe, and efficacious option in simultaneous management of multiple primary and metastatic liver tumors.
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Affiliation(s)
- Peter Schullian
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - Daniel Putzer
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - Gernot Eberle
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - Gregor Laimer
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - Reto Bale
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
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Yang BS, Liu LX, Yuan M, Hou YB, Li QT, Zhou S, Shi YX, Gao BL. Multiple imaging modality-guided radiofrequency ablation combined with transarterial chemoembolization for hepatocellular carcinoma in special locations. ACTA ACUST UNITED AC 2020; 26:131-139. [PMID: 32071022 DOI: 10.5152/dir.2019.18540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE We aimed to evaluate the safety and effectiveness of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) guided by multiple imaging modalities for hepatocellular carcinomas (HCCs) in special (i.e., high-risk or unfavorable) locations compared with those in conventional locations. METHODS A total of 122 HCC patients were enrolled, including 85 patients (69.7%) with HCC in conventional locations and 37 (30.3%) with HCC in special locations. The clinical data, overall survival (OS), progression-free survival (PFS), and procedure-related adverse events were analyzed. RESULTS RFA combined with TACE was successfully performed in all patients. Three complications (2.5%) occurred, with no significant difference between the conventional (n=1, 1.2%) and special (n=2, 5.4%) locations (P = 0.218). Complete tumor necrosis rate was not significantly different between the conventional (n=73, 85.9%) and special (n=34, 91.9%) locations at one-month imaging (P = 0.353). After a follow-up of 3-48 months, the PFS was 17 months for patients with HCC in conventional locations and 14 months for patients with HCC in special locations; one-year PFS rate was 68.1% in the conventional location group, not significantly (P = 0.741) different from 59.1% in the special location group. The OS was 28 months in the conventional location group while 32 months in the special location group. The cumulative one- and two-year OS rates were 89.9% and 63.3%, respectively, in the conventional location group, not significantly different from 96.3% and 65% in the special location group (P = 0.273). Age (P = 0.043) and tumor size (P < 0.001) were significant prognostic factors for OS, and tumor size (P < 0.001) was the only significant prognostic factor for PFS. CONCLUSION RFA guided by multiple imaging modalities combined with TACE may be safe and effective for treating HCCs in special locations.
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Affiliation(s)
- Bo-Shuai Yang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ling-Xiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China;Shanghai Institute of Medical Imaging, Shanghai, China
| | - Min Yuan
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China;Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yi-Bin Hou
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Qing-Tao Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Su Zhou
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yu-Xin Shi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Bu-Lang Gao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Schullian P, Johnston EW, Putzer D, Eberle G, Laimer G, Bale R. Stereotactic radiofrequency ablation of subcardiac hepatocellular carcinoma: a case-control study. Int J Hyperthermia 2020; 36:876-885. [PMID: 31462110 DOI: 10.1080/02656736.2019.1648886] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the safety and efficacy of stereotactic radiofrequency ablation (SRFA) for the treatment of subcardiac hepatocellular carcinoma (HCC). Material and methods: From 2003 to 2018, 79 consecutive patients underwent 104 multi-probe SRFA sessions for the treatment of 114 subcardiac HCC with a median size of 2.5 cm (0.5-9.5 cm). The results were compared with a randomly selected control group of 79 patients with 242 HCC with a median size of 2.0 cm (0.5-12 cm) following SRFA in other (non-subcardiac) locations with propensity score matching. Results: The 95.6% of the tumors were successfully treated by the first ablation session (primary technical efficacy rate) and 99.1% after the second session (secondary technical efficacy rate). Local tumor recurrence developed in 8 nodules (7.0%). Major complication and perioperative mortality rates were 7.7% (8/104) and 1% (1/104), respectively. The overall survival (OS) rates from the date of the first SRFA with single subcardiac HCCs were 92%, 77% and 65% at 1, 3 and 5 years, respectively, with a median OS of 90.6 months. The disease-free survival (DFS) after SRFA was 75, 34 and 34%, at 1, 3 and 5 years, respectively, with a median DFS of 19.1 months. There was no statistically significant difference with the control group in terms of local tumor control, safety, OS and DFS. Conclusion: SRFA of subcardiac tumors is as safe and efficacious as when treating tumors remote from the heart.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | | | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
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12
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Li X, Xu M, Liu M, Tan Y, Zhuang B, Lin M, Kuang M, Xie X. Contrast-enhanced ultrasound-guided feeding artery ablation as add-on to percutaneous radiofrequency ablation for hypervascular hepatocellular carcinoma with a modified ablative technique and tumor perfusion evaluation. Int J Hyperthermia 2020; 37:1016-1026. [PMID: 32865050 DOI: 10.1080/02656736.2020.1811902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/27/2020] [Accepted: 08/13/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To establish a modified strategy of the feeding artery ablation (FAA) procedure as an add-on to percutaneous radiofrequency ablation (RFA) for patients with hypervascular hepatocellular carcinoma (HCC), and to evaluate the outcomes. MATERIALS AND METHODS For this prospective, single-arm study, from June 2014 to August 2016, twenty-five patients with hypervascular HCC, 2-5 cm in diameter were treated by contrast-enhanced ultrasound (CEUS)-guided FAA before conventional RFA. Technical success of FAA and subsequent perfusion change of the tumor were evaluated by CEUS. Technical efficacy and ablation sizes were evaluated by CT/MRI at 1 month. Therapeutic outcomes, including local tumor progression (LTP), overall survival (OS), and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method. RESULTS One or two target feeding arteries were visible on CEUS for 52.6% (61/116) of the hypervascular HCCs 2-5 cm in diameter. The technical success rate of the FAA was 100%; 13/25 (52.0%) target tumors were evaluated as complete perfusion response, while 12/25 (48.0%) were evaluated as partial perfusion response. The ablation volume was 41.9 ± 17.5 cm3 (14.9-78.2 cm3) and the ablative safety margin was 8.2 ± 1.9 mm (4-12 mm) at the 1-month evaluation. These parameters did not differ significantly between the complete and partial subgroups. The cumulative rates of LTP at 1-, 2-, and 3-year follow-ups were 0.0%, 4.2% and 4.2%, respectively. The 3-year OS and RFS were 70.3% vs. 59.8%, respectively. There were no treatment-related deaths. Major complications occurred in one patient (4.0%). CONCLUSION As an add-on to conventional percutaneous RFA, tailored CEUS-guided FAA can reduce tumor perfusion and provide good local control of HCC.
