Medium-sized Hepatocellular Carcinoma Research Articles

Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial.

To compare the therapeutic response and clinical outcome of CT-guided percutaneous microwave (MWA) and radiofrequency ablation (RFA) for the treatment of small- and medium-sized HCC. In this prospective trial, 50 patients with HCC were randomly assigned to MWA or RFA treatment. MRI was performed 24 h before and after ablation and subsequently in 3-month intervals. Ablation volumes, ablation durations, adverse events (AE), technique efficacy, technical success, local tumor progression (LTP), disease-free survival (DFS), intrahepatic distant recurrence (IDR), and overall survival (OS) rates were evaluated. The mean ablation volume was 66.5 cm³ for MWA and 29.2 cm³ for RFA (p < 0.01). The mean ablation durations for MWA and RFA were 11.2 ± 4.0 min and 16.3 ± 4.7 min, respectively (p < 0.01). Six mild AEs were documented (p > 0.05). All treatments had a technical success rate and a technique efficacy rate of 100 % (50/50, p = 1.00). LTP within 2 years occurred in 1/25 (4 %) in the MWA group and in 4/25 (16 %) in the RFA group (p = 0.06). IDR within 2 years was 8/25 (32 %) for MWA and 14/25 (56 %) for RFA (p < 0.05). The median DFS was 24.5months and 13.4 months for MWA and RFA, respectively (p = 0.02). The 1-, 2-, 3-year OS rates were 100 %, 80 %, 72 % in the MWA group and 72 %, 64 %, 60 % in the RFA group, respectively (p ≥ 0.14). The clinical outcome after MWA or RFA for HCC treatment was very similar with no significant differences in LTP or OS. However, MWA shows a trend toward better DFS with fewer IDRs than RFA. · MWA allows for larger ablation volumes and a shorter treatment duration compared to RFA in patients with HCC.. · MWA shows a trend toward better disease-free survival and fewer intrahepatic distant recurrences compared to RFA.. · The three-year survival rates show no significant difference between the two methods..

Single medium-sized hepatocellular carcinoma treated with sequential conventional transarterial chemoembolization (cTACE) and microwave ablation at 4 weeks versus cTACE alone: a propensity score

BackgroundMicrowave ablation (MWA) is a potentially curative treatment for unresectable patients with hepatocellular carcinoma (HCC) ≤ 3 cm, while its therapeutic efficacy decreases significantly for HCC > 3cm. Previous studies have demonstrated that conventional transarterial chemoembolization (cTACE) combined with MWA (cTACE-MWA) may improve local tumor control rate and reduce the recurrence rate for HCC > 3cm. However, there have been few study designs to analyze the clinical efficacy of cTACE-MWA for medium-sized HCC (3–5cm). Therefore, this study aims to compare the clinical efficacy and safety of cTACE-MWA with cTACE alone for a single medium-sized HCC of 3–5 cm in diameter.MethodsWe retrospectively investigate the data of 90 patients with a single medium-sized HCC who were referred to our hospital and underwent cTACE-MWA or cTACE alone from December 2017 to March 2020. Then, patients were identified with propensity score-matched (1:1). The local tumor response to treatment and time to progression (TTP) were compared using mRECIST criteria between the cTACE-MWA group and the cTACE group.ResultsA total of 42 patients were included after matching (cTACE-MWA: 21; cTACE: 21). Comparing with cTACE, cTACE-MWA demonstrate significantly better local tumor control (ORR: 95.2% vs 61.9%, p = 0.02; DCR: 95.2% vs 66.7%, p = 0.045) and TTP (median 19.8 months vs 6.8 months, p < 0.001). The 1- and 2-year cumulative probabilities of OS were 100% and 95% in the cTACE-MWA group, which were significantly higher than those in the cTACE group (95% and 76%) (p = 0.032). Multivariate Cox regression analysis illustrates that cTACE-MWA was associated with better TTP (hazard ratio, 0.28; 95% CI: 0.1, 0.76; p = 0.012), but tumor size was associated with worse TTP (hazard ratio, 1.71; 95% CI: 1.01, 2.89; p = 0.045).ConclusionscTACE followed by MWA improved TTP and OS in patients with a single medium-sized HCC, and no major complication was observed in this study.

Combination Therapy by Transarterial Injection of Miriplatin-Iodized Oil Suspension with Microwave Ablation for Medium-Sized Hepatocellular Carcinoma: the Preliminary Experience.

