Ablation Therapy For Hepatocellular Carcinoma Research Articles

Microwave Ablation Therapy for Hepatocellular Carcinoma: The Effect of Metabolic Heat on Temperature Distribution

Hepatocellular carcinoma is the main cause of liver cancer and one of the most occurring cancers worldwide. Microwave Ablation (MWA) is a method to destroy cancer cells by heating tumors above 50°C. Cancerous tissues can have high metabolic heat rates and affect temperature gain and distribution in thermal therapies. This research clarifies the metabolic heat effects in MWA therapy of liver cancer. Using Pennes Bioheat transfer equation with finite element numerical method, this research simulates temperature distribution with metabolic heat value ranging from 368,1 W/m3 to 29000 W/m3. The heat generated by metabolic heat is lower than the MWA heat source. However, the temperature increase should be considered as it can increase healthy surrounding tissue temperature to dangerous levels.

Outcomes of Patients Receiving Radiofrequency Ablation Therapy for Hepatocellular Carcinoma: Effect of Self-Care Management Guidelines

Outcomes of Patients Receiving Radiofrequency Ablation Therapy for Hepatocellular Carcinoma: Effect of Self-Care Management Guidelines

Tips for Preparing and Practicing Thermal Ablation Therapy of Hepatocellular Carcinoma.

Thermal ablation therapy, including radiofrequency ablation (RFA) and microwave ablation (MWA), is considered the optimal locoregional treatment for unresectable early-stage hepatocellular carcinomas (HCCs). Percutaneous image-guided ablation is a minimally invasive treatment that is being increasingly performed because it achieves good clinical outcomes with a lower risk of complications. However, the physics and principles of RFA and MWA markedly differ. Although percutaneous thermal ablation under image guidance may be challenging in HCC cases with limited access or a risk of thermal injury, a number of ablative techniques, each of which may be advantageous and disadvantageous for individual cases, are available. Furthermore, even when a HCC is eligible for ablation based on tumor selection and technical factors, additional patient factors may have an impact on whether it is the appropriate treatment choice. Therefore, a basic understanding of the advantages and limitations of each ablation device and imaging guidance technique, respectively, is important. We herein provide an overview of the basic principles of tissue heating in thermal ablation, clinical and laboratory parameters for ablation therapy, preprocedural management, imaging assessments of responses, and early adverse events. We also discuss associated challenges and how they may be overcome using optimized imaging techniques.

Relationship between Being Overweight and Clinical Outcomes of Ablation Therapy for Hepatocellular Carcinoma under Ultrasound Guidance: A Retrospective Analysis.

This study aimed to investigate the effect of being overweight on the outcome of ablation therapy for patients with early-stage hepatocellular carcinoma (HCC). This retrospective study included 198 patients with HCC who underwent radiofrequency ablation or microwave ablation at Gunma Saiseikai Maebashi Hospital between April 2017 and December 2021. We divided the patients into two groups based on their body mass index (BMI): overweight (BMI ≥ 25 kg/m2, n = 74 (37.4%)) and non-overweight (BMI < 25 kg/m2, n = 124 (62.6%)). The technical success rates (TSRs) in the first session were 78.4% and 90.3% in overweight and non-overweight patients, respectively, with a significant difference (p = 0.03). Additional ablation therapy for residual tumors was required in 15 (20.3%) overweight and 11 (8.9%) non-overweight patients (p = 0.03), resulting in 95.9% and 99.2% TSRs at the final session, respectively, without a significant difference (p = 0.3). While local tumor progression and distant recurrence rates were not significantly different between the two groups, overall survival was better in overweight patients than in non-overweight patients (p < 0.001). Despite the potential adverse impact of being overweight on public health problems, the present findings showed the relationship between being overweight and improved survival. The negative aspects of being overweight might remain as minor technical issues in HCC patients receiving ablation therapy.