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Affiliation(s)
- Xiaoju Li
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Ming Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Ming Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yang Tan
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Bowen Zhuang
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Manxia Lin
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Ming Kuang
- Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
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Wang C, Chan C, Chao Y. The effectiveness of local ablation for small hepatocellular carcinoma using artificial ascites. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Chia‐Chi Wang
- Department of GastroenterologyTaipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University Hualien Taiwan
| | - Cheng‐Yi Chan
- Department of RadiologistTaipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University Hualien Taiwan
| | - You‐Chen Chao
- Department of GastroenterologyTaipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University Hualien Taiwan
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Hsieh YC, Limquiaco JL, Lin CC, Chen WT, Lin SM. Radiofrequency ablation following artificial ascites and pleural effusion creation may improve outcomes for hepatocellular carcinoma in high-risk locations. Abdom Radiol (NY) 2019; 44:1141-1151. [PMID: 30460530 DOI: 10.1007/s00261-018-1831-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the outcomes of radiofrequency ablation (RFA) following artificial ascites (AA) and artificial pleural effusion (AP) creation for hepatocellular carcinoma (HCC) in high-risk locations. MATERIALS AND METHODS Eligible patients were divided into 2 study periods (non-AAAP and AAAP groups) with AAAP performed in the latter period. Local tumor progression, primary technique effectiveness and complications were compared between patients with and without AAAP. Cumulative probability of local tumor progression and overall survival were estimated with Kaplan-Meier curves. RESULTS One hundred thirty-eight patients with 195 tumors were evaluated. AAAP was performed in 48 patients with 76 tumors. Local tumor progression rates at 12 and 24 months were 9.3% and 22.2% in the non-AAAP group versus 5.5% and 9% in the AAAP group (p < 0.0001). Primary technique effectiveness was achieved in 76.5% of the non-AAAP group versus 89.5% of the AAAP group (p = 0.046). Night (7.6%) major complications occurred in the non-AAAP group and 2 (2.6%) cases occurred in the AAAP group. Therapy-oriented severity grading system after RFA was lower in the AAAP group (p = 0.02). Overall survival rates at 12 and 24 months were 85.6% and 77.7% in the non-AAAP group versus 97.2% and 89.7% in the AAAP group (p = 0.033). CONCLUSION RFA following AA and AP for high-risk located HCC may improve outcomes.
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Affiliation(s)
- Yi-Chung Hsieh
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Jenny L Limquiaco
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
- Division of Gastroenterology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Chen-Chun Lin
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Shi-Ming Lin
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan.
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15
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Bai XM, Yang W, Zhang ZY, Jiang AN, Wu W, Lee JC, Chen MH, Yan K. Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer. Int J Hyperthermia 2019; 35:183-193. [PMID: 30200791 DOI: 10.1080/02656736.2018.1488279] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the long-term efficacy and prognostic factors of ultrasound-guided percutaneous radiofrequency ablation (RFA) for breast cancer liver metastasis (BCLM). METHODS Between 2000 and 2015, 69 patients who underwent ultrasound-guided percutaneous RFA for BCLM and had regular follow-up examinations were included. All patients had undergone resection of the primary breast cancer and had received chemotherapy, endocrine therapy or both after surgery. The sample included two males and 67 females with an average age of 50.3 ± 10.0 years (31-76 y). The mean maximum diameter of metastatic lesions in the liver was 2.9 ± 1.4 cm (1.0-6 cm). Thirty-five patients had a single metastasis, while 34 patients had multiple liver metastases (2-5 lesions). Survival results were generated using Kaplan-Meier estimates and a multivariate analysis was performed using the Cox regression model. RESULTS In total, 92 RFA sessions were performed and 135 BCLM lesions were treated. Major complications occurred in one of the 92 sessions (1.1%). Technical efficacy was achieved in 92.6% of lesions (125/135 lesions). Local tumor progression occurred in 11.6% (8/69) of patients and new intrahepatic metastasis occurred in 55.1% (38/69) of patients. From the time of initial RFA, the median overall survival was 26 months, and the one-, two-, three- and five -year survival rates were 81.8, 50.1, 25.3 and 11.0%, respectively. Based on the multivariate analysis, the following three factors were identified as independent prognostic factors for overall survival: tumor size (p = .017), positive estrogen receptor status (p = .009) and extrahepatic metastatic disease (p = .001). The median progression-free survival was 24 months, and the one-, two-, three- and five -year survival rates after RFA were 77.4, 47.0, 23.7 and 8.5%, respectively. Additionally, the independent prognostic factors for progression-free survival included tumor size (p = .011), ER positivity (p = .001), margin size (p = .017) and extrahepatic metastatic disease (p < .001). CONCLUSION The results of this study showed that RFA is a safe and locally effective method for the treatment of BCLM, especially in patients with lesions measuring less than 3 cm in diameter, a single liver metastasis, positive estrogen receptor status and no extrahepatic metastases. Also, patients with margin size >10 mm had no local tumor progression.
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Affiliation(s)
- Xiu-Mei Bai
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Wei Yang
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Zhong-Yi Zhang
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - An-Na Jiang
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Wei Wu
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Jung-Chieh Lee
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Min-Hua Chen
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Kun Yan
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
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Long Y, Yan R, Li K, Luo L, Zeng Q, Tan L, Zhang M, Zheng R, Xu E. Radiofrequency ablation of liver cancers adjacent to the gallbladder without gallbladder isolation under contrast-enhanced ultrasound monitoring: a preliminary study. Int J Hyperthermia 2018; 36:139-145. [PMID: 30489164 DOI: 10.1080/02656736.2018.1539776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the feasibility, safety and efficacy of intra-procedural contrast-enhanced ultrasound (CEUS) monitoring of the radiofrequency ablation (RFA) of liver cancers adjacent to gallbladder (GB) without GB isolation. MATERIALS AND METHODS From May 2016 to July 2017, patients with liver cancers adjacent to GB (≤10 mm) who intended to undergo ultrasound-guided RFA without GB isolation in our hospital were prospectively enrolled. During the RFA procedures, CEUS was employed to evaluate the therapeutic response and the perfusion of the intact GB wall. The outcomes of GB and liver cancers were followed up and recorded. RESULTS 23 patients (18 male, 5 female) with 23 liver cancers (mean 18 mm, range 8-34 mm) adjacent to GB were enrolled. There were 12 tumors that abutted the GB while 11 tumors located within 10 mm of the GB. After the RFA procedures, intra-procedural CEUS evaluation demonstrated the perfusion of the GB wall was intact in all 23 patients and technical success rate of RFA was 100% (23/23). According to the contrast-enhanced CT/MR one month after RFA, the technical efficacy rate was 100% (23/23). During the follow-up period (range: 12-23 months, median: 17 months), no local tumor progression occurred and no major complications arised. Overall survival at 1-year was 100%. Thickening of GB wall was detected in 11 patients. The thickness of GB wall returned to the pre-ablation level in five patients. CONCLUSION CEUS-monitored RFA of liver cancers adjacent to GB without GB isolation was feasible, safe and effective.
