Efficacy Of Percutaneous Radiofrequency Ablation Research Articles

Safety and efficacy of percutaneous radiofrequency ablation for hepatocellular carcinoma: a textbook outcome analysis.

The Textbook Outcome (TO) is a quality indicator accounting for both efficacy and safety. Herein, we aimed to assess TO in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (RFA). All consecutive patients undergoing RFA for HCC between 2014 and 2020, were included. TO was defined as 1) no post-RFA complications or mortality within 30 days after RFA, 2) no prolonged hospital stay 3) no 30-day readmission and 4) the achievement of a complete response (CR) of the target lesion/s at 1-month. Overall, 50.3% of 376 patients fulfilled all the quality indicators to achieve TO. Probabilities of TO achievement decreased in presence of moderate comorbidities (odds ratio[OR]:0.43; 95%C.I.:0.22-0.80;p=0.008), a performance status of 1 (OR: 0.58;95%C.I.:0.37-0.89; p=0.013), the treatment of 2 nodules (OR: 0.71; 95%C.I.:0.41-0.98; p=0.048) or ≥3 nodules (OR: 0.41; 95%C.I.: 0.22 - 0.78; p=0.007); the treatment of 2-3cm nodules (OR:0.49;95%C.I.:0.31-0.79;p=0.003) or >3cm nodules (OR: 0.36;95%C.I.:0.18-0.73;p=0.004). Risk-stratification provided TO achievement ranging between 77.9% and 14.3%. Patients with TO also had improved survival (p=0.028). About half of patients get TO from RFA. Stratification by clinical and tumoral characteristic should aid provision of RFA in clinical practice, facilitating patient information and providing reference values for future comparative studies.

Artificial pneumothorax improves radiofrequency ablation of pulmonary metastases of hepatocellular carcinoma close to mediastinum

BackgroundTo investigate the feasibility, safety and efficacy of percutaneous radiofrequency ablation (RFA) of pulmonary metastases from hepatocellular carcinoma (HCC) contiguous with the mediastinum using the artificial pneumothorax technique.MethodA total of 40 lesions in 32 patients with pulmonary metastases from HCC contiguous with the mediastinum accepted RFA treatment from August 2014 to May 2018 via the artificial pneumothorax technique. After ablation, clinical outcomes were followed up by contrast enhanced CT. Technical success, local tumor progression (LTP), intrapulmonary distant recurrence (IDR), and adverse events were evaluated. Overall survival (OS) and local tumor progression free survival (LTPFS) were recorded for each patient.ResultsThe tumor size was 1.4 ± 0.6 cm in diameter. RFA procedures were all successfully performed without intra-ablative complications. Technical success was noted in 100% of the patients. Five cases of LTP and 8 cases of IDR occurred following the secondary RFA for treatment. Slight pain was reported in all patients. No major complications were observed. The 1, 2, and 3-year LTPFS rates were 90.6, 81.2, and 71.8%, and the 1, 2, and 3-year OS rates were 100, 100 and 87.5%, respectively.ConclusionArtificial pneumothorax adjuvant RFA is a feasible, safe, and efficient method for treatment of pulmonary metastases from HCC contiguous with the mediastinum.

Safety and efficacy of percutaneous radiofrequency ablation for hepatocellular carcinoma patients with haemophilia.

This study aimed to evaluate the safety and efficacy of RFA for HCC in haemophilia patients. From July 2008 to June 2019, 217 patients with HCC underwent 300 RFA sessions. Of these, 18 sessions were performed in ten haemophilia patients (H group) and 282 in 207 non-haemophilia patients (NH group). The patients' characteristics, incidence of haemorrhagic complications and rates of local tumour recurrence were compared between the groups. A majority of the haemophilia patients received clotting factor concentrate replacement therapy before and after RFA treatment, with the aim of reaching a plasma clotting factor level of higher than 60%-80%. Twelve haemorrhagic complications were observed in the NH group (4.2%; 12/282). Major bleeding requiring control procedures was observed in two patients and minor bleeding with careful observation was noted in ten patients. No bleeding complications were observed in the H group (0/18). There were no significant differences in the 5-year local tumour recurrence rates after RFA treatment between the groups (35.0% in the H group and 32.1% in the NH group). RFA could be an effective and a safe method for HCC treatment in patients with haemophilia.