Serum Thioredoxin Level for Assessment of Response after Ablation Therapy for Hepatocellular Carcinoma in Egyptian Patients

Background: Hepatocellular Carcinoma (HCC) is a major health problem worldwide and its diagnosis is still challenging. Thioredoxin (TRX) is a class of small redox proteins known to be present in all organisms. It plays a role in many important biological processes, including redox signaling.&#x0D; Aims: The main aim of this study was to study the serum thioredoxin level for assessment of response after ablation therapy for hepatocellular carcinoma in Egyptian patients.&#x0D; Patients and Methods: This prospective case study was carried out in Department of Tropical Medicine and Infectious Diseases, Tanta University Hospital. The duration of study was from April 2019 till April 2020. &#x0D; Results: Significant differences were found between the four groups regarding TRX as group B and C showed significant elevation in TRX level compared to group A &amp; D. TRX was significantly decreased after 6 months compared to 3 months and preoperative. TRX at cutoff 100 ng/ml can differentiate between early HCC and liver cirrhosis with the sensitivity, specificity, PPV and NPV was 95%, 85%, 86% and 94% respectively. There were positive significant correlations between TRX and focal lesion size. There were also positive significant correlations between TRX and aspartate transaminase (AST), Total bilirubin, direct bilirubin and international normalization ratio (INR). In group C after therapeutic intervention, there was a significant decrease in TRX level among patients showing complete response compared to those with partial response or progressive course.&#x0D; Conclusions: TRX could serve as a potential diagnostic biomarker for HCC. TRX could be used as a predictive marker of therapeutic ablation outcome in hepatocellular carcinoma patients.

Safety and efficacy of pentazocine-midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma.

Background and AimRadiofrequency ablation (RFA) therapy is frequently used as first‐line treatment for small hepatocellular carcinoma (HCC). RFA is often associated with pain; however, no definitive solution has been established for its relief. We retrospectively analyzed the safety and efficacy of the combination of pentazocine and midazolam to relieve pain experienced by HCC patients undergoing RFA.MethodsWe studied 77 patients with 98 HCCs treated with RFA between January 2015 and August 2019. Patients were divided into two groups: the sedative‐free group, which included those who received pentazocine alone, and the pentazocine–midazolam group, which included those who received a combination of pentazocine and midazolam. The degrees of analgesia and sedation were evaluated using the numerical rating scale (NRS) and the Richmond Agitation‐Sedation Scale (RASS), respectively. Other parameters such as treatment time, awakening time, midazolam dosage, vital signs, local recurrence rate, and time to recurrence were also examined.ResultsThe median NRS score and RASS score were significantly lower in the pentazocine–midazolam group. Ninety‐five percent of patients in the pentazocine–midazolam group had no memory of the RFA session. The treatment time and awakening time were prolonged for the pentazocine–midazolam group. No significant differences in oxygen saturation, recurrence rates, and time to local recurrence were observed between groups.ConclusionA combination of pentazocine and midazolam is safe and effective for pain and anxiety relief experienced by patients undergoing RFA for local treatment of HCC.

Percutaneous Thermal Ablation Therapy of Hepatocellular Carcinoma (HCC): Microwave Ablation (MWA) versus Laser-Induced Thermotherapy (LITT).

The purpose of this study is to compare the efficacy and safety of microwave ablation (MWA) versus laser-induced thermotherapy (LITT) as a local treatment for hepatocellular carcinoma (HCC,) with regard to therapy response, survival rates, and complication rates as measurable outcomes. This retrospective study included 250 patients (52 females and 198 males; mean age: 66 ± 10 years) with 435 tumors that were treated by MWA and 53 patients (12 females and 41 males; mean age: 67.5 ± 8 years) with 75 tumors that were treated by LITT. Tumor response was evaluated using CEMRI (contrast-enhanced magnetic resonance imaging). Overall, 445 MWA sessions and 76 LITT sessions were performed. The rate of local tumor progression (LTP) and the rate of intrahepatic distant recurrence (IDR) were 6% (15/250) and 46% (115/250) in the MWA-group and 3.8% (2/53) and 64.2% (34/53) in the LITT-group, respectively. The 1-, 3-, and 5-year overall survival (OS) rates calculated from the date of diagnosis were 94.3%, 65.4%, and 49.1% in the MWA-group and 96.2%, 54.7%, and 30.2% in the LITT-group, respectively (p-value: 0.002). The 1-, 2-, and 3-year disease-free survival (DFS) rates were 45.9%, 30.6%, and 24.8% in the MWA-group and 54.7%, 30.2%, and 17% in the LITT-group, respectively (p-value: 0.719). Initial complete ablation rate was 97.7% (425/435) in the MWA-group and 98.7% (74/75) in the LITT-group (p-value > 0.99). The overall complication rate was 2.9% (13/445) in the MWA-group and 7.9% (6/76) in the LITT-group (p-value: 0.045). Based on the results, MWA and LITT thermal ablation techniques are well-tolerated, effective, and safe for the local treatment of HCC. However, MWA is recommended over LITT for the treatment of HCC, since the patients in the MWA-group had higher survival rates.

