RFA Group Research Articles

Adjuvant immunotherapy with autologous dendritic cells for hepatocellular carcinoma, randomized phase II study

ABSTRACTOur previous phase I/IIA study showed that autologous dendritic cells (DCs) pulsed with tumor-associated antigens are well tolerated in patients with hepatocellular carcinoma (HCC). In this randomized, multicenter, open-label, phase II trial, we investigated the efficacy and safety of this DC-based adjuvant immunotherapy with 156 patients, who treated for HCC with no evidence of residual tumor after standard treatment modalities. Patients were randomly assigned to immunotherapy (n = 77; injection of 3 × 107 DC cells, six times over 14 weeks) or control (n = 79; no treatment). The primary end point was recurrence-free survival (RFS), and the secondary endpoints were immune response and safety. The RFS between the immunotherapy and control groups was not significantly different (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.60–1.56; p = 0.90). However, post-hoc subgroup analyses revealed that DC immunotherapy significantly reduced the risk of tumor recurrence of non-radiofrequency ablation (non-RFA) group patients (n = 83, HR, 0.49; 95% CI, 0.26–0.94; p = 0.03), whereas unexpectedly increased the risk of recurrence in RFA group (n = 61, p = 0.01). Tumor-specific immune responses were significantly enhanced (both p < 0.01) in the immunotherapy group. Baseline serum interleukin (IL)-15 was statistically correlated with RFS prolongation (HR, 0.16; 95% CI, 0.03–1.58; p = 0.001) within the immunotherapy groups. Overall adverse events were more frequent in the immunotherapy group (p < 0.001) but were mainly mild to moderate in severity. In conclusion, adjuvant immunotherapy with DC vaccine reduces the risk of tumor recurrence in HCC patients who underwent standard treatment modalities other than RFA. Baseline IL-15 might be a candidate biomarker for DC-based HCC immunotherapy.

Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial.

The LUMIRA trial evaluated the effectiveness of radiofrequency (RFA) and microwave ablation (MWA) in lung tumours ablation and defining more precisely their fields of application. It is a controlled prospective multi-centre random trial with 1:1 randomization. Fifty-two patients in stage IV disease (15 females and 37 males, mean age 69 y.o., range 40-87) were included. We randomized the patients in two different subgroups: MWA group and RFA group. For each group, we evaluated the technical and clinical success, the overall survival and complication rate. Inter-group difference was compared using Chi-square test or Fisher's exact test for categorical variables and one-way ANOVA test for continuous variables. For RFA group, there was a significant reduction in tumour size only between 6 and 12months (p value=0.0014). For MWA group, there was a significant reduction in tumour size between 6 and 12months (p value=0.0003) and between pre-therapy and 12months (p value=0.0215). There were not significant differences between the two groups in terms of survival time (p value=0.883), while the pain level in MWA group was significantly less than in RFA group (1.79<3.25, p value=0.0043). In conclusion, our trial confirms RFA and MWA are both excellent choices in terms of efficacy and safety in lung tumour treatments. However, when compared to RFA therapy, MWA produced a less intraprocedural pain and a significant reduction in tumour mass.

Effect of the FXa inhibitors Rivaroxaban and Apixaban on platelet activation in patients with atrial fibrillation

Rivaroxaban and Apixaban, increasingly used for stroke prevention in non-valvular atrial fibrillation (AF), might impact platelet reactivity directly or indirectly. By inhibition of Factor Xa (FXa) they preclude not only generation of relevant thrombin amounts but also block signalling of FXa via protease activated receptors. However, weather FXa-inhibition affects platelet haemostasis remains incompletely known. One hundred and twenty-eight patients with AF on chronic anticoagulation with either Rivaroxaban or Apixaban for at least 4 weeks were included in the study. In a time course group (25 on Rivaroxaban, 13 on Apixaban) venous blood samples were taken before NOAC medication intake in the morning as well as 2 and 6h afterwards. In 90 patients (Rivaroxaban n = 73, Apixaban n = 17) blood samples were drawn during left atrial RFA procedures before as well as 10 and 60min after the first heparin application (RFA group). Platelet reactivity analyzed by whole blood aggregometry (Multiplate Analyzer, Roche) in response to ADP, Collagen, TRAP and ASPI (arachidonic acid) was not altered by Rivaroxaban or Apixaban neither in the time course nor in the RFA group. Moreover, soluble P-selectin, Thrombospondin, von Willebrand Factor and beta thromboglobulin plasma levels, measured by ELISA, showed no statistically significant changes in both clinical settings for either FXa-inhibitor. The present study fails to demonstrate any significant changes on platelet reactivity in patients with AF under chronic Rivaroxaban or Apixaban medication, neither for trough or peak levels nor in case of a haemostatic activation in vivo as depicted by RFA procedures.