Efficacy of percutaneous radiofrequency ablation for hepatocellular carcinoma treatment in patients aged ≥80 years

BackgroundAlthough radiofrequency ablation (RFA) is a minimally invasive treatment for early-stage hepatocellular carcinoma (HCC), it remains unclear whether RFA achieves favorable outcomes in patients aged ≥80 years. This study aimed to determine the efficacy and safety of RFA for HCC in patients aged ≥80 years. MethodsA total of 512 naïve patients with HCC who had undergone RFA from January 2001 to December 2016 were enrolled. They were categorized into the ≥80-year-old group and the control group (aged <80 years). The primary endpoint was overall survival (OS), and the secondary endpoints were recurrence-free survival, complications associated with RFA, and cause of death. Propensity score matching was performed to adjust for patients’ sex, liver function, tumor number, tumor diameter, and hepatitis C virus infection. Finally, the data of 68 patients in the ≥80-year-old group and 68 in the control group were analyzed; their baseline characteristics, primary endpoint, and secondary endpoints were compared. ResultsThere were significant differences in the alanine aminotransferase level and prothrombin time between the groups. The cumulative OS rate was not significantly different between the groups (P = 0.83): 98.5%, 87.9%, and 50.5% in the ≥80-year-old group and 94.1%, 72.8%, and 49.3% in the control group at 1, 3, and 5 years, respectively. Age ≥80 years was not significantly associated with OS in multivariate analyses. Liver-related death occurred in 17 patients in the ≥80 year-old group and in 16 patients in the control group (P = 1.00). ConclusionsRFA is safe and effective for the treatment of patients with HCC aged ≥ 80 years.

Percutaneous Radiofrequency Ablation Combined With Transarterial Chemoembolization Plus Sorafenib for Large Hepatocellular Carcinoma Invading the Portal Venous System: A Prospective Randomized Study.

BackgroundHepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) portends a worse prognosis. The objective of this study was to compare the efficacy of percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) plus sorafenib to that of the most commonly utilized regimen of TACE plus sorafenib in large HCCs with type I/II PVTT.MethodsAn open-label, single-center, prospective, randomized trial of participants with tumors ≥5 cm and type I/II PVTT was performed. Participants with previously untreated HCCs were divided into two groups: RFA + cTACE + sorafenib (study group, n = 40) and cTACE + sorafenib (control group, n = 40). The primary endpoint was the objective response rate (ORR), the secondary endpoints included the overall survival (OS); time to progression (TTP); and toxicity. Prognostic factors were analyzed using cox-regression analysis.Results80 patients were enrolled into this study with integrated clinical data. Under a median follow-up of 506 days, the median age was 57.5 years (range: 28–80 years). The ORR of study group was higher than control group (70% vs 22.5%, p<0.001). Furthermore, the median OS of study group was superior to that of control group (468 days vs 219 days, HR: 0.44 [95% CI: 0.25–0.78], P = 0.005). Adverse events occurred with 100% probability in both groups (p>0.99), but no treatment-related deaths were recorded. Tumor encapsulation and attaining treatment response predict favorable OS in a multivariate Cox model. The rates of adverse events in both groups were 100% (p>0.99). There were no treatment-related deaths.ConclusionsRFA combined with TACE plus sorafenib is a safe, well-tolerated three-modality treatment for large HCCs with types I/II PVTT, and it demonstrated better efficacy than TACE plus sorafenib alone.

Safety and efficacy of radiofrequency ablation for pulmonary metastases in metastatic colorectal cancer patients: A single center experience.