Recent Advances in Local Thermal Ablation Therapy for Hepatocellular Carcinoma.

Image-guided local thermal ablation (LTA) plays an important role in the treatment of hepatocellular carcinoma (HCC), especially in patients with HCC who are not suitable for hepatectomy. Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most widely used LTA clinically. Radiofrequency ablation can achieve the best result; that is, a similar therapeutic effect as hepatectomy if the tumor ≤3cm, while MWA can effectively ablate tumors ≤5cm. Local thermal ablation has an advantage over liver resection in terms of minimally invasive surgery and can achieve a comparable prognosis and efficacy to liver resection. For borderline liver function, selecting LTA as the first-line therapy may bring more benefits to patients with cirrhosis background. In addition, a combination of multiple therapies for HCC is a good choice, such as LTA combined with transcatheter arterial chemoembolization (TACE), which can achieve a better prognosis than single therapy for larger tumors. For patients who are awaiting liver transplantation, LTA is a good choice. The main problem of LTA needed to be solved is to prevent the local tumor recurrence after ablation in patients with HCC.

A case of Takotsubo cardiomyopathy after microwave ablation therapy for hepatocellular carcinoma

A case of Takotsubo cardiomyopathy after microwave ablation therapy for hepatocellular carcinoma

Integrin αvβ3-targeted polydopamine-coated gold nanostars for photothermal ablation therapy of hepatocellular carcinoma.

Photothermal therapy (PTT) has emerged as a promising cancer therapeutic method. In this study, Arg-Gly-Asp (RGD) peptide-conjugated polydopamine-coated gold nanostars (Au@PDA-RGD NPs) were prepared for targeting PTT of hepatocellular carcinoma (HCC). A polydopamine (PDA) shell was coated on the surface of gold nanostars by the oxidative self-polymerization of dopamine (termed as Au@PDA NPs). Au@PDA NPs were further functionalized with polyethylene glycol and RGD peptide to improve biocompatibility as well as selectivity toward the HCC cells. Au@PDA-RGD NPs showed an intense absorption at 822 nm, which makes them suitable for near-infrared-excited PTT. Our results indicated that the Au@PDA-RGD NPs were effective for the PTT therapy of the αVβ3 integrin receptor-overexpressed HepG2 cells in vitro. Further antitumor mechanism studies showed that the Au@PDA-RGD NPs-based PTT induced human liver cancer cells death via the mitochondrial–lysosomal and autophagy pathways. In vivo experiments showed that Au@PDA-RGD NPs had excellent tumor treatment efficiency and negligible side effects. Thus, our study showed that Au@PDA-RGD NPs could offer an excellent nanoplatform for PTT of HCC.

Predictive impact of the prognostic nutritional index in early-staged hepatocellular carcinoma after operative microwave ablation

BackgroundThe prognostic nutritional index (PNI) is used to assess immune and nutritional status, and is a prognostic factor for several malignant tumors. However, little evidence exists regarding the predictive impact of prognostic nutritional index (PNI) after local ablation therapy for hepatocellular carcinoma (HCC). The aim of this study was to evaluate the value of PNI to predict recurrence and survival after operative microwave ablation in patients with early-stage HCC. MethodsThis retrospective study included 341 patients who underwent operative microwave ablation for HCC in Barcelona Clinic Liver Cancer (BCLC) stage 0-A at our institute between 2007 and 2015. We analyzed overall survival (OS) and recurrence-free survival (RFS), and evaluated factors related to prognosis in multivariate Cox regression analyses. ResultsThe OS rates at 1, 3, 5, and 10 years after microwave ablation were 100%, 92.7%, 85.1%, and 57.5% in patients with high-PNI levels, and 96.5%, 78.2%, 59.7%, and 20.7% in patients with low-PNI levels, respectively (P < 0.001). The RFS rates at 1, 3, 5, and 10 years after microwave ablation were 96.3%, 75.2%, 55.4%, and 30.4% in patients with high-PNI levels, and 94.4%, 48.8%, 36.4%, and 13.1% in patients with low-PNI levels, respectively (P < 0.001). In multivariate analyses, preoperative PNI level was an independent prognostic factor for both OS and RFS. ConclusionOur results revealed the preoperative PNI level was a simple and novel predictive marker of survival and recurrence after microwave ablation in patients with early-stage HCC.