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Affiliation(s)
- Yinglin Long
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Ronghua Yan
- b Department of Radiology, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Kai Li
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Liping Luo
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Qingjing Zeng
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Lei Tan
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Man Zhang
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Rongqin Zheng
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Erjiao Xu
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
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Meng LMD, Zhiyan LMD, Yuejuan GMD, Jiangke TMD, Min CMD, Jinghui DMD. Safety and Efficacy of Percutaneous Radiofrequency Ablation Combined with Percutaneous Ethanol Injection for Hepatocellular Carcinoma in High-risk Locations. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2018. [DOI: 10.37015/audt.2018.180004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yuan W, Yang MJ, Xu J, Yan ZP, Liu R, Qu XD, Wang JH, Qian S. Radiofrequency Ablation Combined With Transarterial Chemoembolization for Specially Located Small Hepatocellular Carcinoma. Technol Cancer Res Treat 2018; 17:1533033818788529. [PMID: 30045673 PMCID: PMC6071156 DOI: 10.1177/1533033818788529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate the safety and efficacy of radiofrequency ablation combined with transarterial chemoembolization in patients with specially located small hepatocellular carcinoma. MATERIALS AND METHODS Between March 2014 and March 2017, a total of 26 patients with 26 lesions (10 perivascular, 6 subdiaphragmatic, 5 subcapsular, 5 perivascular, and subdiaphragmatic location; mean diameter 2.12 (0.62) cm), who received radiofrequency ablation-transarterial chemoembolization treatment, were retrospectively analyzed. Local tumor response was assessed by computed tomography/magnetic resonance imaging 1 month after the procedure. Tumor-free survival was also assessed according to the modified Response Evaluation Criteria in Solid Tumors. Complications were evaluated according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (version 4.0). RESULTS Complete response was achieved in all patients 1 month after the procedure. During a median follow-up duration of 16.76 months (95% confidence interval: 7.78-25.73 months), local tumor recurrence occurred in 2 patients and new intrahepatic lesions developed in 7 patients. The 1-, 2-, and 3-year cumulative local tumor progression rates were 3.84%, 7.69%, and 7.69%, respectively. The median tumor-free survival duration was 21.96 months (95% confidence interval: 17.58-26.34 months). The 1-, 2-, and 3-year tumor-free survival rates were 67.4%, 46.1%, and 39.3%, respectively. CONCLUSION The radiofrequency ablation-transarterial chemoembolization combination therapy appears to be safe and effective and might be a treatment option for specially located small hepatocellular carcinoma lesions that have a risk of incomplete ablation or major complications.
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Affiliation(s)
- Wei Yuan
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Min-Jie Yang
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Jiang Xu
- 3 Department of Rehabilitation, Huai'an Second People's Hospital, The Affiliated Hospital of Xuzhou Medical University, Huai'an, China
| | - Zhi-Ping Yan
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Rong Liu
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Xu-Dong Qu
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Jian-Hua Wang
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Sheng Qian
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
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Efficacy and Safety of Radiofrequency Ablation for Focal Hepatic Lesions Adjacent to Gallbladder: Reconfiguration of the Ablation Zone through Probe Relocation and Ablation Time Reduction. J Vasc Interv Radiol 2017; 28:1395-1399. [DOI: 10.1016/j.jvir.2017.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 01/24/2023] Open
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Ziv O, Goldberg SN, Nissenbaum Y, Sosna J, Weiss N, Azhari H. Optical flow and image segmentation analysis for noninvasive precise mapping of microwave thermal ablation in X-ray CT scans - ex vivo study. Int J Hyperthermia 2017; 34:744-755. [PMID: 28866952 DOI: 10.1080/02656736.2017.1375160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To develop image processing algorithms for noninvasive mapping of microwave thermal ablation using X-ray CT. METHODS Ten specimens of bovine liver were subjected to microwave ablation (20-80 W, 8 min) while scanned by X-ray CT at 5 s intervals. Specimens were cut and manually traced by two observers. Two algorithms were developed and implemented to map the ablation zone. The first algorithm utilises images segmentation of Hounsfield units changes (ISHU). The second algorithm utilises radial optical flow (ROF). Algorithm sensitivity to spatiotemporal under-sampling was assessed by decreasing the acquisition rate and reducing the number of acquired projections used for image reconstruction in order to evaluate the feasibility of implementing radiation reduction techniques. RESULTS The average radial discrepancy between the ISHU and ROF contours and the manual tracing were 1.04±0.74 and 1.16±0.79mm, respectively. When diluting the input data, the ISHU algorithm retained its accuracy, ranging from 1.04 to 1.79mm. By contrast, the ROF algorithm performance became inconsistent at low acquisition rates. Both algorithms were not sensitive to projections reduction, (ISHU: 1.24±0.83mm, ROF: 1.53±1.15mm, for reduction by eight fold). Ablations near large blood vessels affected the ROF algorithm performance (1.83±1.30mm; p < 0.01), whereas ISHU performance remained the same. CONCLUSION The two suggested noninvasive ablation mapping algorithms can provide highly accurate contouring of the ablation zone at low scan rates. The ISHU algorithm may be more suitable for clinical practice as it appears more robust when radiation dose reduction strategies are employed and when the ablation zone is near large blood vessels.
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Affiliation(s)
- Omri Ziv
- a Department of Biomedical Engineering , Technion - IIT , Haifa , Israel
| | - S Nahum Goldberg
- b Department of Radiology , Hadassah Medical Center, Hebrew University , Jerusalem , Israel.,c Department of Radiology , Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Yitzhak Nissenbaum
- b Department of Radiology , Hadassah Medical Center, Hebrew University , Jerusalem , Israel
| | - Jacob Sosna
- b Department of Radiology , Hadassah Medical Center, Hebrew University , Jerusalem , Israel.,c Department of Radiology , Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Noam Weiss
- a Department of Biomedical Engineering , Technion - IIT , Haifa , Israel
| | - Haim Azhari
- a Department of Biomedical Engineering , Technion - IIT , Haifa , Israel
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Park HS, Baek JH, Park AW, Chung SR, Choi YJ, Lee JH. Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques. Korean J Radiol 2017; 18:615-623. [PMID: 28670156 PMCID: PMC5447637 DOI: 10.3348/kjr.2017.18.4.615] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/09/2017] [Indexed: 12/21/2022] Open
Abstract
Radiofrequency ablation (RFA) is a well-known, effective, and safe method for treating benign thyroid nodules and recurrent thyroid cancers. Thyroid-dedicated devices and basic techniques for thyroid RFA were introduced by the Korean Society of Thyroid Radiology (KSThR) in 2012. Thyroid RFA has now been adopted worldwide, with subsequent advances in devices and techniques. To optimize the treatment efficacy and patient safety, understanding the basic and advanced RFA techniques and selecting the optimal treatment strategy are critical. The goal of this review is to therefore provide updates and analysis of current devices and advanced techniques for RFA treatment of benign thyroid nodules and recurrent thyroid cancers.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Auh Whan Park
- Department of Radiology, Vascular & Interventional Radiology Section, University of Virginia Health System, Charlottesville, VA 22908-0170, USA
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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22
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Yan K, Yang W, Chen MH, Zhang ZY, Lee JC, Liao HX, Wu W, Goldberg SN. Clinical application of hepatic wedge ablation for treating liver malignancies of the inferior margin: a new ablation technique. Int J Hyperthermia 2016; 33:203-211. [PMID: 27590572 DOI: 10.1080/02656736.2016.1232441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Min-Hua Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhong-Yi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jung-Chieh Lee
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hai-Xing Liao
- Department of Ultrasound, First Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - S. Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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23
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Xu L, Cai K, Yang R, Lin Q, Yue H, Liu F. Simulation of multi-probe radiofrequency ablation guided by optical surgery navigation system under different active modes. Comput Assist Surg (Abingdon) 2016; 21:107-116. [DOI: 10.1080/24699322.2016.1210679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Leyi Xu
- Department of Biomedical Engineering, South China University of Technology, Guangzhou, China
| | - Ken Cai
- School of Information Science and Technology, Zhongkai University of Agriculture and Engineering, Guangzhou, China
| | - Rongqian Yang
- Department of Biomedical Engineering, South China University of Technology, Guangzhou, China
| | - Qinyong Lin
- Department of Biomedical Engineering, South China University of Technology, Guangzhou, China
| | - Hongwei Yue
- School of Information Engineering, Wuyi University, Jiangmen, China
| | - Feng Liu
- School of Information Technology and Electrical Engineering, the University of Queensland, Brisbane, QLD, Australia
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Wells SA, Hinshaw JL, Lubner MG, Ziemlewicz TJ, Brace CL, Lee FT. Liver Ablation: Best Practice. Radiol Clin North Am 2015; 53:933-71. [PMID: 26321447 DOI: 10.1016/j.rcl.2015.05.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tumor ablation in the liver has evolved to become a well-accepted tool in the management of increasing complex oncologic patients. At present, percutaneous ablation is considered first-line therapy for very early and early hepatocellular carcinoma and second-line therapy for colorectal carcinoma liver metastasis. Because thermal ablation is a treatment option for other primary and secondary liver tumors, an understanding of the underlying tumor biology is important when weighing the potential benefits of ablation. This article reviews ablation modalities, indications, patient selection, and imaging surveillance, and emphasizes technique-specific considerations for the performance of percutaneous ablation.