Radiofrequency ablation for liver metastases in patients with gastric cancer as an alternative to hepatic resection

BackgroundThe purpose of this retrospective study was to determine whether RFA could provide an alternative treatment modality for selected patients who are not candidates for hepatic resection.MethodsA total of 18 consecutive patients with liver metastases alone from gastric cancer treated with radiofrequency ablation (RFA, n = 11) or hepatic resection (HR, n = 7) at Seoul St. Mary’s Hospital, Korea, between January 2000 and September 2014, were enrolled.ResultsThe median OS and DFS in the RFA group were 40.5 ± 22.3 and 10.3 ± 1.07 months, respectively. There was no significant difference between the RFA and HR groups in terms of baseline characteristics except for performance status. Mean survival and DFS times of all patients were 60.1 ± 9.4 and 40.9 ± 10.2 months, respectively. Mean OS times in the HR and RFA groups were 67.5 ± 15.4 and 51.1 ± 9.8 months (P = 0.671), respectively, and the mean DFS time in the HR group (74.1 ± 14.2 months) was longer than that in the RFA group (26.9 ± 9.2 months), but the difference was not significant (P = 0.076).ConclusionsIn patients who are not candidates for surgical treatment, RFA may be an alternative to HR.

Pulsed RFA of Sphenopalatine Ganglion vs. Alcohol Neurolysis for Facial Pain in Cancer-Related Pain: A Prospective Study (S802)

•Analyze the effectiveness and comparison of PRFA of Sphenopalatine ganglion and alcohol neurolysis for severe pain.•Pain Relief and Quality of life. Pain is present in up to 80% of patients with cancer of the head and neck. Pulsed radiofrequency ablation (PRFA) is relatively new use of an older procedure, conventional thermal radiofrequency. This study was designed to analyze the effectiveness and comparison of PRFA of Sphenopalatine ganglion and alcohol neurolysis for severe pain in the orofacial region in advanced head and neck cancer pain patients on oral morphine or fentanyl patch with or without adjuvant and to assess the Quality of life before and after radiofrequency ablation. 20 consecutive consenting patients of on oral morphine or fentanyl patch for cancer or cancer related pain in facial region were enrolled into the study and were divided into two equal groups of 10 patients each. One group received pulsed radiofrequency (Group P) after a positive diagnostic block and other group was given a diagnostic block followed by alcohol neurolysis (Group A). The pain intensity, percentage of pain relief, analgesic consumption, breakthrough pain, changes of any medication, side effects were recorded in each visits. Pain score (VRS) decreased in both the groups but statistically significantly in PRFA group (Group P) on 2nd day onward (1.4 vs 2.1 at 1week, 2.2 vs 2.6 at 1 month, 1.8 vs 2.8 at 3 month and 2.6 vs 3.1 at 6 month. All the patients experienced relief of pain and it was found to be statistically significant (P value<0.05). Analgesic consumption was decreased in both the groups. 2 patients in alcohol group reported burning as a side effect with 1 patient in RFA group reported increased pain for 2 days. The Karnofsky score improved from the baseline of 60 to 90 subsequently in both groups. Pulse Radio Frequency ablation and alcohol neurolysis of Sphenopalatine ganglion can be done for effective management of cancer facial pain.

Effects of Two Current Great Saphenous Vein Thermal Ablation Methods on Visual Analog Scale and Quality of Life.

Background The aim of the study is to compare the current two endovenous thermal ablation methods by examining the effects on the visual analog scale (VAS) and the short form-36® quality of life index. Methods Ninety-six patients who underwent unilateral endovenous thermal ablation of great saphenous vein were included. ClosureFast™ catheters were used in the RFA group and 1470 nm radial fiber laser catheters were used in the EVLA group. Results The RFA group consisted of 41 patients and the EVLA group consisted of 55 patients. The preoperative baseline characteristics of both groups were similar. On the day of operation, VAS values were 2.8 ± 1.1 in the RFA group and 3.6 ± 1.8 in the EVLA group (p = 0.02). Comparisons of short form-36 parameters in both groups showed them to be similar except the pain detected at postoperative 1st week (48.1 ± 5.4 for RFA, 44.9 ± 7.6 for EVLA, p = 0.04). Conclusion Results in postprocedural quality of life were found to be similar in both of the techniques. However, in terms of postoperative pain, radiofrequency ablation is still superior to the 1470 nm radial fiber laser catheters.

The safety and efficacy of low dose BCG intravesical instillation for the treatment of uremic or kidney transplant patients with recurrent urothelial carcinoma of the bladder

RFA. In this cohort, local recurrence-free survival (p 1⁄4 0.76) and metastases-free survival (p 1⁄4 0.51) were similar between PN and RFA. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival (p < 0.001 for all). In the RFA group, all patients have been biopsy before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlated to PADUA score. 13 patients were under local anesthesia, the other were under IVGA by anesthesiologist. Only one patient presented mild pneumothorax after RFA without intervention treatment. Renal function deterioration after procedure did not reveal clinical significance. Tumor recurrence was recognized by CT scan in 3 patients during followup, who repeated RFA treatment without recurrence. CONCLUSIONS: For carefully selected patients, RFA represent a less invasive alternative associated with less morbidity and fewer complications and a promising treatment compared with partial nephrectomy. However, the long-term efficacy of these approaches remains to be established.

