Local Tumor Progression Rates Research Articles

Fusion imaging techniques and contrast-enhanced ultrasound for thermal ablation of hepatocellular carcinoma – A prospective randomized controlled trial

Objectives: This randomized controlled trial (RCT) aims to compare the clinical application values of contrast-enhanced ultrasound (CEUS), computed tomography/magnetic resonance-CEUS (CT/MR-CEUS), and three-dimensional ultrasound-CEUS (3DUS-CEUS) Fusion imaging (FI) techniques in the assistance of thermal ablation for hepatocellular carcinoma (HCC).Methods: A RCT was conducted on 374 patients with 456 HCCs between January 2016 and September 2017. CEUS, CT/MR-CEUS, and 3DUS-CEUS FI techniques were randomly used to assist HCC ablation. All lesions were ablated according to a previously determined plan, and FI groups required a 5-mm ablative margin. The primary endpoints were technical efficacy of thermal ablation and local tumor progression (LTP).Results: According to randomization, 153 (18.8 ± 8.0 cm), 153 (18.3 ± 6.6 cm) and 150 (19.1 ± 6.9 cm) HCCs were assigned to CT/MR-CEUS, 3DUS-CEUS and CEUS groups respectively. Technical efficacy rates (99.3% vs. 100% vs. 100%) were achieved in the three groups, showing no statistical differences (p = 1.000). The median follow-up time was 24 (1–37) months. LTP rates at 1 and 2 years were 3.4%, 12.2% for CT/MR-CEUS FI, 4.8%, 9.0% for 3DUS-CEUS FI, and 8.6%, 19.9% for CEUS, respectively (p = .105). The results of subgroup analysis for LTP were statistically significant when patients with albumin-bilirubin (ALBI) grade 2 and 3 (p = .000), and tumor located at risky positions (p = .042). In addition, the p value in group of multiple tumors was close to .05 (p = .052).Conclusions: All the three techniques are feasible for intraoperative HCC thermal ablation. Compared with CEUS, FI techniques are more suitable in patients with ALBI grade 2 and 3, multiple tumors, and in tumors at risky locations.

Intraprocedural contrast-enhanced ultrasound-CT/MR fusion imaging assessment in HCC thermal ablation to reduce local tumor progression: compared with routine contrast-enhanced ultrasound

Purpose: To evaluate whether local tumor progression (LTP) would be further reduced when contrast-enhanced ultrasound (CEUS)-CT/MR fusion imaging was used as intraprocedural assessment method in hepatocellular carcinoma (HCC) thermal ablation compared with routine CEUS.Materials and methods: This prospective non-randomized study was conducted from December 2010 to July 2012. CEUS-CT/MR fusion imaging and routine CEUS were used for treatment response assessment in the ablation procedure of 146 HCCs and 122 HCCs, respectively. Supplementary ablations were performed immediately if necessary. The primary technique efficacy rate, LTP rate and overall survival (OS) rate were calculated.Results: For CEUS-CT/MR fusion imaging and routine CEUS, the technical success rate, technique efficacy rate and supplementary ablation rate were 86.3% (126/146) and 98.4% (120/122) (p = .000), 99.2% (125/126) and 94.2% (113/120) (p = .032), and 14.3% (18/126) and 4.2% (5/120) (p = .006), respectively. The cumulative LTP rate and OS rate were not significantly different between fusion imaging group and routine CEUS group. However, for lesions that were larger than 3 cm or close to major vessels (41 lesions in fusion imaging group and 44 lesions in routine CEUS group, who received transcatheter arterial chemoembolization before ablation), the cumulative LTP rate was significantly lower in fusion imaging group than in routine CEUS group (p = .032).Conclusion: Although intraprocedural CEUS-CT/MR fusion imaging has certain limitations in application, it might provide a potential more efficient method compared with routine CEUS in reducing LTP in HCC thermal ablation, especially for difficult ablation lesions.