Purpose: To evaluate the feasibility and safety of transarterial injection of a miriplatin-iodized oil suspension combined with Emprint miriplatin-iodized oil suspension-microwave ablation in patients with medium-sized (3-5 cm) hepatocellular carcinomas. Materials and Methods: This retrospective study included a total of 11 patients with 12 hepatocellular carcinomas (mean size, 3.6 ± 0.6 cm) underwent miriplatin-iodized oil suspension-microwave ablation. Microwave ablation was performed under the guidance of computed tomography fluoroscopy following transarterial miriplatin-iodized oil suspension injection on the same day. Technical success, complications, and local tumor progression were assessed. Results: The primary and secondary technical success rates were 75.0% and 100%, respectively. The number of treatment sessions per nodule was 1.25 ± 0.45. A total 15 sessions were required to achieve technical success (one session in nine lesions, two sessions in three lesions). Two major complications (pneumothorax [n = 1] and hemorrhage [n = 1]) occurred (2/15, 13.3%). No local tumor progression was observed during the follow-up period (mean 12.0 ± 2.0 months, range 2.7-23.9 months). Conclusions: Miriplatin-iodized oil suspension-microwave ablation for medium-sized hepatocellular carcinomas can be safely performed with good local control.

Impact of resection versus radiofrequency ablation on medium-sized hepatocellular carcinomas: Long-term outcome and prognostic factors

Background: Liver resection (LR) is considered the main therapeutic strategy for small hepatocellular carcinomas (HCCs) (<3 cm). Recently, the efficacy of complete response after radiofrequency ablation (RFA) in medium-sized HCCs (3–5 cm) has been proposed. Comparative analyses of LR and RFA in HCC patients with single or multiple nodules and tumor sizes ranging from 3 to 5 cm are lacking. Aim: The purpose of this study is to compare the long-term outcomes of 132 patients diagnosed with medium-sized HCCs between 2010 and 2017 who underwent LR (n = 72) or RFA (n = 60) and met the inclusion criteria. Methods: Data were retrospectively analyzed using a prospective database. The treatment-related outcomes and risk factors of overall survival (OS) and disease-free survival (DFS) were investigated using univariate and multivariate Cox regression analyses. Results: The hospital stay was shorter in the RFA group than in the LR group (5.4 days vs. 14.3 days, respectively; P < 0.0001). RFA was associated with fewer treatment-related complications. OS and DFS were better in the LR group than in the RFA group. Treatment modality and albumin and alpha-fetoprotein levels were predictors for OS, while treatment modality and tumor number were predictors for DFS. Conclusion: LR is an effective treatment for patients with medium-sized HCCs in terms of long-term outcomes (OS and DFS), while RFA may be used as an alternative treatment to LR with comparable OS.

Combined Transarterial Chemoembolization with Microwave Ablation versus Microwave Alone for Treatment of Medium Sized Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths. The only definitive treatment for both HCC and cirrhosis is liver transplantation, but long wait times in some regions and a relatively fixed number of donor organs negatively impact access to liver transplantation. The aim of the work was to evaluate and compare the short outcome of patients with medium-sized HCC who will undergo percutaneous microwave ablation (MWA) alone and in combination with TACE. This prospective study included 40 patients with medium-sized HCC lesions who were classified into two groups; Group A that included twenty patients treated by TACE followed by percutaneous MWA after 2 weeks and group B that included twenty patients treated by 2 sessions of percutaneous MWA with 2 weeks interval. Full history taking, clinical examination, laboratory investigation, abdominal ultrasonography and abdominal tri-phasic computed tomography (CT) with contrast were obtained from the two groups. Laboratory and radiological follow up of the cases were done at 1 and 3 months after the treatment. There was no statistically significant difference in the sociodemographic criteria, laboratory measurement and clinical criteria between the cases in the two study groups before initiation of treatment. The response was slightly better in the combined treatment group, but it did not show a statistically significant difference. The incidence of complications was higher in the MWA group. Hepatocellular carcinoma is a common complication of HCV related cirrhosis. Association of TACE-MWA led to better response rates than MWA with fewer complications.

Switching monopolar radiofrequency ablation improves long-term outcomes of medium-sized hepatocellular carcinoma.