Management of solitary recurrent HCC: Is re-resection justified for those with adverse prognostic factors?

Introduction: Post-resection recurrence for HCC is common and there is a lack of convincing evidence regarding its treatment modalities. Method: Retrospective study of 1445 HCC patients who underwent initial liver resection at Queen Mary Hospital, Hong Kong was performed. The survival after recurrence after re-resection, TACE or RFA were analyzed. Results: 351 patients (24.2%) developed solitary intrahepatic recurrence. Re-resection achieved a significant better overall survival after recurrence compared with TACE or RFA group, with 5-year survival after recurrence of 55.2%, 36.4% and 34.4% respectively (p = 0.005). For those with multifocal HCC in the primary resection, re-resection achieved a significantly better overall survival after recurrence (53.3%, 30.2% and 16.1%, p = 0.021). For recurrence within 2 years of primary resection, re-resection showed a trend of better survival compared with the RFA or TACE group with 5 year-survival after recurrence to be 48.8%, 30% and 23.5% (p = 0.095). Similar finding was also found for those who has advanced stage (UICC stage 3) in the primary resection, with 5-year overall survival after recurrence to be 50%, 23.8% and 22% (p = 0.115). By multivariate analysis, microvascular invasion (risk ratio 1.59; 95% CI 1.15–2.21; P = 0.005) and time to recurrence (risk ratio 0.98; 95% CI 0.968–0.993; P = 0.002) were identified as independent risk factors for overall survival after recurrence. Conclusion: Re-resection achieved a significantly better overall survival after solitary recurrence. For those with multifocal tumour or advanced stage in the primary resection or early recurrence, re-resection is associated with a trend of better survival compared with RFA or TACE.

"Playing Through It": Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery.

Preclinical research has demonstrated a window of vulnerability in the immediate aftermath of concussion wherein continued activity and stimulation can impair or prolong neurobehavioral recovery. However, this concept has not been quantified in a human population. To examine the effect of delayed reporting and removal from athletic activity after concussion on recovery time. Cross-sectional study. A National Collegiate Athletic Association Division I university. Ninety-seven athletes who sustained a sport-related concussion between 2008 and 2015 were analyzed (age = 20.4 ± 1.3 years). Athletes were grouped as immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA). Days missed was defined as the number of days between the concussion-causing event and clearance for return to contact. Associations between RFA group and prolonged (8 or more days') versus normal (7 or fewer days') recovery were also analyzed. Fifty (51.5%) of the 97 athletes did not immediately report concussion symptoms. The D-RFA athletes averaged 4.9 more days missed than the I-RFA athletes. Membership in the specific RFA group predicted days missed even after controlling for sex, concussion history, learning disability or attention-deficit/hyperactivity disorder diagnosis, diagnosed psychological disorder, and acute symptom severity (R( 2) change = 0.097, β = .319, P = .002). The D-RFA athletes were approximately 2.2 times more likely to have a prolonged recovery (8 or more days) compared with the I-RFA athletes (χ(2) = 10.268, P = .001, ϕ = 0.325). Athletes who do not immediately report symptoms of a concussion and continue to participate in athletic activity are at risk for longer recoveries than athletes who immediately report symptoms and are immediately removed from activity. Continuing to participate in athletic activity during the immediate aftermath of a concussion potentially exposes the already injured brain to compounded neuropathophysiologic processes.

Consolidation with external-beam radiation therapy for liver transplant waitlisted patients with hepatocellular carcinoma does not affect dropout Rate

Background: Liver transplant (LT) candidates with hepatocellular carcinoma (HCC) are treated with multimodal therapy. These bridge-to-transplant interventions include chemoembolization (TACE), ablation (RFA) and external-beam radiotherapy (XRT). We hypothesized that XRT may impact waitlist dropout, perioperative complications and/or post-transplant HCC recurrence. Methods: Retrospective analysis from 2008 to 2015 of 75 waitlisted HCC patients receiving TACE alone (group 1), TACE + RFA (group 2), or XRT + TACE (group 3), adjusted for liver disease severity. Results: 35 pts received TACE alone, 20 TACE + RFA and 20 TACE + XRT. Demographics and liver disease characteristics were matched in all groups (Table 1). Waitlist dropout was 6%, 5% and 10% in groups 1, 2 and 3, respectively (p = 0.453). The XRT group received more transfusions (PRBCs, platelets and autologous p = 0.026, 0.001, and 0.005, respectively). Crude post-transplant survival was equivalent (p = 0.785, log rank, Figure 1). Recurrence free survival from LT was similar between groups (p = 0.542). The number of embolizations predicted both time to transplant (p ≤ 0.001) and disease recurrence (p = 0.006). Intention to treat survival from initial TACE was equivalent (p = 0.707), but adjusted survival from initial TACE was associated with increased tumor size (p = 0.020). Time from treatment to transplant was not different between groups (p = 0.181). