Medium-sized Hepatocellular Carcinoma Research Articles

A Comparison of US-guided Percutaneous Radiofrequency Ablation of Medium-sized Hepatocellular Carcinoma with a Cluster Electrode or a Single Electrode with a Multiple Overlapping Ablation Technique

Purpose To compare ablation zone, local therapeutic efficacy, and complications of ultrasound (US)–guided percutaneous radiofrequency (RF) ablation of medium-sized hepatocellular carcinomas (HCCs) with a cluster electrode versus a single electrode with multiple overlapping ablations. Materials and Methods From February 2005 to January 2009, a total of 79 consecutive patients (57 men, 22 women; mean age, 58.6 y) with 79 HCCs (range, 2.5–4.0 cm) underwent percutaneous RF ablation with a cluster electrode (n = 37) or a single electrode with multiple overlapping ablations (n = 42). These methods were compared in terms of ablation zone size on immediate follow-up computed tomography and the rates of technique effectiveness and cumulative local tumor progression on further follow-up (range, 12.0–46.2 mo; median, 24.3 mo). Results Baseline characteristics did not differ between groups. The ablation zone in the cluster group was significantly smaller in the longitudinal dimension (43.7 mm ± 4.8 vs 46.5 mm ± 5.9; P = .03), but greater in the short axial dimension (30.7 mm ± 3.9 vs 27.3 mm ± 5.5; P = .03), compared with that in the overlapping ablation group. Technique effectiveness rates in the cluster and overlap groups were 100% and 92.9% (39 of 42), respectively ( P = .24). The cumulative local tumor progression rate was significantly lower in the cluster group than in the overlapping group (1- and 3- year follow-up: 8.1 and 18.8% vs 23.8 and 42.2%, P = .04). Complications were more frequent in the cluster group than in the overlapping group (27.0% vs 7.1%; P = .03). Conclusions In US-guided percutaneous RF ablation of medium-sized HCCs, the cluster electrode showed better local therapeutic efficacy than the single electrode with multiple overlapping ablations, probably because of the favorable shape of the ablation zone; however, complications occurred more frequently.

Medium-Sized (3.1–5.0 cm) Hepatocellular Carcinoma: Transarterial Chemoembolization Plus Radiofrequency Ablation Versus Radiofrequency Ablation Alone

This study was designed to retrospectively compare the effectiveness of combined transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) with that of RFA alone in patients with medium-sized (3.1-5.0cm) hepatocellular carcinoma (HCC). From March 2000 to April 2010, 57 patients, each with a single medium-sized HCC, were treated with combined TACE and RFA, and 66 were treated with RFA alone. During follow-up (mean, 42.5±33.2months; range, 2.6-126.2months), local tumor progression was observed in 40% of treated lesions in the combined treatment group and in 70% in the RFA-alone group. The 1-, 3-, 5-, and 7-year local tumor progression rates were significantly lower in the TACE+RFA group (9%, 40%, 55%, and 66%, respectively) than in the RFA-alone group (45%, 76%, 86%, and 89%, respectively; P<0.001). Multivariate analysis showed that treatment allocation (odds ratio [OR], 1.78; P=0.016) and Child-Pugh class (OR, 1.96; P=0.008) were significant independent factors associated with patient survival. The rates of major complications were 0% for the combined treatment group and 3% for the RFA-alone group. The combination of TACE and RFA is safe and provides better local tumor control than RFA alone for the treatment of patients with medium-sized HCC. Our multivariate analysis showed that RFA-alone treatment and Child-Pugh class B were poor independent factors for determining the patient survival period.

Medium-Sized HCC: Achieving Effective Local Tumor Control with Combined Chemoebolization and Radiofrequency Ablation

Medium-Sized HCC: Achieving Effective Local Tumor Control with Combined Chemoebolization and Radiofrequency Ablation

Hepatocellular Carcinoma With Cirrhosis: Are Patients With Neoplastic Main Portal Vein Invasion Eligible for Percutaneous Radiofrequency Ablation of Both the Nodule and the Portal Venous Tumor Thrombus?

The purpose of this study was to examine the results of percutaneous radiofrequency ablation of both medium-sized hepatocellular carcinoma (HCC) and the accompanying main portal venous tumor thrombus in patients with cirrhosis. From January 2005 to January 2008, among 1,837 consecutively registered patients with HCC seen at our institution, 412 had HCC and portal venous invasion; 27 of the 412 had a single HCC nodule accompanied by main portal venous tumor thrombus. Thirteen patients (10 men, three women; mean age, 70 years; range, 66-74 years) with 13 HCC nodules 3.7-5 cm in diameter extending into the main portal trunk underwent percutaneous radiofrequency ablation. Fourteen matched patients (10 men, four women; mean age, 69 years; range, 67-73 years) with 14 HCC nodules 3.6-4.8 cm in diameter extending into the main portal trunk refused radiofrequency ablation and composed the control group. Diagnosis of main portal venous tumor thrombus was made with fine-needle biopsy in all cases. Radiofrequency ablation was performed first on the main portal venous tumor thrombus and then on the HCC nodule. Efficacy of radiofrequency was defined as complete necrosis of HCC and complete recanalization of the main portal trunk and its branches. HCC necrosis was evaluated with enhanced CT. Recanalization of portal vessels was analyzed with color Doppler and contrast-enhanced ultrasound. Radiofrequency ablation was performed under ultrasound guidance with a perfused needle electrode. Complete necrosis of the HCC associated with complete recanalization of the main portal vein and its branches was achieved in 10 patients (efficacy, 77%). In the other three patients, necrosis of the HCC ranged from 70% to 90%, and recanalization of the main portal trunk was not complete. No major complications occurred. In three cases, mild to moderate ascites and increased aspartate aminotransferase and alanine aminotransferase levels were found. The follow-up periods ranged from 3 to 36 months among the treated patients and 2 to 10 months among the untreated patients. The cumulative survival rate was 77% 6, 12, and 36 months after procedure in the treated group and 43% and 0% 6 and 12 months after diagnosis in the untreated group (p < 0.0001). All 10 successfully treated patients were alive and the portal system was patent at the end of the follow-up period. All three untreated patients died of progressive disease within 5 months of diagnosis. Radiofrequency ablation can destroy both single intraparenchymal medium-sized HCCs and the accompanying main portal venous tumor thrombus with high efficacy and safety and a low rate of complications.

Long-term Results of Percutaneous Ethanol Injection for the Treatment of Hepatocellular Carcinoma in Korea

ObjectiveTo evaluate the long-term follow-up results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in Korea.Materials and MethodsSixty-eight nodular HCCs initially detected in 64 patients, were subjected to US-guided PEI as a first-line treatment. Long-term survival rates, local tumor progression rates, and complications were evaluated, as were the influences of tumor size and Child-Pugh class on these variables.ResultsNo major complications occurred. The overall survival rates of the 64 patients at three and five years were 71% and 39%, and their cancer-free survival rates were 22% and 15%, respectively. The overall survival rate of patients with a small HCC (≤ 2 cm) was significantly higher (p = 0.014) than that of patients with a medium-sized HCC (≤ 2 cm). The overall survival rate of patients with Child-Pugh class A was significantly higher (p = 0.049) than that of patients with Child-Pugh class B. Of 59 cases with no residual tumor, local tumor progression was observed in ablation zones in 18, and this was not found to be significantly influenced by tumor size or Child-Pugh class.ConclusionThe results of our investigation of the long-term survival rates of PEI in HCC patients in Korea (a hepatitis B virus-endemic area) were consistent with those reported previously in hepatitis C endemic areas. Patients with a smaller tumor or a better liver function exhibited superior survival rates.