141 Background: Radiofrequency ablation (RFA) has been increasingly used for the treatment of pulmonary metastases from several types of malignancies. Methods: A retrospective analysis was performed for the safety and efficacy of percutaneous RFA in patients with metastatic colorectal cancer between October 2016 and June 2019 as well as assessing prognostic factors of local tumor control. Results: RFA was carried out for 48 lung metastases in 31 consecutive colorectal cancer patients. Male was 17 patients (55%), and the median age at RFA was 61 years (range, 42-81). The mean diameter of metastases targeted for RFA was 12 mm (range, 4-32), and 17 tumors (35%) were located in a sub-pleural or deep position. Although five cases (10%) were failed due to immediate complications, there was no procedure-related death. In terms of immediate complication, a total of 12 cases (25%) had events including nine pneumothorax (percutaneous drain in four), one pleural effusion, and two hemoptysis (ICU care in one). Delayed complications were lung abscess and diaphragm injury in each one patient, respectively. At the time of analysis, the median follow-up duration from RFA was 12.0 months (interquartile range, 6.5-23.1). Only two patients (6%) died of disease progression, and 3-year overall survival rate was 85.5% (95% CI, 75.5-95.5). RFA site progression was observed in 11 patients (23%), and 1-year and 2-year progression-free survival rates were 71.5% (95% CI, 58.7-84.3) and 56.6% (95% CI, 42.6-70.6), respectively. Multivariate analysis showed that extra-pulmonary progression (hazard ratio 17.49; p = 0.023) was only one independent prognostic factor associated with RFA site progression after adjusting for confounding factors including sex, age, performance, tumor size, location, contact with the vessel, last chemotherapy response, and duration. Conclusions: RFA is a comparatively safe and effective option for the treatment of small-sized lung metastases; however, the control of extra-pulmonary metastases should be accompanied for effective local control.

Percutaneous radiofrequency ablation for small hepatocellular carcinoma in hepatic dome under MR-guidance: clinical safety and efficacy

Purpose To evaluate the clinical safety and efficacy of percutaneous radiofrequency ablation (RFA) using multitined expandable electrodes under magnetic resonance imaging (MRI) guidance in the treatment of small hepatocellular carcinomas (HCCs) in the hepatic dome. Materials and methods The data of 49 patients with 50 HCC lesions in the hepatic dome who underwent MRI-guided RFA from April 2010 to January 2018 were retrospectively analyzed. Planning, targeting, and controlling were performed under MR-guidance during the procedure. The complications after RFA were observed. Follow-up MRI was performed to evaluate the curative effect. The local progression-free survival, recurrence-free survival, and overall survival rates were calculated using the Kaplan-Meier survival curve. Results The procedures were successfully accomplished in all patients without major complications. The mean follow-up time was 36.9 ± 25.8 months (range, 3–99 months). Technical success was 100% after one RFA session with MRI assessment after 1 month. Local tumor progression was observed in one patient (2%) with the lesion located in the hepatic dome at 4 months on a subsequent follow-up MRI. The progression-free survival time was 25.0 ± 22.7 months (median, 17.0 months). The 1-,3-, and 5-year local tumor progression-free survival rates were all 98.0%. The 1-,3-, and 5-year recurrence-free survival rates were 68.1%, 39.9%, and 28.5%, respectively, and the estimated overall survival rates were 93.7%, 76.3%, and 54.3%, respectively. Conclusion Planning, targeting, and controlling of RFA were well supported by MRI with acceptable time. MRI-guided RFA for small HCCs in the hepatic dome is safe and effective with fewer RF sessions.

Percutaneous Radiofrequency Ablation for Metachronous Hepatic Metastases after Curative Resection of Pancreatic Adenocarcinoma

ObjectiveTo retrospectively evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma who had previously received curative surgery.Materials and MethodsBetween 2002 and 2017, percutaneous RFA was performed on 94 metachronous hepatic metastases (median diameter, 1.5 cm) arising from pancreatic cancer in 60 patients (mean age, 60.5 years). Patients were included if they had fewer than five metastases, a maximum tumor diameter of ≤ 5 cm, and disease confined to the liver or stable extrahepatic disease. For comparisons during the same period, we included 66 patients who received chemotherapy only and met the same eligibility criteria described.ResultsTechnical success was achieved in all hepatic metastasis without any procedure-related mortality. During follow-up, local tumor progression of treated lesions was observed in 38.3% of the tumors. Overall median survival and 3-year survival rates were 12 months and 0%, respectively from initial RFA, and 14.7 months and 2.1%, respectively from the first diagnosis of liver metastasis. Multivariate analysis showed that a large tumor diameter of > 1.5 cm, a late TNM stage (≥ IIB) before curative surgery, a time from surgery to recurrence of < 1 year, and the presence of extrahepatic metastasis, were all prognostic of reduced overall survival after RFA. Median overall (12 months vs. 9.1 months, p = 0.094) and progression-free survival (5 months vs. 3.3 months, p = 0.068) were higher in the RFA group than in the chemotherapy group with borderline statistical difference.ConclusionRFA is safe and may offer successful local tumor control in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma. Patients with a small diameter tumor, early TNM stage before curative surgery, late hepatic recurrence, and liver-only metastasis benefit most from RFA treatment. RFA provided better survival outcomes than chemotherapy for this specific group with borderline statistical difference.