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Affiliation(s)
- Shane A Wells
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA.
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
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25
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Wang CC, Kao JH. Artificial ascites is feasible and effective for difficult-to-ablate hepatocellular carcinoma. Hepatol Int 2015; 9:514-9. [DOI: 10.1007/s12072-015-9639-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/11/2015] [Indexed: 12/15/2022]
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26
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Li M, Yu X, Liang P, Dong B, Liu F. Ultrasound-guided percutaneous microwave ablation for hepatic malignancy adjacent to the gallbladder. Int J Hyperthermia 2015; 31:579-87. [DOI: 10.3109/02656736.2015.1014869] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Huang H, Liang P, Yu XL, Cheng ZG, Han ZY, Yu J, Liu FY. Safety assessment and therapeutic efficacy of percutaneous microwave ablation therapy combined with percutaneous ethanol injection for hepatocellular carcinoma adjacent to the gallbladder. Int J Hyperthermia 2015; 31:40-7. [PMID: 25766386 DOI: 10.3109/02656736.2014.999017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study sought to evaluate the safety and efficacy of ultrasound-guided (US-guided) percutaneous microwave (MW) ablation combined with percutaneous ethanol injection (PEI) to treat liver tumours adjacent to the gallbladder. MATERIALS AND METHODS A total of 136 patients with hepatocellular carcinoma (HCC) adjacent to the gallbladder, who underwent ultra-sonographically-guided percutaneous MW ablation, which was combined with PEI in 132 patients, were retrospectively assessed. The patient population characteristics, tumour features, local tumour progression and treatment were compared and analysed. The safety and efficacy of the therapy were assessed by clinical data and imaging in follow-up examinations. RESULTS All patients were completely treated with two sessions; 120 patients underwent one session, 16 patients underwent two sessions. The primary technique was effective in 95.6% of the cases, according to the computed tomography (CT) or magnetic resonance imaging (MRI) in the one-month follow-up (132 of 138 sessions). PEI and other therapies were performed in the patients who had been incompletely treated (all six patients underwent PEI, and some underwent other therapies, including one transcatheter arterial chemoembolisation (TACE), one liver transplantation and two liver resections). There was a median follow-up period of 30.1 months and a range of 4 to 68 months. None of the patients had major complications. There were no treatment-related deaths. Twenty-six patients died of primary disease progression that was not directly attributable to MW ablation (19.1%, 26/136). Local tumour progression was noted in five patients (3.7%, 5/136), who had completely ablated tumours at follow-up. The patients with locally progressing tumours underwent additional therapy (three patients underwent PEI, one patient TACE, and one liver resection). CONCLUSION Ultrasound-guided percutaneous MW ablation, in combination with percutaneous ethanol injection and thermal monitoring, is a safe and effective treatment for HCC adjacent to the gallbladder.
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Affiliation(s)
- Hui Huang
- Department of Interventional Ultrasound, Chinese PLA General Hospital , Beijing , China
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Yang W, Yan K, Wu GX, Wu W, Fu Y, Lee JC, Zhang ZY, Wang S, Chen MH. Radiofrequency ablation of hepatocellular carcinoma in difficult locations: Strategies and long-term outcomes. World J Gastroenterol 2015; 21:1554-1566. [PMID: 25663774 PMCID: PMC4316097 DOI: 10.3748/wjg.v21.i5.1554] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/29/2014] [Accepted: 09/19/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate the treatment strategies and long-term outcomes of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in difficult locations and to compare the results with non-difficult HCC.
METHODS: From 2004 to 2012, a total of 470 HCC patients underwent ultrasound-guided percutaneous RFA. Among these HCC patients, 382 with tumors located ≤ 5 mm from a major vessel/bile duct (n = 87), from peripheral important structures (n = 232) or from the liver capsule (n = 63) were regarded as difficult cases. There were 331 male patients and 51 female patients, with an average age of 55.3 ± 10.1 years old. A total of 235 and 147 patients had Child-Pugh class A and class B liver function, respectively. The average tumor size was 3.4 ± 1.2 cm. Individual treatment strategies were developed to treat these difficult cases. During the same period, 88 HCC patients with tumors that were not in difficult locations served as the control group. In the control group, 74 patients were male, and 14 patients were female, with an average age of 57.4 ± 11.8 years old. Of these, 62 patients and 26 patients had Child-Pugh class A and class B liver function, respectively. Regular follow-up after RFA was performed to assess treatment efficacy. Survival results were generated from Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model.
RESULTS: Early tumor necrosis rate in the difficult group was similar to that in the control group (97.6% vs 94.3%, P = 0.080). The complication rate in the difficult group was significantly higher than that in the control group (4.9% vs 0.8%, P = 0.041). The follow-up period ranged from 6 to 116 mo, with an average of 28 ± 22.4 mo. Local progression rate in the difficult group was significantly higher than that in the control group (12.7% vs 7.1%, P = 0.046). However, the 1-, 3-, 5-, and 7-year overall survival rates in the difficult group were not significantly different from those in the control group (84.3%, 54.4%, 41.2%, and 29.9% vs 92.5%, 60.3%, 43.2%, and 32.8%, respectively, P = 0.371). Additionally, a multivariate analysis revealed that tumor location was not a significant risk factor for survival.
CONCLUSION: There was no significant difference in long-term overall survival between the two groups even though the local progression rate was higher in the difficult group.