The Islanding effect - a special method of percutaneous peritumor ethanol injection for hepatocellular carcinoma: 15-year follow-up outcome.

Percutaneous ethanol injection is a well-known ablation therapy for hepatocellular carcinoma and is well-tolerated, inexpensive, and effective with few adverse events. In this study, another type of ethanol injection was introduced in the present study.Sixty two patients with hepatocellular carcinoma received 133 percutaneous peritumor ethanol injection treatments and the 15-year follow-up outcomes were analyzed through a collected database.The technical efficiency was 89.5% (119/133 treatments) after the first percutaneous peritumor ethanol injection procedure. However, after the second repeated percutaneous peritumor ethanol injection procedure, technical efficiency increased to 98.5% (131/133 treatments). The 1 year, 3 years, 5 years, 10 years, and 15 years rates of tumor recurrence were 12.9%, 50.0%, 59.7%, 74.2%, and 74.2%, respectively. Multivariate analysis demonstrated that diabetes, Child–Pugh class B, and tumor size greater than 2 cm were significantly related to tumor recurrence. The 1 year, 3 years, 5 years, 10 years, and 15 years rates of overall survival were 98.4%, 83.6%, 61.3%, 19.4%, and 0%, respectively. Multivariate analysis demonstrated that Child–Pugh class B, tumor size greater than 2 cm, and multiple tumors were significantly related to overall survival.Compared with other ablation methods (including peritumor ethanol injection), percutaneous peritumor ethanol injection can avoid tumor ruptures, reduce tumor proliferation and metastasis, and is suitable for the treatment of small tumors. In addition, when combined with other treatment methods, percutaneous peritumor ethanol injection can form a tumor metastatic isolation zone in advance and improve the comprehensive treatment effect.

Laparoscopic ablation therapies for hepatocellular carcinoma: could specific indications for the laparoscopic approach influence the effectiveness?

Percutaneous thermo-ablation (TA) may be unfeasible for the tumor location: laparoscopic ablation therapies (LATs) are an alternative option. The aim of this study is to assess the efficacy of LATs in the treatment of HCC not eligible for percutaneous TA or surgical resection. LAT was offered to 503 patients fulfilling at least one of the following criteria: (a) patients with a single nodule or up to three nodules smaller than 3cm not suitable for surgery; (b) patients not suitable for percutaneous TA; (c) short-term recurrence of HCC (< 3months). Technical success was achieved with one session in 467 patients (93%). One-month mortality and severe morbidity rates were 0.4% and 2.19%, respectively. During a median follow-up of 38.4months in the remaining 501 patients, 361 (67%) developed intrahepatic recurrence: it appeared as a local tumor progression (LTP) in 74 cases (15%). Subcapsular lesions showed lower LTP rates (p = 0.008), as well as HCC nodules contiguous to viscera (p = 0.012). In the treatment of HCC, LAT has proved to be a safe and effective technique that enables to treat lesions not eligible for percutaneous approach, with a low morbidity rate.

Hepatic infarction after transcatheter arterial chemoembolization and radiofrequency ablation therapy for hepatocellular carcinoma

Hepatic infarction after transcatheter arterial chemoembolization and radiofrequency ablation therapy for hepatocellular carcinoma

Role of MRI in the assessment of treatment response after radiofrequency and microwave ablation therapy for hepatocellular carcinoma

PurposeThe purpose of this study was to assess the role of dynamic contrast enhanced and diffusion MR imaging in the detection of tumor viability after radiofrequency and microwave ablation therapy of hepatocellular carcinoma. Subjects and methodsThe study was done on 50 patients with HCC underwent radiofrequency or microwave ablation. Patients were classified into resolved group if there’s no MRI evidence of tumor viability at the ablated lesion and unresolved group if there’s evidence of tumor viability. ResultsIn the early 1month post-ablation period, heterogenous signal of the ablation zone in the precontrast T1 and T2 images was noted that gradually become more homogenous in the 3–12months follow-up. Ill defined persistent perilesional enhancement is considered as a benign finding that was present in 100% of patients imaged within the 1st month and persists only in 5% after 9–12months. The mean ADC value of the malignant lesions was 0.91±0.09×10−3mm2/s, while the mean ADC value of the benign post-ablation parenchymal changes was 1.29±0.12×10−3mm2/s with a cutoff value of 1.05×10−3mm2/s. ConclusionMRI provides a powerful tool in the assessment of treatment response after RFA and MWA of hepatocellular carcinoma.

The Efficacy and Safety of Dendritic Cells Co-Cultured with Cytokine-Induced Killer Cell Therapy in Combination with TACE-Predominant Minimally-Invasive Treatment for Hepatocellular Carcinoma: a Meta-Analysis.

To evaluate the efficacy and safety of dendritic cells (DCs) co-cultured with cytokine-induced killer cell (CIK) immunotherapy combined with transcatheter arterial chemoembolization (TACE) or TACE plus local ablation therapy for hepatocellular carcinoma (HCC). Our meta-analysis included a comprehensive search for relevant studies published through December 12, 2014. We used Cochrane Library, PubMed, CBM, VIP, CNKI, and Wanfang data. Depending on the heterogeneity among the included studies, we calculated the pooled odds ratio (OR) and mean difference (MD) using fixed- or random-effects models. Publication biases were assessed using funnel plots and Begg's tests. Sensitivity analyses were also performed. Seven randomized controlled trials (RCTs) and one controlled clinical trial (CCT) that included 693 patients and met the inclusion criteria were analyzed. Pooled results showed that DC-CIK immunotherapy combined with TACE or TACE plus local ablation therapy significantly improved 1-year (OR = 2.00, p = 0.02) and 2-year overall survival (OR = 1.77, p = 0.04). A favored overall response rate (ORR) (OR = 1.51, p = 0.03), disease control rate (DCR) (OR = 1.81, p = 0.01), and better quality of life (OR = 3.30, p < 0.01) were observed in the DC-CIK group. Additionally, when tumor-associated T lymphocyte subsets were compared, our analyses demonstrated that the percentage of CD3+ T cells (MD(CD3+) = 21.37, p = 0.005) and the ratio of CD4+/CD8+ (MD(CD4+/CD8+) = 2.83, p = 0.02) were significantly increased in the DC-CIK therapy group. The combination of DC-CIK immunotherapy and TACE or TACE plus local ablation therapy improves 1- and 2-year overall survival, ORR, DCR, and provides a better quality of life for patients with HCC.

Clinical value of dynamic 3-dimensional contrast-enhanced ultrasound imaging for the assessment of hepatocellular carcinoma ablation

ObjectiveThe aim of the study was to investigate the performance of dynamic 3-dimensional contrast-enhanced ultrasound (3D-CEUS) on assessment of efficacy of local ablation therapy of hepatocellular carcinoma (HCC) with contrast-enhanced computed tomography (CT) as reference standard. MethodsEighty-nine HCC lesions from 75 patients undergoing ultrasound-guided percutaneous thermal ablation or chemical ablation were studied by both dynamic 3D-CEUS and contrast-enhanced CT 1month after ablation. Imaging results from two imaging modalities were evaluated independently by experienced readers to determine whether the treated lesions were ablated incompletely (residual unablated tumor) or completely. Sensitivity, specificity, positive and negative predictive values, and accuracy to identify incomplete ablation were calculated for dynamic 3D-CEUS imaging with contrast-enhanced CT as reference standard. ResultsContrast-enhanced CT reported that 80.9% (72/89) of all the treated lesions were completely ablated and 19.1% (17/89) were incompletely ablated. The dynamic 3D-CEUS identified 82.0% (73/89) and 18.0% (16/89) of lesions as completely and incompletely ablated, respectively. With contrast-enhanced CT as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of dynamic 3D-CEUS for identifying residual unablated tumor were 88.2% (15/17), 98.6% (71/72), 93.8% (15/16), 97.3% (71/73), and 96.6% (86/89), respectively. The Kappa value for identifying residual unablated tumor between contrast-enhanced CT and dynamic 3D-CEUS was 0.89. ConclusionsDynamic 3D-CEUS is highly consistent with contrast-enhanced CT in assessment of efficacy of HCC ablation and has potential to serve as an alternative to contrast-enhanced CT in the follow-up assessment after HCC ablation.