Radiofrequency ablation (RFA) of medium-sized (3-5 cm) hepatocellular carcinoma (HCC) is suboptimal. Switching monopolar RFA (SW-RFA) enlarges the ablative volume to better cover larger tumors. This study aims to compare the long-term outcomes of medium-sized HCC treated by either SW-RFA or single-monopolar RFA (S-RFA). We retrospectively reviewed 139 cases (147 medium-size HCC) between 2008 and 2014. Under propensity score matching, a total of 43 paired patients with medium-size HCC and balanced clinical variables treated by either SW-RFA or S-RFA were selected for comparison. SW-RFA showed a higher rate of achieving an adequate safety margin (p = 0.002). After a mean follow-up period of 40.4 months, SW-RFA produced significantly lower global RFA failure rates (p < 0.001) and better overall survival (p = 0.005) compared to S-RFA. SW-RFA was independently associated with a decreased risk of global RFA failure (hazard ratio [HR]: 0.136, 95% confidence interval [CI]: 0.030-0.607, p = 0.009) and improved overall survival (HR: 0.337, 95% CI: 0.152-0.747, p = 0.007). By last follow-up, the SW-RFA group maintained a superior tumor-free rate (p = 0.010) and fewer progressions to Barcelona Clinic Liver Cancer stage C (p = 0.011). Major complication rates were comparable in both groups (SW-RFA: 2.3% vs. S-RFA: 4.7%, p = 1.000). The switching multi-monopolar ablation technique could be beneficial for patients with medium-sized HCCs given sustained control of larger tumors with better overall survival. • Switching monopolar ablation could provide a sustained local tumor control and better overall survival than single-monopolar ablation for the medium-sized hepatocellular carcinoma. • Compared to single-monopolar ablation, switching monopolar ablation could create a larger homogeneous coagulation volume by using a shorter total ablation time to achieve a higher rate of adequate safety margin for a medium-sized HCC. • Patients with medium-sized HCC can be maintained at a higher rate of tumor-free status and at a lower risk of progression into BCLC stage C in the follow-up period after ablation by switching monopolar than by single-monopolar ablation.

Thermal ablation of medium-sized hepatocellular carcinomas using intraoperative ultrasound fusion imaging: A propensity score-matched analysis

ObjectiveTo explore the value of ultrasound fusion imaging for the thermal ablation of medium-sized hepatocellular carcinomas (HCCs). Materials and MethodsFrom December 2010 to June 2018, patients with medium-sized (3.1-5.0cm) HCCs who underwent radiofrequency ablation (RFA) or microwave ablation (MWA) with the assistance of ultrasound fusion imaging were enrolled in this retrospective study. Technical efficacy, local tumor progression (LTP), intrahepatic distant recurrence (IDR), overall survival (OS), tumor-free survival (TFS) and major complications were evaluated during the follow-up period. The therapeutic outcomes were compared between the RFA/MWA combined with trans-arterial chemoembolization (TACE) group and the RFA/MWA alone group with propensity-score matching (PSM) analysis. ResultsA total of 112 patients with 115 medium-sized HCCs were finally enrolled in this study. The median duration of follow-up was 33 months (range, 2-104 months). The technique efficacy was 100% (115/115). The 1-, 3-, 5-year OS rates and TFS rates were 95.5%, 76.7%, 71.5% and 74.1%, 48.7%, 41.8%, respectively. The corresponding LTP rates and IDR rates were 5.4%, 7.3%, 7.3% and 21.8%, 46.9%, 50.3%, respectively. The incidence of major complications was 5.4% (6/112). After PSM analysis (19 patients in each group), the therapeutic outcomes, including the OS, TFS, and LTP rates, were comparable in the two groups (P > 0.05). ConclusionsWith the assistance of ultrasound fusion imaging, thermal ablation of medium-sized HCC could achieve a satisfactory local control rate and long-term survival. The outcomes were comparable in the stratified analysis between the RFA/MWA alone group and the RFA/MWA+TACE group after PSM analysis.

The role of microwave ablation in treatment of small and medium sized hepatocellular carcinoma

Back ground and aim of work: Microwave ablation (MWA) is effective and safe technique used in treatment of hepatocellular carcinoma (HCC). The aim of this study is to investigate the role of microwave ablation in treatment of small and medium sized hepatocellular Carcinoma. Methods: This prospective study included 50 patients who underwent microwave ablation for small and medium size hepatocellular carcinoma with abdominal ultrasound guidance. All patients' demographic, laboratory investigations and complications were recorded. To evaluate efficacy of microwave ablation, Contrast-enhanced computed tomography was done one month and repeated three months after the ablation. Results: Complete ablation of the tumor was done in 92% of small HCC patients (less than or equal 3 cm) whereas in 64% among medium size HCC patients (more than 3 and up to 4 cm). Tumor recurrence was recorded in one patient (4%) with medium size HCC. There was significant decline in serum alpha fetoprotein levels one month after ablation compared to before the procedure. No major complications of the procedure or mortality were reported. Conclusion: Microwave ablation is safe and effective in small to medium size HCC tumors treatment with no recorded major complications or mortality in addition to acceptable local tumor control.