Outcomes of Patients with Hepatocellular Carcinoma Treated with Conventional Transarterial Chemoembolization Using Guidance Software

PurposeTo evaluate the outcomes of conventional transarterial chemoembolization using guidance software for hepatocellular carcinoma (HCC) patients. Materials and MethodsOne hundred two patients with treatment-naïve HCC with ≤ 7-cm and ≤ 5 lesions treated with conventional transarterial chemoembolization using guidance software were selected. Technical success was classified into 3 grades by computed tomography performed 1 week after transarterial chemoembolization: (i) A, complete embolization with a safety margin; (ii) B, entire tumor embolization without a safety margin; and (iii) C, incomplete embolization. Intrahepatic tumor recurrence was classified into 2 categories: local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Overall survival (OS) and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, the incidences of LTP between grade A and B tumors, IDR with/without LTP, and OS with/without LTP were compared by the log-rank test. ResultsOne hundred fifty-six (82.1%) tumors were determined to be grade A, 26 (13.7%) were determined to be grade B, and 8 (4.2%) were determined to be grade C. The 1-, 3-, and 5-year LTP and IDR rates were 31.7%, 49.4%, and 59.4% and 33.9%, 58.2%, and 73.3%, respectively. LTP developed more frequently in grade B tumors than grade A tumors (P = .0016). IDR developed more frequently in patients with LTP than without LTP (P = .0004). The 1-, 3-, and 5-year OS rates were 96.1%, 71.1%, and 60%, respectively; the 1-, 3-, and 5-year OS rates in patients with/without LTP were 95.7%, 69.8%, and 59.3% and 96.2%, 71.6%, and 59.4%, respectively (P = .9984). ConclusionsTransarterial chemoembolization guidance software promotes the technical success of transarterial chemoembolization and excellent OS in HCC patients.

Radiofrequency ablation for subcardiac hepatocellular carcinoma: therapeutic outcomes and risk factors for technical failure.

To compare the therapeutic outcomes and safety of radiofrequency (RF) ablation for subcardiac and non-subcardiac hepatocellular carcinoma (HCC) and to evaluate the risk factors for technical failure of the procedure. This retrospective study was approved by the institutional review board. Between September 2002 and May 2016, 73 patients with subcardiac HCC and the same number of patients with non-subcardiac HCC matched by tumor size were included. Subcardiac HCC was defined as an index tumor that was located ≤ 1cm from the pericardium in axial or coronal images. Cumulative local tumor progression (LTP) was compared between the two groups using the log-rank test. Prognostic factors for technical failure were assessed using multivariable logistic analysis. Technical success rates between both groups were not significantly different (91.8% in the subcardiac HCC group vs. 95.9% in the non-subcardiac HCC group; p = 0.494). The cumulative LTP rates were 15.4% and 19.1% at 3 and 5years, respectively, in the subcardiac HCC group, and 10.7% and 15.5% in the non-subcardiac HCC group, without significant difference (p = 0.862). The distance between the index tumor and pericardium (odds ratio [OR], 0.14; p = 0.023) and tumor in segment IV (reference, left lateral sector; OR, 36.53; p = 0.029) were significant factors for technical failure in patients with subcardiac HCC. RF ablation was an effective treatment for subcardiac HCC. However, tumor location should be considered in the planning of treatment to avoid technical failure. • RF ablation for subcardiac HCC is technically feasible without major complications. • RF ablation was an effective treatment for subcardiac HCC in terms of LTP. • Risk factors for technical failure were distance of the index tumor from the heart (cutoff value of 0.5cm) and the location of the tumor (segment IV).

Radiofrequency ablation following artificial ascites and pleural effusion creation may improve outcomes for hepatocellular carcinoma in high-risk locations

PurposeTo 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 methodsEligible 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.ResultsOne 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).ConclusionRFA following AA and AP for high-risk located HCC may improve outcomes.

Three-dimensional contrast-enhanced ultrasound fusion imaging predicts local tumor progression by evaluating ablative margin of radiofrequency ablation for hepatocellular carcinoma: a preliminary report