New horizons in ablation therapy for hepatocellular carcinoma.

Historically ablative treatment for hepatocellular cancer (HCC) has been regarded as inferior to transplantation and resection and has therefore been reserved for patients not suitable for surgical intervention in stage 0-A HCC according to the Barcelona Clinic Liver Cancer classification system. In the wake of surgical strategies challenging the current Barcelona Clinic Liver Cancer treatment guidelines and improvements in imaging, targeting and ablation technologies, ablation is likely to occupy a more central role in the management of patients with HCC, challenging its historically perceived inferiority to resection.

Local ablation therapy with contrast-enhanced ultrasonography for hepatocellular carcinoma: a practical review.

A successful program for local ablation therapy for hepatocellular carcinoma (HCC) requires extensive imaging support for diagnosis and localization of HCC, imaging guidance for the ablation procedures, and post-treatment monitoring. Contrast-enhanced ultrasonography (CEUS) has several advantages over computed tomography/magnetic resonance imaging (CT/MRI), including real-time imaging capability, sensitive detection of arterial-phase hypervascularity and washout, no renal excretion, no ionizing radiation, repeatability, excellent patient compliance, and relatively low cost. CEUS is useful for image guidance for isoechoic lesions. While contrast-enhanced CT/MRI is the standard method for the diagnosis of HCC and post-ablation monitoring, CEUS is useful when CT/MRI findings are indeterminate or CT/MRI is contraindicated. This article provides a practical review of the role of CEUS in imaging algorithms for pre- and post-ablation therapy for HCC.

P0250 : Effect of irreversible electroporation (IRE) on the porcine liver: comparison with radiofrequency ablation

Background and Aims: Irreversible electroporation (IRE) is a promising, non-thermal ablation therapy for hepatocellular carcinoma, which, unlike radiofrequency thermal ablation (RFA), induces apoptosis through irreversible formation of nanoscale pores in the cell membrane with delivery of high-voltage electric current and is considered to improve safety in the vicinity of heat-sensitive blood vessel and bile duct. The aim of the present study is to clarify the acute pathological effect of IRE on the liver and also to compare with effect of RFA. Methods: Three pigs underwent ultrasound-guided IRE and RFA of normal liver under general anesthesia and at laparotomy. A total of 9 IRE ablated areas and 3 RFA ablated areas were created. We examined histopathologic findings of ablated areas at 4 hours after therapy with immunohistochemical methods. The pathologic findings according to IRE ablation conditions were compared with findings of RFA. Results: In IRE zones, various degree of congestion and hemorrhage, apoptotic change of hepatocytes, defluxion of portal endothelial cells and cholangitis were observed in hepatic lobules. With the increase in the total pulse number of IRE delivered, these pathological findings became remarkable. NADPH-diaphorase enzyme histochemistry performed in IRE zones demonstrated the stainability is very weak in the hepatic lobule, which reflecting defluxion of hepatocytes and reduced activity of viable hepatocytes in acute phase, while the stainability is lost in the central portion of RFA. Silver impregnation stain and collagen type 4 immunohistochemistry showed that reticular fibers and collagen fibers around the sinusoid remain well-preserved in IRE zones, on the other hand, those in RFA zones are very poorly stained. The vessels in IRE zones demonstrated a relatively intact configuration of positive smooth muscle cells for Caldesmon staining and endothelial cells for Factor 8 staining, with the minimal endothelial damage, while the vessels in RFA zones demonstrated a negative or weakened reaction. Bile duct epithelial cells showed a positive reaction for cytokeratin 7 staining in IRE zones with desquamated cells, while an entirely negative reaction in RFA zones, revealing protein denaturation. Conclusions: Unlike RFA, IRE induces apoptosis of hepatocytes, endothelium of the blood vessels and mucosal membrane of the bile ducts, whereas preservation of sinusoidal framework and vascular structure may have the potential for liver regeneration.