Percutaneous Radiofrequency Ablation With a Multiple-Electrode Switching System for Medium-Sized Hepatocellular Carcinomas

Objective This study aimed to retrospectively evaluate the safety and short-term therapeutic efficacy of radiofrequency ablation (RFA) with a multiple-electrode switching system (MESS) to treat medium-sized (3.1–5.0 cm) hepatocellular carcinomas (HCCs). Summary of Background Data Conventional monopolar RFA is limited in achieving local control for tumors larger than 3 cm. Therefore, MESS-RFA was developed, and it can create a sufficiently large ablation volume, including the target tumor and a 5- to 10-mm safety margin in medium-sized tumors. Methods We performed a total of 168 RFAs with a MESS for 166 patients. The patients were treated under ultrasonographic guidance by a percutaneous switching system RFA with a multichannel RF generator and 2 or 3 internally cooled electrodes. Technical effectiveness, local progression, and remote recurrence of HCC were determined. Results For the 166 isolated HCC tumors, the complete ablation rate of MESS-RFA was 98.79% (164 of 166). Mean ablation time per procedure was 12.33 ± 3.01 minutes; mean ablation diameter was 5.79 ± 0.61 cm. The complication rate was 2.41%. During follow-up (averaging 16.54 months), local tumor progression occurred in 15 of 166 patients (9.03%) with technical effectiveness, whereas new HCCs were detected in 40 of 166 patients (24.09%). Multivariate analyses revealed that local tumor progression was only associated with serum α-fetoprotein levels above 100 ng/mL as a risk factor. Conclusion MESS-RFA for achieving sufficient ablation volume is safe and efficient. This method also showed relatively successful therapeutic effectiveness on short-term follow-up in the treatment of medium-sized HCCs.

Combined Transarterial Chemoembolization and Percutaneous Radiofrequency Ablation: More Promising Evidence of Effectiveness in Treating Solitary, Medium-Sized Hepatocellular Carcinoma.

Locoregional therapy (LRT) has become a cornerstone in the management of patients with surgically unresectable hepatocellular carcinoma (HCC). Transarterial chemoembolization and percutaneous radiofrequency (RF) ablation—both prototypical LRTs with long track records of use—prolong overall survival (OS) in HCC patients ( 1 Lo C.M. Ngan H. Tso W.K. et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002; 35: 1164-1171 Crossref PubMed Scopus (2200) Google Scholar , 2 Llovet J.M. Real M.I. Montana X. et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359: 1734-1739 Abstract Full Text Full Text PDF PubMed Scopus (2871) Google Scholar , 3 Lencioni R. Cioni D. Crocetti L. et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology. 2005; 234: 961-967 Crossref PubMed Scopus (708) Google Scholar ) but have shortcomings when used independently ( 4 Carmi L. Georgiades C. Combination percutaneous and intraarterial therapy for the treatment of hepatocellular carcinoma: a review. Semin Intervent Radiol. 2010; 27: 296-301 Google Scholar ). Although transarterial chemoembolization is the current standard of care for patients with Barcelona Clinic Liver Cancer stage B (intermediate-stage) HCC, it is considered a palliative treatment rather than a curative treatment. To this end, rates of complete (ie, 100%) pathologic necrosis are modest—ranging as low as 20%–35% ( 5 Riaz A. Lewandowski R.J. Kulik L. Ryu R.K. Mulcahy M.F. Baker T. et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with chemoembolization. Cardiovasc Intervent Radiol. 2010; 33: 1143-1152 Crossref PubMed Scopus (78) Google Scholar , 6 Shim J.H. Han S. Shin Y.M. et al. Optimal measurement modality and method for evaluation of responses to transarterial chemoembolization of hepatocellular carcinoma based on enhancement criteria. J Vasc Interv Radiol. 2013; 24: 316-325 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar )—and result in unacceptably high tumor progression rates, with median time-to-progression of 3.1–13.5 months ( 7 Lencioni R. de Baere T. Soulen M.C. Rilling W.S. Geschwind J.F. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data. Hepatology. 2016; 64: 106-116 Crossref PubMed Scopus (391) Google Scholar ), ensuring that most HCC patients succumb to cancer despite repeated transarterial chemoembolization aimed at disease control. Conversely, RF ablation is considered a definitive therapy for Barcelona Clinic Liver Cancer stage A (early-stage) HCC tumors ≤3 cm, although as tumor size exceeds 3 cm, there is a significant reduction in the rate of complete coagulative necrosis due to heat dissipation with increasing distance from the RF ablation electrode, which results in higher local tumor progression rates, as confirmed in a study of nearly 1500 early-stage HCC tumors treated with RF ablation ( 8 Kim Y.S. Lim H.K. Rhim H. et al. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol. 2013; 58: 89-97 Abstract Full Text Full Text PDF PubMed Scopus (267) Google Scholar ). In addition, RF ablation is susceptible to heat sink effects, or convective heat loss due to blood flow in adjacent vessels, which may limit therapeutic efficacy ( 9 McGhana J.P. Dodd 3rd, G.D. Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol. 2001; 176: 3-16 Crossref PubMed Scopus (572) Google Scholar , 10 Lu D.S. Yu N.C. Raman S.S. et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology. 2005; 234: 954-960 Crossref PubMed Scopus (320) Google Scholar ). Moreover, HCCs larger than 2 cm are more frequently associated with satellite tumors and microscopic vascular invasion, which may precipitate treatment failure or disease recurrence despite satisfactory target tumor ablation ( 11 European Association for Study of Liver, European Organisation for Research and Treatment of CancerEASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Eur J Cancer. 2012; 48: 599-641 Abstract Full Text Full Text PDF PubMed Scopus (374) Google Scholar ). Given the individual limitations of transarterial chemoembolization and RF ablation, there is a pressing need to validate more effective treatment permutations to enhance the efficacy of LRT. Chemoembolization Combined with Radiofrequency Ablation for Medium-Sized Hepatocellular Carcinoma: A Propensity-Score AnalysisJournal of Vascular and Interventional RadiologyVol. 30Issue 10PreviewTo compare survival outcomes of patients with single medium-sized hepatocellular carcinomas (HCCs) who underwent treatment with transarterial chemoembolization, radiofrequency (RF) ablation, or a combination of the 2 therapies. Full-Text PDF

Combination of Chemoembolization plus Radiofrequency Ablation May Provide Better Survival Outcomes than Monotherapy for HCC

Combination of Chemoembolization plus Radiofrequency Ablation May Provide Better Survival Outcomes than Monotherapy for HCC

Comparison of Stereotactic Body Radiation Therapy and Transarterial Chemoembolization for Unresectable Medium-Sized Hepatocellular Carcinoma

This study compared the local control and overall survival (OS) between stereotactic body radiation therapy (SBRT) and transarterial chemoembolization (TACE) in medium-sized (3-8 cm) hepatocellular carcinoma (HCC). From January 2008 to October 2017, 188 patients with medium-sized HCC underwent either TACE (n = 142) or SBRT (n = 46). We adjusted for imbalances in treatment assignment using propensity score matching. Infield control (IFC) and OS were analyzed retrospectively. The median follow-up time was 17.1 months for all patients and 26.6 months for surviving patients. The 3-year IFC was 63.0% for the TACE group and 73.3% for the SBRT group. Multivariable analysis identified the independent predictors for IFC as treatment modality (SBRT vs TACE), sex (female vs male), and recurrence status (recurrence vs new diagnosis). The 3-year OS was 22.9% for the TACE group and47.4% for the SBRTgroup. Multivariable analysis identified the independent predictors of OS as number of tumors, treatment modality (SBRT vs TACE), albumin-bilirubin grade, tumor volume, Eastern Cooperative Oncology Group status, and recurrence status. Propensity scorematching analysis revealed that the SBRT group had better IFC (3-year IFC of 77.5% vs 55.6%; P = .007) and OS (3-year OS of 55.0% vs 13.0%; P < .001) than the TACE group. For recurrent HCC, the SBRT group exhibited superior IFC (3-year IFC of 75% vs 57.5%; P = .022) and OS (3-year OS of 58.3% vs 5.9%; P < .001) compared with the TACE group. However, there was no difference in IFC or OS between TACE and SBRT for patients with newly diagnosed HCC. SBRT has better IFC and OS rates than TACE in patients with medium-sized HCC, particularly for recurrent cases, which warrants prospective randomized controlled trials of TACE and SBRT.

Clinical value of ultrasound fusion imaging for the thermal ablation of 3-5 cm hepatocellular carcinoma

Objective To investigate the effectiveness and safety of thermal ablation of patients with 3-5 cm hepatocellular carcinoma (HCC) under the assistance of ultrasound fusion imaging. Methods From December 2010 to December 2017, 76 HCC patients with 78 medium-size (3-5 cm) lesions who underwent radiofrequency ablation (RFA) or microwave ablation (MWA) were included in the study.Ultrasound fusion imaging was used to assist the ablation procedures and assess the technical success immediately, then guided supplementary ablation. Contrast-enhanced CT/MR was performed one month after ablation to assess the technique efficacy rate. The complication, local tumor progression (LTP) rate were followed up. Results According to the ultrasound fusion imaging evaluation, 24 lesions (30.8%, 24/78) received supplementary ablation immediately during the ablation procedure. Seventy-one of 78 liver tumors were evaluated to achieve 5 mm ablative margin while the other 7 liver tumors were not achieved. There were no ablation-related deaths, and the major complication rate was 6.6%(5/76). The technique efficacy rate was 100%(78/78) according to the contrast-enhanced CT/MR one-month later. Patients were followed up from 6 to 79 months with a median time of 22 months. LTP occurred in 4 lesions and the LTP rate was 5.1% (4/78). Conclusions With the assistance of ultrasound fusion imaging, thermal ablation of medium-sized HCC is effective and safe which could achieve a higher technique efficacy rate and a lower LTP rate. Key words: Ultrasonography; Liver neoplasms; Fusion imaging; Thermal ablation

Survival benefit of higher fraction dose delivered by three-dimensional conformal radiotherapy in hepatocellular carcinoma smaller than 10 cm in size.

Objective: Even in early-stage hepatocellular carcinoma (HCC), patients are often ineligible for surgical resection, transplantation, or local ablation due to advanced cirrhosis, donor shortage, or difficult tumor location. To compare the safety and efficacy of different fractions on the survival of patients with tumors smaller than 10 cm in size, hepatocellular carcinoma (HCC) patients ineligible for curative therapies were treated with three-dimensional conformal radiotherapy (3DCRT).Methods: A total of 198 HCC patients who had tumors smaller than 10 cm and were not eligible for surgical resection or local ablation therapy received 3DCRT. Participants were separated into two groups. The treatment for Group A (n=111) was a median total dose of 53 Gy with a fraction of 2.5–4.9 Gy given three times a week, while treatment for Group B (n=87) was a median total dose of 52 Gy with a fraction of 5.0–7.0 Gy given three times a week. Propensity score matching (PSM) was conducted, and after the PSM, 81 pairs of patients arose. The Kaplan–Meier method was adopted to analyze overall survival; multivariate analysis was applied to identify the prognostic factors of survival.Results: The median follow-up time was 19.7 months (ranging from 1 to 186 months). The median survival for Group A patients versus Group B patients was 14.4 versus 24.8 months (P=0.003), respectively. The overall survival rates at 1, 3, and 5 years were 57.7%, 30.6%, and 18.9% for Group A patients and 73.6%, 43.7%, and 33.3% for Group B patients, respectively (P=0.009). In addition, the results in the PSM model appeared to be similar between the two groups. After PSM, the association between four independent prognostic factors and worse overall survival was discovered as follows: tumor size (>5 cm), Child–Pugh class B, portal vein tumor thrombosis, and fraction of 2.5−4.9 Gy/fx. The two groups also shared similar toxicities.Conclusions: Higher fraction dose radiotherapy delivered by 3DCRT was effective, as it offered a survival benefit without aggravating the toxicities in patients with small- to medium-sized HCC tumors who were ineligible for curative therapies.

Monopolar Radiofrequency Ablation for Medium-sized Hepatocellular Carcinoma: Preliminary Experience with Single-Electrode Overlapping Ablation and Multiple-Electrode Switching System

BackgroundRadiofrequency ablation (RFA) has been regarded as an effective treatment for early and small hepatocellular carcinoma (HCC). In vivo porcine studies showed a multiple-electrode switching system could create larger necrotic areas than single-electrode or cluster-electrode ablations. Some recent studies demonstrated a multiple-electrode RFA system could achieve local control of medium-sized HCCs. This study aimed to evaluate the treatment results of monopolar RFA with either single-electrode overlapping ablations or a multiple-electrode switching system in treating medium-sized (3-5 cm) HCC. MethodsA total of 20 patients with medium-sized hepatocellular carcinomas were included in this study. Nine patients (6 males and 3 females) were treated with single- electrode monopolar RFA. Eleven patients (4 males and 7 females) were treated with multiple- electrode switching monopolar RFA. Twelve patients (60%) included in this study had multi- nodular HCCs at the time of treatment. The tumor size was slightly larger in the multiple- electrode group (4.6 ± 0.3 cm) compared to that in the single-electrode group (3.6 ± 0.6 cm). CT or MR imaging studies were performed at 1 month after RFA to evaluate treatment effectiveness. Thereafter, local tumor progression, treatment effectiveness and survival after RFA were evaluated. ResultsOverall, 18 of 20 patients (90%) showed satisfactory ablation of HCCs 1 month after their RFA procedures. Treatment effectiveness was achieved in 8 patients (88.9%) with single-electrode overlapping ablation and 10 (90.9%) patients with multiple-electrode switching system. The mean follow-up periods were 14.9 (range, 2-26) months in the single-electrode group, and 20.2 (range 4-41) months in the multiple-electrode group. Among the 18 patients who achieved primary tumor control, 2 patients (1 in the single-electrode group and 1 in the multiple-electrode group) had local progression noted during follow-up examinations. ConclusionsMedium-sized hepatocellular carcinoma can be effectively ablated with monopolar radiofrequency ablation by either single-electrode overlapping ablation or a multiple-electrode switching system. Regarding mid-term treatment responses, both RFA approaches can achieve similar treatment effectiveness, local tumor progression rate, and survival probabilities. Multiple-electrode switching RFA can treat larger medium-sized HCC with comparable mid-term efficacy as smaller medium-sized HCC treated with single-electrode overlapping RFA.

Percutaneous ultrasonography-guided radiofrequency ablation of hepatocellular carcinomas: usefulness of image fusion with three-dimensional ultrasonography

To evaluate the usefulness of fusion imaging with real-time ultrasonography (US) and three-dimensional (3D) US for the guidance of radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs) 2-5 cm in diameter. This study was conducted as a retrospective cohort study. It was approved by the institutional review board and informed consent was waived. During percutaneous RFA of HCCs, targeting was performed under conventional fusion imaging guidance, whereas monitoring and controlling were conducted under fusion with 3D US guidance. Technical success, technique effectiveness, incidence of major complications, and local tumour progression rate were evaluated. According to tumour size (small: <3 cm versus medium: 3-5 cm), the roundness indexes of the ablation zones and local tumour progression rates were compared. There were 29 small-sized HCCs (2.5 ± 0.3 cm) and 17 medium-sized HCCs (3.4 ± 0.5 cm). All RFA procedures were performed in a single RFA session. Both the technical success and technique effectiveness rates were 100%. One patient with medium-sized HCC developed a hepatic abscess (n = 1) as a major complication. The local tumour progression rate was 8.7% (4/46) with a mean follow-up period of 18.2 months. The roundness indexes of the ablation zone were not significantly different between small- and medium-sized HCCs, and the local tumour progression rates were also not significantly different between the two groups [3.4% (1/29) versus 17.6% (3/17); p = 0.135]. Image fusion with real-time US and 3D US is useful for the guidance of percutaneous RFA for HCCs 2-5 cm in diameter.

Clinical outcome of medium-sized hepatocellular carcinoma treated with microwave ablation.

To evaluate the outcomes of patients with medium-sized hepatocellular carcinoma (HCC) who underwent percutaneous microwave ablation (MWA). We retrospectively reviewed all patients with a single medium-sized HCC who underwent percutaneous MWA from January 2010 to January 2013. Technical success, technical effectiveness and complications were subsequently observed. Survival curves were constructed using the Kaplan-Meier method. The Cox proportional hazards model was fitted to each variable. The relative prognostic significance of the variables for predicting overall survival rate, recurrence-free survival rate and local tumor recurrence(s) was assessed using univariate analysis. All variables with a P value < 0.20 were subjected to multivariate analysis. The study included 182 patients (mean age, 58 years; age range: 22-86 years) with a single HCC (mean size, 3.72 ± 0.54 cm; range: 3.02-5.00 cm). The estimated technical effectiveness rate was 93% in 182 patients. The major complication rate was 2.7% (5/182), including liver abscess in 4 cases, and abdominal bleeding at the puncture site in 1 case. Thirty-day mortality rate was 0.5% (1/182). One patient died due to liver abscess-related septicemia. Cumulative recurrence-free survival and overall survival (OS) rates were 51%, 36%, 27% and 89%, 74%, 60% at 1, 2, and 3 years, respectively. Age (P = 0.017) and tumor diameter (P = 0.029) were independent factors associated with local tumor recurrence. None of the factors had a statistically significant impact on recurrence-free survival. Serum albumin level (P = 0.009) and new lesion(s) (P = 0.029) were independently associated with OS. Percutaneous MWA is a relatively safe and effective treatment for patients with medium-sized HCC.

Percutaneous radiofrequency ablation with internally cooled wet electrodes versus cluster electrodes for the treatment of single medium-sized hepatocellular carcinoma

BackgroundTo compare the effectiveness and complications of radiofrequency ablation (RFA) using cluster electrodes or internally cooled wet (ICW) electrodes in patients with medium-sized hepatocellular carcinomas (HCCs). MethodsBetween February 2008 and September 2013, 40 patients (31 men and 9 women; mean age, 61.2 years) with a single medium-sized HCC (mean size, 3.5 ± 0.5 cm; range, 3.1–5.0 cm) underwent percutaneous RFA with cluster electrodes (n = 19) or ICW electrodes (n = 21). Technical success, technical effectiveness, ablation volume, major complications, and local tumor progression were compared. ResultsAfter the initial RFA, technical success was achieved in 84% of patients and 90% of patients treated by cluster electrodes and ICW electrodes, respectively (P = 0.654). At 1 month, technical effectiveness was achieved by cluster electrodes and ICW electrodes in 84% and 100% of patients, respectively (P = 0.098). During follow-up period (mean, 17.8 months; range, 0–67 months), the median local tumor progression rates were 21.3 months in the cluster group and 31.0 months in the ICW group. The 6-month, 1-, 2-, and 4-year local tumor progression rates were significantly lower after RFA with ICW electrodes (0%, 7%, 25%, and 57%, respectively) than after RFA with cluster electrodes (26%, 33%, 53%, and 68%, respectively; P = 0.036). Major complications occurred in 15.8% of patients treated with cluster electrodes and in 4.8% of patients treated with ICW electrodes (P = 0.331). ConclusionFor the treatment of medium-sized HCCs, percutaneous RFA using ICW electrodes results in lower rate of local tumor progression and fewer serious complications, compared to cluster electrodes.

Small- and Medium-sized Hepatocellular Carcinomas: Monopolar Radiofrequency Ablation with a Multiple-Electrode Switching System—Mid-term Results

To prospectively assess the safety and mid-term therapeutic effectiveness of monopolar radiofrequency (RF) ablation with a multiple-electrode switching system for treating small- and medium-sized (≤ 5 cm) hepatocellular carcinomas (HCCs). The institutional review board approved this prospective study, and all patients gave informed consent. From February 2009 to January 2010, 166 patients (110 men and 56 women; age range, 38-86 years; mean age, 62 years ± 10 [standard deviation]) with 166 HCCs less than or equal to 5 cm in diameter were treated with monopolar RF ablation with a multiple-electrode switching system. One of three experienced radiologists performed the RF ablation. Technique effectiveness, ablation volume and time, and major complications were evaluated by means of computed tomography (CT) immediately after RF ablation and at follow-up CT examinations at 1 month and then every 3 months after the procedure. The overall survival, disease-free survival, and local tumor progression-free survival rates were evaluated by using the Kaplan-Meier method. The technique effectiveness rate determined 1 month after RF ablation was 99.4%. Mean ablation parameters were as follows: volume, 85 cm(3) ± 54; maximum diameter, 61 mm ± 13; and minimum diameter, 43 mm ± 11. The major complication rate was 4.8%. The 6-month and 1-, 2-, and 3-year local tumor progression rates were 2%, 6%, 10%, and 11%, respectively. The overall survival rates at 1, 2, and 3 years after RF ablation were 99%, 97%, and 96%, and corresponding local tumor progression-free survival rates were 94%, 90%, and 89%, respectively. The disease-free survival rates at 1, 2, and 3 years after RF ablation were 75%, 60%, and 54%, respectively. Monopolar RF ablation with a multiple-electrode switching system in small- and medium-sized HCCs was safe and efficient, and it provided successful local tumor control and high local tumor progression-free survival rates because an adequate ablation volume was obtained.

Percutaneous Radiofrequency Ablation with Multiple Electrodes for Medium-Sized Hepatocellular Carcinomas

ObjectiveTo prospectively evaluate the safety and short-term therapeutic efficacy of switching monopolar radiofrequency ablation (RFA) with multiple electrodes to treat medium-sized (3.1-5.0 cm), hepatocellular carcinomas (HCC).Materials and MethodsIn this prospective study, 30 patients with single medium-sized HCCs (mean, 3.5 cm; range, 3.1-4.4 cm) were enrolled. The patients were treated under ultrasonographic guidance by percutaneous switching monopolar RFA with a multichannel RF generator and two or three internally cooled electrodes. Contrast-enhanced CT scans were obtained immediately after RFA, and the diameters and volume of the ablation zones were then measured. Follow-up CT scans were performed at the first month after ablation and every three months thereafter. Technical effectiveness, local progression and remote recurrence of HCCs were determined.ResultsThere were no major immediate or periprocedural complications. However, there was one bile duct stricture during the follow-up period. Technical effectiveness was achieved in 29 of 30 patients (97%). The total ablation time of the procedures was 25.4 ± 8.9 minutes. The mean ablation volume was 73.8 ± 56.4 cm3 and the minimum diameter was 4.1 ± 7.3 cm. During the follow-up period (mean, 12.5 months), local tumor progression occurred in three of 29 patients (10%) with technical effectiveness, while new HCCs were detected in six of 29 patients (21%).ConclusionSwitching monopolar RFA with multiple electrodes in order to achieve a sufficient ablation volume is safe and efficient. This method also showed relatively successful therapeutic effectiveness on short-term follow up for the treatment of medium-sized HCCs.