Purpose: To investigate the feasibility of three-dimensional contrast-enhanced ultrasound (3DCEUS) fusion in evaluating ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and compare with those of computed tomography (CT) fusion.Patients and methods: In total, 55 patients (47 men, 8 women; mean age, 56.0 ± 10.6 years) with 55 HCCs were included. Pre- and post-RFA 3DCEUS images were fused to assess AM immediately after RFA. The AM measured on fusion imaging was categorized into two groups: (A) AM <5 mm, and (B) AM ≥5 mm. The agreement of AM evaluation was compared between 3DCEUS and CT fusion. The influence of AMs evaluated by 3DCEUS fusion on the risk of local tumor progression (LTP) was assessed.Results: For 3DCEUS fusion, registration success rate was 96.4% (53/55). AM evaluation resulted in 28 tumors in group A and 25 tumors in group B. For CT fusion, AM evaluation resulted in 31 tumors with AM <5 mm and 23 tumors with AM ≥5 mm. AM was successful evaluated by both technique in 53 (96.4%) tumors. The agreement between 3DCEUS and CT fusion was excellent (kappa coefficient = 0.924, p < .001). LTP was identified in 5 tumors (9.4%, 5/53). LTPs all occurred in the area where unachieved 5 mm AM was evaluated by 3DCEUS fusion. Cumulative rate of LTP was significantly higher in group A than in group B (28% versus 0%; p = .033, log-rank test).Conclusions: 3DCEUS fusion enables AM evaluation for HCC immediately after RFA with comparable accuracy to CT fusion. AM <5 mm evaluated by 3DCEUS fusion has high predictive value for LTP.

Ultrasound-guided percutaneous radiofrequency ablation to treat hepatocellular carcinoma in the caudate lobe

Objective To study the feasibility, efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) in the caudate lobe. Methods From November 2006 to June 2017, 31 patients with 31 HCCs located in the caudate lobe were treated with percutaneous RFA at the First Affiliated Hospital of Sun Yat-sen University. The treatment efficacy, complications, and the local tumor progression (LTP), disease-free survival (DFS) and overall survival (OS) rates were analyzed. Results Residual tumors were detected in 5 patients after the first treatment. Complete necrosis was achieved in all the patients after the second treatment. The mean number of ablation sessions was 1.16±0.37. At a follow-up period which ranged from 3 to 65 months, 19 patients had died, 10 patients were still alive, and 2 patients were lost to follow-up. The 1-, 2-, 3-, and 5-years OS rates were 78.4%, 48.5%, 12.1% and 12.1%, respectively. On follow-up, 9 caudate lobe HCC lesions were detected to have LTP. The 1-, 2-, and 3-years LTP rates were 21.5%, 41.6% and 41.6%, respectively; while the 1-, 2-, and 3-years DFS rates were 22.3%, 11.2% and 11.2%, respectively. Ablation-related complications were detected in 4 patients. Conclusions Ultrasound-guided percutaneous RFA was safe and effective for patients with HCC in the caudate lobe. These patients should be followed-up closely to detect LTP. Key words: Hepatocellular carcinoma; Caudate lobe of liver; Radiofrequency ablation

Evaluation of hepatocellular carcinoma ablative margins using fused pre- and post-ablation hepatobiliary phase images.

To retrospectively evaluate the utility of fusion images of pre- and post-ablation hepatobiliary phase (HBP) series to assess the ablation margins after radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs). Additionally, to identify factors indicative of an adequate ablation margin and predictors of local tumor progression (LTP). Fifty-nine HCCs in 29 patients were treated by RFA and followed-up for > 1year (mean 37.9months). Fusion images of pre- and post-ablation HBP series were created using a non-rigid registration and manual correlation. The ablation margin appearance was classified as ablation margin + (ablation margin completely surrounding the tumor), ablation margin-zero (a partially discontinuous ablation margin without protrusion of HCC), ablation margin-(a partially discontinuous ablation margin with protrusion of HCC), and indeterminate (index tumor was not visible). The minimal ablation margin was measured, and clinical factors were examined to identify other risk factors for LTP. LTP was observed at follow-up in 12tumors. The mean minimal ablation margin was 3.6mm. Multivariate analysis revealed that the ablation margin status was the only significant factor (p = 0.028). The cumulative LTP rates (3.3%, 3.3%, and 3.3% at 1, 2, and 3years, respectively) in 30 ablation margin + nodules were significantly lower (p = 0.006) than those (20.0%, 28.0%, and 32.2% at 1, 2, and 3years, respectively) in 25 ablation margin-zero nodules. Fusion images enable an early assessment of the ablation efficacy in the majority of HCCs. The ablation margin status is a significant factor for LTP.