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29
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 2014; 25:1691-705.e4. [PMID: 25442132 PMCID: PMC7660986 DOI: 10.1016/j.jvir.2014.08.027] [Citation(s) in RCA: 361] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/11/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022] Open
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215.
| | - Luigi Solbiati
- Department of Radiology, Ospedale Generale, Busto Arsizio, Italy
| | - Christopher L Brace
- Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton, England
| | | | | | - Min-Hua Chen
- Department of Ultrasound, School of Oncology, Peking University, Beijing, China
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Thierry de Baère
- Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Gerald D Dodd
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Damian E Dupuy
- Department of Diagnostic Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Gianfelice
- Medical Imaging, University Health Network, Laval, Quebec, Canada
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Edward Leen
- Department of Radiology, Royal Infirmary, Glasgow, Scotland
| | - Riccardo Lencioni
- Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy
| | - Peter J Littrup
- Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P McGahan
- Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, California
| | | | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Philippe L Pereira
- Clinic of Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Academic Hospital Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hyunchul Rhim
- Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Bradford J Wood
- Radiology and Imaging Science, National Institutes of Health, Bethesda, Maryland
| | - S Nahum Goldberg
- Department of Radiology, Image-Guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Radiofrequency thermoablation of HCC larger than 3 cm and less than 5 cm proximal to the gallbladder without gallbladder isolation: a single center experience. BIOMED RESEARCH INTERNATIONAL 2014; 2014:896527. [PMID: 25247192 PMCID: PMC4163369 DOI: 10.1155/2014/896527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/07/2014] [Indexed: 12/12/2022]
Abstract
Radiofrequency ablation (RFA) is an effective minimally invasive treatment for nonsurgical hepatocellular carcinoma (HCC), but ablation of tumors close to the gallbladder could be associated with several complications. We report our experience on the treatment of HCC close to the gallbladder with RFA. Eight RFA procedures were performed in eight patients with HCC larger than 3 cm and less than 5 cm close to the gallbladder. In all cases, a percutaneous approach was used. There were no major complications. Only in two patients a minimal wall thickening of the gallbladder was observed. Contrast enhanced computed tomography carried out after 30 days from the first procedure showed complete necrosis in seven patients (87%). Only one patient had local recurrence at 11 months of followup. Although limited, our experience suggests that, after careful preprocedural planning, in experienced hands and with appropriate technology, percutaneous RFA could be safely performed even for lesions larger than 3 cm located in close adjacency to the gallbladder.
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31
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Fairchild AH, Tatli S, Dunne RM, Shyn PB, Tuncali K, Silverman SG. Percutaneous cryoablation of hepatic tumors adjacent to the gallbladder: assessment of safety and effectiveness. J Vasc Interv Radiol 2014; 25:1449-55. [PMID: 24906627 DOI: 10.1016/j.jvir.2014.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/25/2014] [Accepted: 04/27/2014] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess safety and effectiveness of percutaneous image-guided cryoablation of hepatic tumors adjacent to the gallbladder. MATERIALS AND METHODS Twenty-one cryoablation procedures were performed to treat 19 hepatic tumors (mean size, 2.7 cm; range, 1.0-5.0 cm) adjacent to the gallbladder in 17 patients (11 male; mean age, 59.2 y; range, 40-82 y) under computed tomography (n = 15) or magnetic resonance imaging (n = 6) guidance in a retrospective study. All tumors (mean size, 2.67 cm; range, 1.0-5.0 cm) were within 1 cm (mean, 0.4 cm) of the gallbladder; seven (33%) were contiguous with the gallbladder. Primary outcomes included complication rate and severity and postprocedure gallbladder imaging findings. Secondary outcomes included technical success and technique effectiveness at 6 months. RESULTS Complications occurred in six of 21 procedures (29%); one (5%) was severe. Ice balls extended into the gallbladder lumen in 20 of 21 procedures (95%); no gallbladder-related complications occurred. The most common gallbladder imaging finding was mild, asymptomatic focal wall thickening after nine of 21 procedures (42%), which resolved on follow-up. Technical success was achieved in 19 of 21 sessions (90%). Six-month follow-up was available for 16 tumors; of these, all but two (87%) had no imaging evidence of local tumor progression. CONCLUSIONS Percutaneous cryoablation of hepatic tumors adjacent to the gallbladder can be performed safely and successfully. Although postprocedural gallbladder changes are common, they are self-limited and clinically inconsequential, even when the ice ball extends into the gallbladder lumen.
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Affiliation(s)
- Alexandra H Fairchild
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.
| | - Servet Tatli
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
| | - Ruth M Dunne
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
| | - Kemal Tuncali
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115
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Guo WX, Sun JX, Cheng YQ, Shi J, Li N, Xue J, Wu MC, Chen Y, Cheng SQ. Percutaneous radiofrequency ablation versus partial hepatectomy for small centrally located hepatocellular carcinoma. World J Surg 2013; 37:602-7. [PMID: 23212793 DOI: 10.1007/s00268-012-1870-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is not known whether percutaneous radiofrequency ablation (PRFA) could get the same treatment efficacy and fewer complications as partial hepatectomy (PH) in patients with small centrally located hepatocellular carcinoma (HCC). The present study was designed to evaluate the efficacy of PH and PRFA in the treatment of small centrally located HCC. METHODS From January 2002 until December 2007, 196 patients with small centrally located HCC (≤5 cm) were included. Of these 196 patients, 94 received PRFA and 102 patients were treated with PH. Treatment outcomes, including major complications and survival data, were studied. RESULTS No treatment-related death occurred in either group. There were no significant differences in survival rates between the two groups. The 1-, 3-, and 5-year disease-free survival rates for the PRFA and PH groups were 57.9%, 36.4%, 34.0%, and 59.8%, 42.4%, 40.8%, respectively (P = 0.50). The 1-, 3-, and 5-year overall survival rates for the two groups were 94.3%, 74.7%, and 49.8%, and 89.2%, 74.1%, and 63.1%, respectively (P = 0.96). PRFA had a lower rate of major complications than PH (8.5 vs. 19.6%), and the hospital stay was also shorter in the PRFA group than in the PH subgroup (4 vs. 13 days). CONCLUSIONS Based on the data obtained, we concluded that PRFA might be equal to PH for the treatment of small centrally located HCC. However, PRFA has the benefits of shorter hospital stay as well as a lower rate of complications.
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Affiliation(s)
- Wei-Xing Guo
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, No. 225 Changhai Road, Shanghai, 200438, People's Republic of China
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Wong J, Lee KF, Yu SCH, Lee PSF, Cheung YS, Chong CN, Ip PCT, Lai PBS. Percutaneous radiofrequency ablation versus surgical radiofrequency ablation for malignant liver tumours: the long-term results. HPB (Oxford) 2013; 15:595-601. [PMID: 23458320 PMCID: PMC3731580 DOI: 10.1111/hpb.12014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/18/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) has been used to treat hepatocellular carcinoma (HCC) and liver metastases for more than 10 years with promising early outcomes. Preliminary results comparing percutaneous and surgical approaches have shown no difference in short-term outcomes. In this study, the longer-term outcomes were presented. METHODS Patients with liver malignancies treated by RFA were prospectively studied from 2003 to 2011. Post-ablation assessment by computed tomography (CT) scan and serum biochemistry was performed at regular intervals. Recurrence rates and long-term survival were analysed. RESULTS A total of 233 patients with liver malignancies (75.5% HCC and 24.5% liver metastases) were analysed. Three RFA approaches were used (percutaneous 58.4%, laparoscopic 9.4% and open 32.2%). The median follow-up time was 29 months. Complete ablation was achieved in 83.7%, with no difference between the two approaches. More wound and chest complications were observed in the surgical group. Intra-hepatic recurrences were observed in 69.5%; extra-hepatic recurrences were detected in 22.3%, with no difference between the two groups. There was no statistical difference between the two approaches in overall 1-, 3- and 5-year survival. CONCLUSION An extended period of follow-up in patients with liver malignancies showed that RFA is an effective treatment. No difference was demonstrated between the percutaneous and surgical approach, in terms of recurrence and survival.