Role of Artificial Ascites Pre-Radiofrequency Ablation of Sub Capsular Liver Tumors

AbstractBackground: Radiofrequency ablation for liver tumours is a common practice because of its many advantages including feasibility, relatively low cost, being a day case procedure, and minimal invasiveness. Sub-capsular hepatomas manage-ment represents a challenge due to liability of thermal injury to major organs and occurrence of serious complications.Aim of Study: To assess the safety and technical efficacy of percutaneous radiofrequency ablation after artificial ascites in sub-capsular hepatoma.Methods: In our study, 18 patients had hydro dissection procedure done to facilitate ultrasound guided Radiofrequency Ablation (RFA) for sub-capsular hepatic lesions. Hydro dissection was performed with 5% dextrose in water to displace adjacent structures away from the liver capsule. RFA system with cluster or single internally cooled electrodes were used for treatment of hepatic malignancies. The feasibility, safety, and efficacy of this technique were assessed on follow-up.Results: Our patients' mean age was 59.6 years old. No major complications related to hydro dissection were recorded. One of our patients had a thermal injury (5.5%). No patients suffered from biliary injury, haemorrhage or tumour seeding. Mean hydro dissection displacement of nearby organs was 1.6cm.Conclusion: Hydro-dissection (artificial ascites) proved to improve technical efficacy and safety for ultrasound guided radiofrequency of sub-capsular hepatomas.

Reiterative Radiofrequency Ablation in the Management of Pediatric Patients with Hepatoblastoma Metastases to the Lung, Liver, or Bone.

Conventional treatments of systemic chemotherapy and surgical resection for recurrent or metastatic hepatoblastoma (HB) may be inhibitive for the pediatric patient and family who have already been through extensive therapies. This single-institution case series evaluates the safety and efficacy of percutaneous radiofrequency ablation (RFA) in the management of metastatic HB. Between March 2008 and February 2015, RFA was used as part of multidisciplinary management for HB recurrence or metastasis in 5 children (median 5.0years old) in an attempt to provide locoregional control and preclude additional surgery. Combined local treatments of 38 metachronous metastases included surgical metastasectomy (14 lesions: 7 lung, 7 liver), percutaneous RFA (23 lesions: 21 lung, 1 liver, 1 bone), and stereotactic radiotherapy (1 liver lesion). For lesions treated with RFA (median diameter 6mm, range 3-15mm), local control was achieved in 22/23 metastases (95.6%) with median follow-up of 30.1months after RFA (range 18.9-65.7). Median hospitalization was 3days (2-7), with major complications limited to 1 pneumothorax requiring temporary small-caliber chest tube. Four children remain in complete remission with median follow-up of 67months (range 41.2-88.8) after primary tumor resection, with mean disease-free survival of 31.7months after last local treatment. One child succumbed to rapidly progressive disease 12months after RFA (23.9months after primary tumor resection). RFA provides a safe and effective reiterative treatment option in the multidisciplinary management of children with metastatic HB.

Safety and Efficacy of Percutaneous Radiofrequency Ablation Combined with Percutaneous Ethanol Injection for Hepatocellular Carcinoma in High-risk Locations

Safety and Efficacy of Percutaneous Radiofrequency Ablation Combined with Percutaneous Ethanol Injection for Hepatocellular Carcinoma in High-risk Locations

Radiofrequency ablation of surface v/s intraparenchymal hepatocellular carcinoma in cirrhotic patients.

Objective:To retrospectively evaluate the safety and technical efficacy of percutaneous radiofrequency ablation (RFA) of surface hepatocellular carcinoma (HCC) in comparison to intraparenchymal HCC in cirrhotic patients.Materials and Methods:Surface lesions were defined as tumours located or reaching within 1cm of liver capsule including exophytic lesions. Seventy-four surface HCC including 21 exophytic in 58 patients (surface group) and 60 intraparenchymal HCC in 54 patients (intraparenchymal group) measuring up to 4 cm in maximum extent underwent percutaneous [ultrasound (US) or computed tomography-guided (CT-guided)] RFA. The response to the treatment was assessed by contrast enhanced CT/magnetic resonance imaging (MRI) done at 1, 3, 6, 9, and 12 months of RFA and thereafter every 4–6 months. In case of features suggesting residual disease, a repeat RFA was performed. The technical success after single-session RFA, complications and disease recurrence rates were calculated and compared between two groups.Results:Technical success achieved after first session of RFA in surface HCC was 95% (70/74) and intraparenchymal HCC was 97% (58/60). Hundred percent secondary success rate was achieved in both groups after second repeat RFA in residual lesion. No major difference in complication and local recurrence rate in both group on follow-up in surface HCC and intraparenchymal HCC. No case of needle track, peritoneal seeding, and treatment mortality was found.Conclusions:The complication rate and efficacy of RFA for surface and exophytic HCC's were comparable to that of intraparenchymal HCC. Hence surface and exophytic lesions should not be considered a contraindication for RFA in cirrhotic patients.