Multiple antenna placement in microwave ablation assisted by a three-dimensional fusion image navigation system for hepatocellular carcinoma

Purpose: This study was conducted to compare a three-dimensional (3D) fusion image navigation system (FINS) with ultrasound (US) for guiding percutaneous microwave ablation (PMWA) for treatment of hepatocellular carcinoma (HCC).Materials and methods: This is a retrospective, non-randomized, comparative study. Our team developed a 3D FINS and used it to guide PMWAs for HCCs in 19 patients (3D group) and compared the results to those of 24 PMWAs guided by US (US group). The complete ablation rate of the first session, the local tumor progression (LTP), intrahepatic recurrence and disease-free survival were compared between the groups.Results: The 3D FINS was successfully applied in all 19 patients. The mean size of HCCs was 4.14 cm ±0.95 in 3D the group and 4.07 cm ±0.91 in the US group. Major complications were identified at 5.3% in the 3D group and 4.2% in the US group (p = .865). Average time of image fusion was 404.53 ± 161.84 s. There were more antenna insertions in the 3D group (3.68 ± 1.57) than in the US group (2.71 ± 1.12) (p = .02). The complete ablation rate of the first session was higher in the 3D group (94.7%) than in the US group (62.5%) (p = .034). The mean follow-up period was 11.4 months ±4.9 in the 3D group and 9.8 months ±5.5 in the US group. There were no significant differences in technique efficacy rate and LTP rate between the two groups.Conclusions: The 3D FINS could be a safe, feasible and effective technique for guiding PMWA of HCC, which could help an operator improve the complete ablation rate of the first session.

Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided radiofrequency ablation in the treatment of solitary large hepatocellular carcinoma

PurposeTo introduce the technique and investigate the clinical efficacy of transcatheter arterial chemoembolization (TACE) in combination with simultaneous DynaCT-guided radiofrequency ablation (RFA) in the treatment of solitary large hepatocellular carcinomas (HCCs) (maximal diameter > 5 cm).Materials and methodsForty-six patients who received TACE combined with simultaneous DynaCT-guided RFA for solitary large HCCs between January 2012 and August 2016 were reviewed, and the success rate, safety, local tumor progression (LTP), and overall survival (OS) were retrospectively investigated. OS and time to progression were analyzed with the Kaplan–Meier method.ResultsTechnical success rate was 100%, average operative time for DynaCT-guided RFA was 45.3 ± 4.8 min, average radiation dose was 730.5 ± 78.8 mGy, and no life-threatening complications were observed. At 1-month follow-up enhanced MRI, complete remission was achieved in 82.6% of patients (38/46), and partial remission in 17.4% (8/46). The median follow-up period was 29.5 months (interquartile range 4.0–69.0 months). At 1, 2, and 3 years after surgery, the LTP rates were 4.3, 13.1, and 30.4%, respectively, and the OS rates were 89.1, 71.7, and 56.5%, respectively.ConclusionDynaCT-guided TACE + RFA is safe and feasible for the treatment of solitary large HCCS. TACE combined with simultaneous RFA provides a new treatment option for solitary large HCCs in which DynaCT has important clinical value.

Percutaneous ablation of the tumor feeding artery for hypervascular hepatocellular carcinoma before tumor ablation

Objective: To evaluate the efficiency and safety of percutaneous ablation of the tumor feeding artery (PAA) before radiofrequency ablation (RFA) for hypervascular hepatocellular carcinoma (HCC) under ultrasound guidance.Patients and methods: In total, 94 patients with hypervascular HCC and tumor feeding artery visible by contrast-enhanced ultrasound were prospectively randomized to receive either PAA combined with RFA (RFA + PAA) or RFA alone. This study was registered at the clinical trials registry website (No. NCT03143140). The mean tumor size was 3.2 ± 0.9 cm (2.0–5.0 cm). The mean follow-up was 23.7 ± 9.7 months (4–44 months). The technical success, local tumor progression and intrahepatic distant recurrence rates were compared. Survival analysis was performed using the Kaplan–Meier method and compared with the log-rank test.Results: The local tumor progression rate was lower for the PAA + RFA group than for the RFA group (8.5% vs 21.3%, p = .082). No significant differences in the technical success and intrahepatic distant recurrence rates were observed between the two groups (97.9% vs 91.5%, p = .203 and 40.4% vs 42.6%, p = .834). The 1- and 3-year local tumor progression-free survival rates were 91.5% and 69.9% vs 68.1% and 52.1% for the PAA + RFA vs RFA groups, respectively (p = .052). The 1- and 3-year overall survival rates were 95.7% and 69.1% vs 89.4% and 66.6% in the PAA + RFA vs RFA groups, respectively (p = .744). The major complication rate was 4.3% in both groups.Conclusions: PAA appears to be an effective and safe technique for the treatment of hypervascular HCC, with a lower local tumor progression rate than that of conventional RFA.

Percutaneous US/MRI Fusion-guided Radiofrequency Ablation for Recurrent Subcentimeter Hepatocellular Carcinoma: Technical Feasibility and Therapeutic Outcomes.

Purpose To evaluate the technical feasibility and therapeutic outcomes of percutaneous US/MRI fusion-guided radiofrequency ablation (RFA) of recurrent subcentimeter-sized hepatocellular carcinomas (HCCs). Materials and Methods For this retrospective study, between January 2012 and December 2014 a total of 194 planning US examinations were performed in 186 patients (159 men and 27 women; mean age, 61.1 years ± 10.0 [standard deviation]) for newly developed subcentimeter recurrent HCCs. These recurrent HCCs were defined as hypervascular nodules (>5.5 mm and <10 mm) with typical MRI findings of HCC. The study assessed how often US/MRI fusion-guided percutaneous RFA was deemed technically feasible at planning US examination (the feasibility rate) and the therapeutic outcomes after RFA, including the rates of technical success, technique efficacy, local tumor progression (LTP), and major complications. Cumulative LTP rates were estimated with the Kaplan-Meier method. Results The feasibility rate of percutaneous RFA at planning US examination was 65.7% (138 of 210 HCCs). The most common reason for RFA infeasibility was that an index tumor was inconspicuous at US. Among 138 subcentimeter HCCs feasible for RFA, 125 lesions underwent percutaneous RFA. The rates of both technical success and technique efficacy were 98.4% (123 of 125). The cumulative LTP rates at 1, 2, and 3 years were 3.6%, 5.4%, and 7.4%, respectively. The major complication rate was 2.5% (three of 119). Conclusion Percutaneous US/MRI fusion-guided radiofrequency ablation (RFA) was feasible in approximately two-thirds of subcentimeter recurrent hepatocellular carcinomas (HCCs). Percutaneous US/MRI fusion-guided RFA is a safe and effective treatment modality for patients with subcentimeter recurrent HCCs.

Percutaneous Radiofrequency Ablation of Small (1-2 cm) Hepatocellular Carcinomas Inconspicuous on B-Mode Ultrasonographic Imaging: Usefulness of Combined Fusion Imaging with MRI and Contrast-Enhanced Ultrasonography.

Purpose To assess usefulness of adding contrast-enhanced ultrasonography (CEUS) to fusion imaging (FI) for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs) inconspicuous on FI alone. Therapeutic outcomes of RFA under CEUS-added FI guidance for HCCs inconspicuous on FI alone were also evaluated. Methods This prospective study was approved by the institutional review board and informed consent was obtained from all patients. Planning US was performed with FI for 126 patients with a single HCC (1–2 cm) to evaluate the feasibility of RFA by grading lesion conspicuity score using a four-point scale. RFA was performed under CEUS-added FI guidance for HCCs inconspicuous on FI alone. We evaluated how many HCCs initially inconspicuous on FI became conspicuous after adding CEUS. After CEUS-added FI-guided RFA, therapeutic outcomes including rates of technical success, primary technique efficacy, major complications, and local tumor progression were assessed. Results After adding CEUS, 90.5% (19/21) of all tumors initially inconspicuous on FI became conspicuous, thus enabling direct targeting for RFA. Technical success and primary technique efficacy rates were 94.7% (18/19) and 100% (19/19), respectively. No major complications were observed after RFA. Cumulative local tumor progression rates after RFA were estimated to be 5.3%, 10.8%, and 10.8% at 1, 2, and 3 years, respectively. Conclusion Adding CEUS to FI is useful for improving the conspicuity of HCCs inconspicuous on FI alone, thus enabling successful percutaneous RFA with excellent therapeutic outcomes.

Microwave Ablation in the Management of Colorectal Cancer Pulmonary Metastases.