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Affiliation(s)
- John Wong
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Kit-Fai Lee
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Simon Chun-Ho Yu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Paul Sing-Fun Lee
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Yue-Sun Cheung
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Ching-Ning Chong
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Philip Ching-Tak Ip
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Paul Bo-San Lai
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
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Radiofrequency ablation for postoperative recurrences of intrahepatic cholangiocarcinoma. Chin J Cancer Res 2013; 23:295-300. [PMID: 23359754 DOI: 10.1007/s11670-011-0295-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 05/19/2011] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Role of contrast enhanced ultrasound in radiofrequency ablation of metastatic liver carcinoma. Chin J Cancer Res 2013; 24:44-51. [PMID: 23359761 DOI: 10.1007/s11670-012-0044-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To investigate the application of contrast enhanced ultrasound (CEUS) in planning and guiding for radiofrequency ablation (RFA) for metastatic liver carcinoma (MLC). METHODS 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. RESULTS 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). CONCLUSION 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.
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Levit E, Bruners P, Günther RW, Mahnken AH. Bile aspiration and hydrodissection to prevent complications in hepatic RFA close to the gallbladder. Acta Radiol 2012; 53:1045-8. [PMID: 22855419 DOI: 10.1258/ar.2012.120190] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) of liver tumors is a mainstay of interventional oncology. Its application, however, is limited by tumor size and location with lesions located within 1 cm to the gallbladder being at increased risk for complications. PURPOSE To evaluate the safety of hepatic RFA after bile aspiration with or without additional hydrodissection for lesions adjacent to the gallbladder. MATERIAL AND METHODS Six patients undergoing RFA of tumors with a distance of less than 1 cm to the gallbladder were retrospectively identified from a computer database. All patients underwent RFA combined with percutaneous bile aspiration from the gallbladder. In four patients additional hydrodissection was performed. Technical success and post-interventional complications were assessed by reviewing images and patient charts. RESULTS Ablations were successfully completed in 5/6 patients. In one patient with incomplete ablation re-ablation was performed 2 months after the initial procedure. Minor complications occurred in three patients, including right-sided pleural effusion, hematoma in the gallbladder fossa, and intralesional hemorrhage in one patient each. There were no cases with cholecystitis or damage to the gallbladder during follow-up. CONCLUSION Bile aspiration with or without additional hydrodissection permits safe RFA of tumors located close to the gallbladder.
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Affiliation(s)
- Elena Levit
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Aachen
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Aachen
- Applied Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Rolf W Günther
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Aachen
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Aachen
- Applied Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Gallbladder Needle Decompression during Radiofrequency Ablation of an Adjacent Liver Tumour. Can Assoc Radiol J 2012; 63:S37-40. [DOI: 10.1016/j.carj.2011.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/04/2011] [Indexed: 11/22/2022] Open
Abstract
Gallbladder perforation with bile leak can result from thermal injury during radiofrequency ablation of liver tumours. Two case studies demonstrate a technique for preventing gallbladder injury to the peritoneal surface of a distended gallbladder adjacent to the anticipated hepatic ablation zone. The use of percutaneous gallbladder needle decompression can safely separate or retract the peritoneal surface of the gallbladder from a contiguous hepatic radiofrequency ablation zone.
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Kelogrigoris M, Laspas F, Kyrkou K, Stathopoulos K, Georgiadou V, Thanos L. Percutaneous radiofrequency ablation for malignant liver tumours in challenging locations. J Med Imaging Radiat Oncol 2012; 56:48-54. [PMID: 22339745 DOI: 10.1111/j.1754-9485.2011.02328.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the treatment results of radiofrequency ablation (RFA) for primary and metastatic malignant liver tumours in challenging locations and also to present the treatment strategy that was used in these cases. PATIENTS AND METHODS From January 2007 to January 2010, we performed CT-guided RFA on 528 lesions in 402 patients (265 men and 137 women; mean age 65.1 years, range 19-82 years) with liver tumours (primary and metastatic) of which 98 lesions in 84 patients (55 men and 29 women; mean age 67.8 years, range 33-82 years) were located in challenging locations, defined as less than 5 mm from a large vessel or an extrahepatic organ (heart, lung, gall bladder, right kidney or gastrointestinal tract). The sizes of the tumours ranged 1.5-6 cm. We used two different RFA systems with an expandable needle electrode (RITA; Rita Medical Systems, Inc, Mountain View, CA, USA and MIRAS; Invatec S.r.l., Roncadelle, Italy).The tumours were considered as ablated completely if no viability was found on dual-phase dynamic contrast-enhanced CT at 1 month after RFA. RESULTS Complete ablation was obtained in 89.7% (88/98) of the high-risk located lesions, while 10 (10.3%) of the lesions were managed with repeated RFA because of tumour residue. The 1-, 2- and 3-year survival rates were 82.6, 67.3 and 54.1%, respectively. Minor complications occurred in eight of the 84 patients (9.5%), including small sub-capsular haematoma in four, small pleural effusion in three and partial liver infarction in one. Local tumour progression rate was 9.2% (9/98). CONCLUSION RFA is a safe and effective method of treatment of primary and metastatic liver tumours even located in challenging locations when performed by a well-trained and experienced interventional radiologist.
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Affiliation(s)
- Michalis Kelogrigoris
- Computed Tomography and Interventional Radiology Department, Sotiria Chest Diseases Hospital, Athens, Greece.
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Igarashi T, Shimomura Y, Yamaguchi T, Kawahira H, Makino H, Yu WW, Naya Y. Water-filled laparoendoscopic surgery (WAFLES): feasibility study in porcine model. J Laparoendosc Adv Surg Tech A 2011; 22:70-5. [PMID: 22145608 DOI: 10.1089/lap.2011.0404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Recent surgical techniques have been advancing under endoscopic view and insufflation of carbon dioxide gas to expand the abdominal cavity. Isotonic fluid could be one candidate for expanding cavities to facilitate surgical maneuvering. We tested the feasibility and drawbacks of replacement of irrigating materials using a porcine model (water-filled laparoendoscopic surgery [WAFLES]). MATERIALS AND METHODS Laparoscopic cholecystectomy was performed in two porcine models using instillation of sorbitol solution as irrigant. Solution irrigation was performed through one of four ports, with drainage via another port. Conventional forceps equipped with a monopolar electrode for electrocautery, laparoscope, video processor, ultrasound, and transducer for measuring intraabdominal pressure were used. RESULTS Laparoscopic cholecystectomy was successfully undertaken with the following benefits: (1) clear observation of the dissecting plane throughout maneuvering; (2) control of oozing and spilled bile by irrigation and suction; and (3) ultrasonographic and laparoscopic images can be obtained simultaneously without any restriction to probe location. However, two disadvantages should be noted: (1) difficulties in managing floating organs and (2) interruption of vision by blood. CONCLUSIONS WAFLES provides some benefits for endoscopic surgery with proper devices, including apparatuses for irrigation and suction. Efficient irrigation and selection of proper irrigant and apparatuses are required to establish an acceptable procedure.
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Affiliation(s)
- Tatsuo Igarashi
- Division of Artificial System Engineering, Chiba University, Chiba City, Chiba, Japan.
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Kim YS. Percutaneous interventional procedures in an era of liver transplantation. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 17:96-8. [PMID: 21757979 PMCID: PMC3304643 DOI: 10.3350/kjhep.2011.17.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Komatsu S, Murakami M, Fukumoto T, Hori Y, Hishikawa Y, Ku Y. Risk factors for survival and local recurrence after particle radiotherapy for single small hepatocellular carcinoma. Br J Surg 2011; 98:558-64. [PMID: 21246516 DOI: 10.1002/bjs.7397] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Particle radiotherapy is a novel treatment for malignant tumours. The present study aimed to evaluate risk factors for overall survival and local control after particle radiotherapy of single small hepatocellular carcinoma (HCC), and to identify suitable candidates for this treatment. METHODS All patients with a single HCC smaller than 5 cm in diameter treated by particle radiotherapy between 2001 and 2008 were identified retrospectively from a prospectively collected database. Clinical outcomes and prognostic factors were analysed. RESULTS A total of 150 patients were included. Five-year overall survival and local control rates were 50.9 and 92.3 per cent respectively. Multivariable analysis revealed that several factors, including age and Child-Pugh classification, significantly influenced overall survival. Proximity to the digestive tract and Child-Pugh classification were independent risk factors for local recurrence. Other tumour factors including size, gross classification, previous treatment, macroscopic vascular invasion, and tumour location in relation to the diaphragm and large vessels did not influence local control rate. CONCLUSION Particle radiotherapy seems safe and effective, and may be a novel treatment for small HCC. Recurrences are more frequent when the tumour is located close to the gut.
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Affiliation(s)
- S Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Adán Merino L, Olveira Martín A, Pérez Robledo JP, Prieto I, Gea Rodriguez F, Castillo Grau P, Martín Arranz E, Alonso Gamarra E, Mora Sanz P. [Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma adjacent to the diaphragm]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:709-15. [PMID: 21059478 DOI: 10.1016/j.gastrohep.2010.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/14/2010] [Accepted: 09/07/2010] [Indexed: 01/05/2023]
Abstract
Surgical resection is the first-line curative treatment of hepatocellular carcinoma (HCC). However most patients are unable to undergo surgical resection because of advanced tumoral stage, severe liver dysfunction or poor clinical status. Therefore, image-guided tumor ablation techniques have been introduced for the treatment of unresectable HCC. Among them, radiofrequency ablation (RFA) has been demonstrated to be an effective alternative curative therapy. However, local ablative therapy for tumors located close to structures such as the diaphragm or gastrointestinal tract is technically challenging because of the risk of collateral thermal damage to nearby structures or incomplete treatment of the HCC resulting from poor visibility on sonography. The introduction of artificial ascites can separate adjacent organs from the tumor and improve the sonic window. The aim of this study was to evaluate the feasibility, safety and efficacy of RFA with artificial ascites for HCC adjacent to the diaphragm.
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Affiliation(s)
- Luisa Adán Merino
- Servicio de Aparato Digestivo, Hospital Infanta Leonor, Madrid, España.
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Abstract
Among locoregional treatments for hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) has been accepted as the most popular alternative to curative transplantation or resection, and it shows an excellent local tumor control rate and acceptable morbidity. The benefits of RFA have been universally validated by the practice guidelines of international societies of hepatology. The main advantages of RFA include 1) it is minimally invasive with acceptable morbidity, 2) it enables excellent local tumor control, 3) it has promising long-term survival, and 4) it is a multimodal approach. Based on these pros, RFA will play an important role in managing the patient with early HCC (smaller than 3 cm with fewer than four tumors). The main limitations of current RFA technology in hepatic ablation include 1) limitation of ablation volume, 2) technically infeasible in some tumors due to conspicuity and dangerous location, and 3) the heat-sink effect. Many technical approaches have been introduced to overcome those limitations, including a novel guiding modality, use of artificial fluid or air, and combined treatment strategies. RFA will continue to play a role as a representative ablative modality in the management of HCC, even in the era of targeted agents.
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Affiliation(s)
- Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rhim H, Lim HK, Choi D. Current status of radiofrequency ablation of hepatocellular carcinoma. World J Gastrointest Surg 2010; 2:128-36. [PMID: 21160861 PMCID: PMC2999222 DOI: 10.4240/wjgs.v2.i4.128] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 01/13/2010] [Accepted: 01/20/2010] [Indexed: 02/06/2023] Open
Abstract
Loco-regional treatments for hepatocellular carcinoma (HCC) are important alternatives to curative transplantation or resection. Among them, radiofrequency ablation (RFA) is accepted as the most popular technique showing excellent local tumor control and acceptable morbidity. The current role of RFA is well documented in the evidence-based practice guidelines of European Association of Study of Liver, American Association of Study of the Liver Disease and Japanese academic societies. Several randomized controlled trials have confirmed that RFA is superior to percutaneous ethanol injections in terms of local tumor control and survival. The overall survival after RFA is comparable to after surgical resection in a selected group of patients with smaller (< 3 cm) tumors. Currently, the clinical benefits of combined RFA with transarterial chemoembolization for intermediate stage HCC are increasingly being explored. Here we review the ongoing technical advancements of RFA and future potential.
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Affiliation(s)
- Hyunchul Rhim
- Hyunchul Rhim, Hyo K Lim, Dongil Choi, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
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Percutaneous Radiofrequency Ablation for Hepatic Tumors Abutting the Diaphragm: Clinical Assessment of the Heat-Sink Effect of Artificial Ascites. AJR Am J Roentgenol 2010; 194:W227-31. [DOI: 10.2214/ajr.09.2979] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Percutaneous radiofrequency ablation of hepatocellular carcinoma: assessment of safety in patients with ascites. AJR Am J Roentgenol 2009; 193:W424-9. [PMID: 19843722 DOI: 10.2214/ajr.08.1836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of our study was to assess whether percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is a safe procedure in patients with ascites. MATERIALS AND METHODS From October 2005 to January 2008, 35 patients with one or more HCCs and ascites were referred to our department for planning sonography of RFA. In 15 patients, RFA was determined to be unfeasible. One patient was excluded from the study because of the absence of ascites at the time of RFA. Percutaneous ultrasound-guided RFA was performed in the remaining 19 patients with 24 HCCs. The electrode tract was cauterized at the time of electrode removal. Retrospective assessments of the preprocedural platelet counts and prothrombin times were performed, and patients were evaluated for bleeding complication by checking vital signs, checking serum hemoglobin level, and using CT to determine whether the attenuation value of ascites had increased > 30 HU. RESULTS There were no cases of mortality or major complications that developed after RFA. No significant difference in the maximum thickness of the perihepatic ascites and in the hemoglobin level between the pre- and postprocedural measurements was detected. Hemoperitoneum as a minor complication was noted in two (10.5%) of 19 patients. However, in those two patients, vital signs were stable, follow-up laboratory data were normal, and hemoperitoneum had been completely absorbed on CT images obtained 1 month after RFA. CONCLUSION Percutaneous RFA for HCC can be performed safely in patients with ascites.