Radiofrequency Ablation of Breast Cancer: A Retrospective Study

PurposeTo validate the safety and efficacy of percutaneous radiofrequency ablation (RFA) of breast carcinomas. MethodsThis retrospective study was conducted by the Breast Cancer Society for Minimally Invasive Therapy following approval from institutional review boards, and with the written informed consent of patients. A total of 386 patients with breast cancer treated with RFA at 10 institutions between July 2003 and June 2009 were identified and included in the analysis. Patients underwent a standard RFA procedure with ultrasound guidance and were followed up every 6 to 12 months. In this study, feasibility of RFA procedure and related safety and ipsilateral breast tumor recurrence (IBTR) were examined. Fisher exact or χ2 test evaluated associations between clinicopathological factors and IBTR, and local recurrence-free survival was estimated using the Kaplan-Meier method. ResultsRFA-related adverse events included local pain in 9 patients, skin burns in 15, and nipple retraction in 7. Patients were followed for a median of 50 months. IBTR was more frequently observed in patients with initial tumor sizes > 2 cm (3 of 30, 10%) than in those with initial tumors ≤ 2 cm (8 of 355, 2.3%; P = .015). IBTR-free rates 5 years after RFA were 97%, 94%, and 87% in patients with initial tumor sizes ≤ 1.0 cm, 1.1 to 2.0 cm, and > 2.0 cm, respectively. ConclusionsRFA in breast cancer is a safe and promising minimally invasive treatment for tumors ≤ 2 cm in diameter. Further studies are needed to optimize the technique and evaluate its future role as local therapy.

Efficacy of percutaneous radiofrequency ablation may vary with clear cell renal cell cancer histologic subtype.

The purpose of the study is to determine if clear cell renal cell cancer (RCC) subtype predicts efficacy in percutaneous radiofrequency (RF) ablation of RCC. Patients who underwent percutaneous RF ablation for histologically proven RCC subtypes were retrospectively reviewed. Group comparisons were done using univariate and multivariate logistic regression analysis to determine factors impacting primary, secondary, and total technique effectiveness. A p value less than 0.05 was considered significant. One hundred pathologically proven RCC lesions in 84 patients were analyzed. The median (mean) follow-up was 24 (27) months (range 1-106months). Overall RF ablation primary, secondary and total technique effectiveness was 86%, 9%, and 95%, respectively. Clear cell subtype demonstrated worse treatment efficacy with primary, secondary, and total technique effectiveness of 42/55 (76.4%), 8/55 (14.5%), and 50/55 (90.9%), respectively. Non-clear cell subtypes had primary, secondary, and total technique effectiveness of 44/45(97.8%), 1/45 (2.2%), 45/45 (100%), respectively. The difference in primary (p=0.002), secondary (p=0.032), and total (p=0.038) technique effectiveness between the two groups was statistically significant. Clear cell RCC was a novel predictor of primary, secondary, and total technique efficacy in the percutaneous RF ablation of clear cell RCC.