To review outcomes following microwave ablation (MWA) of colorectal cancer pulmonary metastases and assess predictors of oncologic outcomes. Technical success, primary and secondary technique efficacy rates were evaluated for 50 patients with 90 colorectal cancer pulmonary metastases at immediate, 4-8weeks post-MWA and subsequent follow-up CT and/or 18F-FDG PET/CT. Local tumor progression (LTP) rate, LTP-free survival (LTPFS), cancer-specific and overall survivals were assessed. Complications were recorded according to SIR classification. Median follow-up was 25.6months. Median tumor size was 1cm (0.3-3.2cm). Technical success, primary and secondary technique efficacy rates were 99, 90 and 92%, respectively. LTP rate was 10%. One-, 2- and 3-year LTPFS were: 93, 86 and 86%, respectively, with median LTPFS not reached. Median overall survival was 58.6months, and median cancer-specific survival (CSS) was not reached. One-, 2- and 3-year overall and CSS were 94% and 98, 82 and 90%, 61 and 70%, respectively. On univariate analysis, minimal ablation margin (p < 0.001) and tumor size (p = 0.001) predicted LTPFS, with no LTP for minimal margin ≥ 5mm and/or tumor size < 1cm. Pleural-based metastases were associated with increased LTP risk (p = 0.002, SHR = 7.7). Pre-MWA CEA level > 10ng/ml (p = 0.046) and ≥ 3 prior chemotherapy lines predicted decreased CSS (p = 0.02). There was no 90-day death. Major complications rate was 13%. MWA with minimal ablation margin ≥ 5mm is essential for local control of colorectal cancer pulmonary metastases. Pleural-based metastases and larger tumor size were associated with higher risk of LTP. CEA level and pre-MWA chemotherapy impacted CSS.

Treatment of hepatocellular carcinoma in the caudate lobe: US-guided percutaneous radiofrequency ablation combined with ethanol ablation

To evaluate the technical feasibility and treatment results of ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) combined with ethanol ablation (EA) for hepatocellular carcinoma (HCC) in the caudate lobe. The institutional review board approved this retrospective study and the requirement for informed consent was waived. From October 2009 to June 2016, there were 49 patients with HCC in the caudate lobe underwent ablation. Among them, 14 patients (12 men and two women, mean age: 49.9±14.9 years) with 16 caudate lobe HCCs (mean size: 3±1.1cm) who underwent US-guided RFA-EA were identified. These patients were compared with patients who underwent RFA alone (n=17) and EA alone (n=18). HCCs in the RFA-EA group were larger than those in the EA-alone group (3±1.1 versus 2.1±0.7cm, p=0.028). In the RFA-EA group, all the patients achieved treatment success (14/14) and entered follow-up. After a follow-up period of 17.1±10.6 months (range, 5-36 months), local tumour progression (LTP) was detected in four tumours. The 1- and 2-year LTP rates after RFA-EA were 18.8% and 27.8%, respectively. The 1- and 2-year disease-free survival (DFS) rates were 35.7% and 13.4%. Six patients died, with the 1-, 2-, and 3-year overall survival (OS) rates of 85.1%, 63.1%, and 21%, respectively. There were no significant differences intheLTP, DFS, and OS rates between the RFA-EA group and RFA-alone or EA groups (p=0.363-0.733). US-guided percutaneous RFA-EA appears to be a feasible and effective treatment for HCC in the caudate lobe.

PD61-10 SAFETY AND EFFICACY OF PERCUTANEOUS US AND CT GUIDED MICROWAVE ABLATION OF T1A AND T1B RENAL TUMORS

You have accessJournal of UrologyKidney Cancer: Localized: Ablative Therapy1 Apr 2018PD61-10 SAFETY AND EFFICACY OF PERCUTANEOUS US AND CT GUIDED MICROWAVE ABLATION OF T1A AND T1B RENAL TUMORS Sepideh Shakeri, Sohrab Afshari Mirak, Allan Pantuck, Anthony Sisk, Preeti Ahuja, David.S Lu, and Steven Raman Sepideh ShakeriSepideh Shakeri More articles by this author , Sohrab Afshari MirakSohrab Afshari Mirak More articles by this author , Allan PantuckAllan Pantuck More articles by this author , Anthony SiskAnthony Sisk More articles by this author , Preeti AhujaPreeti Ahuja More articles by this author , David.S LuDavid.S Lu More articles by this author , and Steven RamanSteven Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2834AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the safety and efficacy of image guided Microwaveablation (MWA) in biopsy-proven renal cell carcinomas (RCCs) within at least of 6 months postablation follow-up. METHODS In this IRB approved retrospective study, 88 biopsy - proven renal tumors in 70 patients who underwent the renal MWA from 2013 to 2017 at our institution were evaluated. Data collected included demographic data, tumor characteristic data,procedural protocols and follow-up visits within at least 6 months. Primary outcomes were assessed by technical success, local tumor progression (LTP) and complications (Clavien-Dindo classification system). RESULTS The primary and secondary and overall technical success rate were 93.2%, 100% and 100% respectively.The median nephrometry score was 8 (4-11) and the median size was 2.5cm (0.8-7.4). Six lesions needed second ablation included 83.3 % CC with greater median nephrometry score 9 with median size of 4.1 cm (P=0.004). No change in estimated glomerular filtration rate (eGFR) before and after ablation. The LTP rate was 6.9 % with mean tumor size of 1.9 cm. The most recurrence was in 70% CC, 10% papillary.The complication rate was 6.8% with minor complication (hematoma and severe pain) and no major one. Overall and tumor specific survival rates were 96.7% and 100% for 11.9 months. Two patients died with unrelated causes to the MW ablation (metastatic Melanoma, and pneumonia related sepsis). CONCLUSIONS contrast US and CT guided MWA appears to be a safe andeffective treatment option with low recurrence and complication rates in T1a and T1b RCCs in early (6 months) postablation follow up. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1155-e1156 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Sepideh Shakeri More articles by this author Sohrab Afshari Mirak More articles by this author Allan Pantuck More articles by this author Anthony Sisk More articles by this author Preeti Ahuja More articles by this author David.S Lu More articles by this author Steven Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

3:54 PM Abstract No. 87 Factors affecting local tumor progression after yttrium-90 radiation segmentectomy for hepatocellular carcinoma

Yttrium-90 (Y90) radiation segmentectomy has been shown to yield high response rates with low rates of subsequent local tumor progression for localized hepatocellular carcinoma (HCC). This study assessed factors associated with increased rates of local tumor progression after segmental radioembolization for HCC. In this retrospective study, 101 patients with 132 tumors underwent segmental Y90 radioembolization, with a previously reported mRECIST complete response rate of 92% and objective response rate of 98%. Baseline Child-Pugh score and alpha-fetoprotein level, tumor characteristics (size, infiltrative growth pattern, portal venous invasion), and treatment parameter (delivered Y90 dose) were incorporated in a root-cause analysis to determine which factors were associated with local tumor progression within 2 years of treatment. Death and liver transplant were considered as competing risks for the regression analysis model. Patients were followed to 2 years after the radioembolization. Eleven (8%) of the 132 treated tumors demonstrated local progression during the follow-up period. Six patients underwent liver transplantation, and 15 died. Local tumor progression was most strongly associated with baseline tumor size (0% for tumors ≤3 cm vs. 22% for >3 cm, p400 (hazard ratio 3.66, p = 0.041). Child-Pugh score, infiltrative growth pattern, vascular invasion, and delivered Y90 dose did not reach statistical significance with regards to association with local tumor progression. For localized HCC, segmental Y90 radioembolization shows high efficacy and prolonged local tumor control despite various patient, tumor, and treatment factors. Tumor size is the factor most strongly associated with local tumor progression, with curative rates for tumors ≤3 cm at 2 years.

Immediate Postablation 18F-FDG Injection and Corresponding SUV Are Surrogate Biomarkers of Local Tumor Progression After Thermal Ablation of Colorectal Carcinoma Liver Metastases.