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CT-guided radiofrequency ablation for hepatocellular carcinomas that were undetectable at US: therapeutic effectiveness and safety. J Vasc Interv Radiol 2009; 20:490-9. [PMID: 19328427 DOI: 10.1016/j.jvir.2009.01.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 12/20/2008] [Accepted: 01/05/2009] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine the therapeutic effectiveness and safety of computed tomography (CT)-guided radiofrequency (RF) ablation for hepatocelluar carcinomas (HCCs) that were undetectable at ultrasonography (US). MATERIALS AND METHODS CT-guided RF ablation with use of internally cooled electrodes was performed in 66 patients with 97 HCCs (diameter range, 3-39 mm) in 78 sessions. Two radiologists retrospectively evaluated in consensus the presence or absence of local tumor progression as well as the complications at CT performed immediately after RF ablation and at 1-, 3-, 6-, and 12-month follow-up. The relationship between the occurrence of pneumothorax and the electrode length in the lung in patients treated with the transpulmonary approach was statistically evaluated with use of the Mann-Whitney test. RESULTS The technical success rate of CT-guided RF ablation immediately after RF ablation was 97% (94 of 97 HCCs). The primary technique effectiveness rates of complete ablation 1, 3, 6, and 12 months after RF ablation were 97% (94 of 97 HCCs), 94% (91 of 97 HCCs), 84% (81 of 96 HCCs), and 74% (66 of 89 HCCs), respectively. Major complications were observed in six of the 78 treatment sessions (7.7%). In five of these six sessions, pneumothorax developed immediately after RF ablation; the remaining complication was tumor seeding along the electrode tract. Self-limiting pneumothorax was observed in 12 of 38 sessions (32%) in which the transpulmonary approach was used. The electrode length in the lung was not statistically related to the occurrence of pneumothorax (P = .26). CONCLUSIONS For HCCs that are undetectable at US, CT-guided RF ablation is effective and relatively safe.
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Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol 2009; 19:2630-40. [PMID: 19557416 DOI: 10.1007/s00330-009-1463-x] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 03/18/2009] [Accepted: 04/24/2009] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to assess the feasibility, safety and efficacy of radiofrequency ablation (RFA) with the use of artificial ascites for hepatocellular carcinoma (HCC) adjacent to the diaphragm and gastrointestinal tract. One hundred forty-three patients with 181 HCCs who underwent US-guided percutaneous RFA with the use of artificial ascites were retrospectively reviewed. Among the 181 HCCs, 148 HCCs were defined as problematic nodules for two major reasons: poor sonic window or possible thermal injury. We artificially induced ascites before performing RFA by dripping 5% dextrose in a water solution. We assessed the technical success of introducing artificial ascites, technical feasibility of the use of artificial ascites and complications. The technical success rate, as well as the primary and secondary technique success rate, was assessed by regular follow-up CT examinations. RFA with artificial ascites was successfully achieved in 130 of 143 patients. The primary technique effectiveness was 85.3%. During follow-up (mean, 20.4 months), remote intrahepatic recurrence occurred in 49 patients and local tumor progression occurred in 15 patients. Three (2.1%) of the 143 patients experienced major complications (hemoperitoneum, lobar infarction and biloma) related to the RFA procedure. The use of artificial ascites is a simple and useful technique to minimize collateral thermal injury and to improve the sonic window.
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Kim SW, Rhim H, Park M, Kim H, Kim YS, Choi D, Lim HK. Percutaneous radiofrequency ablation of hepatocellular carcinomas adjacent to the gallbladder with internally cooled electrodes: assessment of safety and therapeutic efficacy. Korean J Radiol 2009; 10:366-76. [PMID: 19568465 PMCID: PMC2702046 DOI: 10.3348/kjr.2009.10.4.366] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 02/27/2009] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the safety and therapeutic efficacy of percutaneous radiofrequency (RF) ablation for the treatment of hepatocellular carcinomas (HCCs) adjacent to the gallbladder with the use of internally cooled electrodes. MATERIALS AND METHODS We retrospectively assessed 45 patients with 46 HCCs (mean size, 2.2 cm) adjacent to the gallbladder (<or=1.0 cm) treated with RF ablation using an internally cooled electrode system. An electrode was inserted into the tumor either parallel (n = 38) or perpendicular (n = 8) to the gallbladder wall. The safety and therapeutic efficacy of the procedures were assessed with clinical and imaging follow-up examinations. Follow-up with the use of CT ranged from four to 45 months (mean, 19 months). The association between variables (electrode direction, electrode type, tumor size, tumor location, lobar location) and the presence of a residual tumor or local tumor progression was also analyzed. RESULTS There were no major complications and minor complications were noted in three patients (7%) including one case of vasovagal syncope and two cases of bilomas. Wall thickening of the gallbladder adjacent to the RF ablation zone was noted in 14 patients (41%) as determined on immediate follow-up CT imaging. Wall thickening showed complete disappearance on subsequent follow-up CT imaging. The primary technique effectiveness rate was 96% (44/46) based on one-month follow-up CT imaging. Local tumor progression was noted in six (14%) of 44 completely ablated tumors during the follow-up period. The direction of electrode insertion (perpendicular), tumor size (>or=3 cm) and tumor location (a tumor that abutted the gallbladder) were associated with an increased risk of early incomplete treatment. No variable was significantly associated with local tumor progression. CONCLUSION Percutaneous RF ablation of HCCs adjacent to the gallbladder using an internally cooled electrode is a safe and effective treatment. Significant risk factors that lead to early incomplete treatment include tumor size, tumor location and electrode direction.
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Affiliation(s)
- Sang Won Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rhim H, Choi D, Kim YS, Lim HK, Choe BK. Ultrasonography-guided percutaneous radiofrequency ablation of hepatocellular carcinomas: a feasibility scoring system for planning sonography. Eur J Radiol 2009; 75:253-8. [PMID: 19427152 DOI: 10.1016/j.ejrad.2009.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 04/01/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was designed to evaluate whether a feasibility scoring system for planning sonography is a reliable predictor of a safe and complete ablation in ultrasonography (US)-guided percutaneous radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs). MATERIALS AND METHODS We retrospectively evaluated the therapeutic outcomes of 108 consecutive patients (M:F, 78:30; mean age, 57.4 years) with a single nodular HCC (mean diameter, 2.0 cm) treated by percutaneous RFA. All patients were assessed for the feasibility of performing an RFA at planning sonography prior to the ablation. The feasibility scoring system consisted of five categories: the safe electrode path (P); the vital organs adjacent to the RFA zone (O); tumor size (S); tumor conspicuity (C); and the heat-sink effect (H). Each category was divided into a four-point scale [1-4]. If a score of 4 in any category was determined, the patient was not considered to be a suitable candidate for percutaneous RFA. We assessed if the score of each category, safety score (P+O), and curability score (S+C+H) correlated with a safe and complete ablation using the chi-squared test and likelihood ratio test for trend. RESULTS The technical success rate was 100% (108/108) based on CT images obtained immediately after ablation. There was no 30-day mortality after RFA. There were major complications (one case of severe vasovagal reflex, one case of hemoperitoneum and one case of a pseudoaneurysm) in three (2.7%) patients, and minor complications (one case of a biloma, one case of subsegmental infarction and one case of abscess) in three (2.7%) patients. Post-ablation syndrome as a side effect was noted in 38 (35.1%) of 108 patients. The primary technique effectiveness rate at 1 month was 95.1% (105/108). Local tumor progression was noted in eight (7.6%) of 105 patients during the follow-up period (range, 3.0-11.5 months; median, 5.8 months; mean, 5.7 months). There was no significant single category to predict complication and local tumor progression (Fisher's exact test, p>0.05). Contrary to the safety score for the probability of complication (p>0.05), the curability score was significantly associated with the probability of local tumor progression (likelihood ratio test for trend; p=0.03). CONCLUSION The new feasibility scoring system for planning US can be used as objective criteria to predict therapeutic efficacy rather than the safety of percutaneous RFA of an HCC.
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Affiliation(s)
- Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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