Staged Radiofrequency Ablation and Surgical Resection for Multiple Lung Metastases of Germ Cell Tumors

Purpose: To evaluate the morbidity and efficacy of percutaneous radiofrequency ablation (RFA) performed before surgical resection for multiple residual lung metastases of germ cell tumors with negative tumor markers. Materials and Methods: This Review Board-approved retrospective study was carried out on five consecutive patients (mean age: 31 years, range: 22–41) treated successively with percutaneous RFA and surgery for multiple lung metastases of germ cell tumors. Mean number of lung metastases before treatment was 9.4. Staged procedures were performed on an average of 7.2 months (range: 1–16) after the primitive tumor resection. Results: The median clinical and imaging follow-up was 26 months (range: 24–36). Percutaneous RFA was technically feasible in one session under general anesthesia and CT guidance in all cases. On average, 2.8 tumors were ablated per patient (range: 1–6), and three of five procedures were bilateral. Three patients developed pneumothorax requiring drainage, but no severe complications were reported. Mean time between RFA and surgical resection of residual tumors was 2.5 months (range: 1–5). No local recurrences were noted, but one patient died due to metastatic evolution. Conclusion: Staged percutaneous RFA and surgical resection could be efficient with low morbidity for the management of multiple lung metastases of germ cell tumors.

Percutaneous radiofrequency ablation of lung metastases from colorectal carcinoma under C-arm cone beam CT guidance.

The aim of this study was to assess the feasibility, safety and efficacy of percutaneous radiofrequency ablation of lung metastases from colorectal carcinoma using C-arm cone beam computed tomography (CBCT) guidance. This single-center prospective observational study was performed from August 2013 to August 2016, and included consecutive patients referred for radiofrequency ablation of lung metastases from colorectal cancer. Radiofrequency ablation procedures were performed under C-arm CBCT guidance. Feasibility was assessed by probe accuracy placement, time to accurate placement and number of C-arm CBCT acquisitions to reach the target lesion. Safety was assessed by the report of adverse event graded using the common terminology criteria for adverse events (CTCAE-V4.0). Efficacy was assessed by metastases response rate using RECIST 1.1 and 18FDG-PET-CT tumor uptake at 6months. Fifty-four consecutive patients (32 men, 22 women) with a mean age of 63±8 (SD) years (range: 51-81years) with a total of 56 lung metastasis from colorectal metastases were treated in a single session. The mean tumor diameter was 25.6±4.5 (SD)mm (range: 17-31mm). Median time to insert the needle into the target lesion was 10min (range: 5-25min). Median number of needles repositioning and C-arm CBCT acquisition per patient was 1 (range: 0-3) and 4 (range: 3-6) respectively. The accuracy for radiofrequency ablation probe placement was 2±0.2 (SD)mm (range: 0-9mm). Pneumothorax requiring chest tube placement occurred in one patient (CTCAE-V4.0 grade 3). At 6months, all patients were alive with tumor response rate of -27% and had no significant activity on the 18FDG-PET CT follow-up. Percutaneous radiofrequency ablation of lung metastases from colorectal cancer under C-arm CBCT guidance is feasible and safe, with immediate and short-term results similar to those obtained using conventional CT guidance.

Study of therapeutic efficacy of percutaneous radiofrequency ablation versus percutaneous microwave ablation for hepatocellular carcinoma

Background In the past two decades, thermal ablation therapy using energy sources has been increasingly accepted due to the advantages of greater capacity to devitalize hepatocellular carcinoma (HCC) with fewer treatment sessions. Among them, radiofrequency ablation (RFA) and microwave ablation (MWA) are the most commonly used modalities. Aim The aim of study was to compare RFA versus MWA in terms of therapeutic efficacy. Patients and methods This study included 130 patients proved to have HCC. They were divided into two groups. Group I included 70 patients who underwent RFA. Group II included 60 patients who underwent MWA. Results Comparison of complete ablation (CA), partial ablation (PA), local tumor progression (LTP), and distant recurrence was made between the two groups. The CA rate was 86.6% for the RF group and 91.6% for the MW group but without significance in lesions lower to 3 cm in diameter (P=0.7981). However, this difference was significant in lesions measuring 3.1–4 cm in diameter; the CA rate was 33.3% for the RF group and 85.7% for the MW group (P=0.0388). The PA rate was 13.3% for the RF group and 8.3% for the MW group but without significance in lesions lower to 3 cm in diameter (P=0.5843). However, this difference was statistically significant in lesions measuring 3.1–4 cm in diameter; the PA rate was 66.6% for the RF group and 14.2% for the MW group (P=0.0045). During the 18-month follow-up period for tumors lower to 3 cm in diameter of both groups, the LTP rate was 21% in the RF group and 13% in the MW group with a nonsignificant difference (P=0.1944), whereas for larger tumors (3.1–4 cm in diameter) the LTP rate was 33% in the RF group and 11% in the MW group with a significant difference (P=0.0387). Tumor distant recurrence was observed in 25 (41.6%) patients of the MW group and in 30 (42.8%) patients of the RF group with a nonsignificant difference (P=1.0000). Conclusion MW ablation is superior to RF ablation in HCC treatment, especially large one.