The aim of this study was to determine whether intraprocedural 18F-FDG PET/CT can be used as a predictor of local tumor progression after percutaneous ablation of colorectal liver metastases. Methods: In this institutional review board-approved prospective study, 39 patients (19 men and 20 women; median age, 56 y) underwent split-dose 18F-FDG PET/CT-guided ablation followed by immediate biopsy and contrast-enhanced CT imaging of the ablation zone. Binary categorization of biopsy tissues was performed on the basis of the presence of only nonviable coagulation necrosis or viable tumor cells. Minimum ablation margin measurements from contrast-enhanced CT imaging were categorized as 0 mm, 1-4 mm, 5-9 mm, or greater than or equal to 10 mm. SUVs were obtained from PET/CT imaging, and SUV ratios were calculated from 3-dimensional regions of interest located in the ablation zone and surrounding normal liver. All predictive variables (biopsy, minimum margin distance, and SUV ratio) were evaluated as predictors of time to local tumor progression identified on imaging using competing-risks regression models (uni- and multivariate analyses). Results: A total of 62 consecutive ablations were evaluated. The mean SUV ratio was significantly higher for viable tumor-positive immediate postablation biopsies (n = 10) than for tumor-negative biopsies (n = 52) (85.8 ± 92.2 vs. 42.3 ± 45.5) (P = 0.03) and for a minimum margin size of less than 5 mm (n = 15) than for a minimum margin size of greater than or equal to 5 mm (n = 47) (78.5 ± 99.1 vs. 38.3 ± 78.5) (P = 0.01). After a median follow-up period of 22.5 (range, 7-52) months, 23 of 62 ablated tumors showed local tumor progression (37.1%). The local tumor progression rate was significantly higher for viable tumor-positive biopsies (8/10) than for negative biopsies (15/52) (80% vs. 29%) (P = 0.001) and for a minimum margin size of less than 5 mm (9/15) than for a minimum margin size of greater than or equal to 10 mm (2/15) (60% vs. 13%) (P = 0.02) but not 5-9 mm (37.5%; 12/32) (P = 0.5). In a competing-risks analysis, biopsy results (P = 0.07) and the minimum margin size (P = 0.08) were borderline significant, but the SUV ratio was not (P = 0.22). However, for negative biopsy ablations, the minimum margin size and SUV ratio were predictive imaging factors for local tumor progression; subdistribution hazard ratios were 0.564 (0.325-0.978) (P = 0.04) and 1.005 (1.001-1.009) (P = 0.005), respectively. Conclusion: The SUV ratio and minimum margin size can independently predict colorectal metastasis local tumor progression after liver ablation when there are no viable tumor cells on immediate postablation biopsies.

Safety margin after radiofrequency ablation of hepatocellular carcinoma: precise assessment with a three-dimensional reconstruction technique using CT imaging

Purpose: To analyse the precise ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and the correlation between AM and local tumour progression (LTP) with a three-dimension (3D) reconstruction technique.Methods: From March 2011 to May 2013, 134 patients who underwent RFA for 159 primary or recurrent HCCs within Milan criteria were enrolled. Contrast-enhanced computed tomography (CECT) scans were performed 1 week before and 1 month after treatment. The AM was measured in various directions using a 3D reconstruction technique that shows the index tumour and ablated zone on the same image. The average of all obtained AMs (average AM) and the smallest AM (min-AM) were calculated.Results: The min-AM after RFA ranged from 1 to 9.3 mm (median ± standard deviation, 4.8 ± 1.8 mm). LTP was observed in 19 tumours from 19 patients. The median min-AM was 3.1 ± 1.6 mm for patients with LTP, while the median min-AM of patients without LTP was 5.1 ± 1.8 mm (p = 0.023). After RFA, the 1-, 2- and 3-year LTP rates were 10.9, 25.9 and 35.1%, respectively, for patients with min-AM <5 mm, and 4.1, 4.1 and 4.1%, respectively, for patients with min-AM ≥5 mm (p = 0.016). Multivariate analysis showed that only min-AM <5 mm was an independent risk factor for LTP after RFA (p = 0.044, hazard ratio =4.587, 95% confidence interval, 1.045–22.296).Conclusions: The 3D reconstruction technique is a precise method for evaluating the post-ablation margin. Patients with min-AM less than 5 mm had a higher probability of developing LTP.

Multipronged ethanol ablation combined with TACE for intermediate hepatocellular carcinoma

Purpose: To retrospectively investigate the efficacy of multipronged ethanol ablation with or without transarterial chemoembolization (TACE) in the treatment of intermediate hepatocellular carcinoma (HCC) (3.1-5.0 cm in diameter) at high-risk locations .Material and methods: From March 2009 to April 2014, 25 consecutive patients with intermediate HCC who underwent multipronged ethanol ablation combined with TACE were included in the combination treatment group, while 50 patients who underwent multipronged ethanol ablation alone were included in the control group.Results: Primary technique effectiveness was achieved in 70 patients (25/25, 100% in the combination treatment group; 45/50, 90% in the control group; p = .162). The local tumor progression (LTP) rates at 1, 3, 5, and 7 years were 8.0%, 24.0%, 24.0%, and 24.0% in the combination treatment group, respectively, which were significantly lower than those in the control group (24.4%, 44.1%, 66.5% and 66.5%, respectively; p = .043). However, no significant differences of overall survival and disease-free survival were found between the two groups (p = .996 and .974, respectively).Conclusion: Multipronged ethanol ablation combined with TACE could improve local tumor control for patients with intermediate HCC at high-risk locations when compared with multipronged ethanol ablation alone, although the survival outcomes were comparable.