Optimum target in percutaneous upper thoracic thermocoagulation in primary hyperhidrosis

Introduction Primary palmar hyperhidrosis is a disabling problem that affects young age groups and usually continues for years without an effective treatment. It is usually accompanied by plantar hyperhidrosis and to a lesser extent by axillary affection. We have tried to improve the efficacy of percutaneous radiofrequency ablation of upper thoracic sympathetic ganglia via imitating what thoracoscopic surgeons do in endoscopic thoracic sympathectomy. Patients and methods A total of 40 patients with primary hyperhidrosis were randomly classified into two groups. Group Tb (n=20) underwent thermocoagulation of sympathetic chain on vertebral body. Group Th (n=20) underwent thermocoagulation of sympathetic chain on the head and neck of ribs. Hand temperature and dryness were followed up during the procedure and on the following intervals: 1 week, 1 month, 3 months, 6 months, 9 months, and 12 months after the procedure. Results During the procedure, the hands of 50% of patients became warm and dry in group Tb and only 40% remained so till 12 months, whereas in group Th, the hands of 100% of the patients became warm and dry during the procedure till 12 months. Conclusion Thermocoagulation of upper thoracic sympathetic chain on the head and neck of the second and third ribs is more effective than attacking the chain on vertebral bodies in patients with primary hyperhidrosis with no recorded complications.

Safety, efficacy and predictors of local recurrence after percutaneous radiofrequency ablation of biopsy-proven renal cell carcinoma.

To evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) for localised renal cell carcinoma (RCC) and examine potential associations between age, gender, tumour size, location, chronic kidney disease, comorbidities, learning curve and local recurrence. We retrospectively analysed survival outcomes for patients with biopsy-proven RCC treated by RFA at Westmead Hospital. Complication data were gathered from all patients that underwent renal RFA. 3 and 5year local recurrence-free (RFS), disease-free (DFS) and overall survival (OS) outcomes were reported. Univariate and multivariate analysis was used to examine each potential predictor. A total of 168 patients were eligible for the study. Forty-eight patients with biopsy-proven RCC had minimum 3-year follow-up. Our complication rate was 1.2% (2/168) and local recurrence rate 10.4% (5/48). Five-year RFS, DFS and OS were 86.8, 82.3 and 92.6% on a median 4.1-year follow-up (IQR 3.4-4.9). None of the patient or tumour-specific characteristics were associated with RFS. Radiofrequency ablation performed at our centre was a safe and effective procedure with low complication rates and durable RFS. Tumour characteristics, comorbidities and learning curve were not associated with local recurrence.

Percutaneous Radiofrequency Ablation of Unresectable Locally Advanced Pancreatic Cancer: Preliminary Results.

The objective of this study was to evaluate the efficacy of percutaneous radiofrequency ablation of locally advanced pancreatic cancer located in the pancreatic body. Patients with biopsy-proven locally advanced pancreatic adenocarcinoma were considered for percutaneous radiofrequency ablation. Postprocedural computed tomography studies and Ca19.9 tumor marker evaluation were performed at 24 hours and 1 month. At computed tomography, treatment effect was evaluated by excluding the presence of complications. The technical success of the procedure is defined at computed tomography as the achievement of tumoral ablated area. Twenty-three patients have been included in the study. Five of the 23 patients were excluded. At computed tomography, the mean size of the intralesional postablation necrotic area was 32 mm (range: 15-65 mm). Technical success of the procedure has been obtained in 16 (93%) of the 18 cases. None of the patients developed postprocedural complications. Mean Ca19.9 serum levels 1 day before, 1 day after, and 1 month after the procedure were 285.8 U/mL (range: 16.6-942.0 U/mL), 635.2 U/mL (range: 17.9-3368.0 U/mL), and 336.0 U/mL (range: 7.0-1400.0 U/mL), respectively. Follow-up duration was less than 6 months for 11 patients and more than 6 months for 7 patients. At the time of the draft of this article, the mean survival of the patients included in the study was 185 days (range: 62-398 days). Percutaneous radiofrequency ablation of locally advanced adenocarcinoma has a high technical success rate and is effective in cytoreduction both at imaging and laboratory controls.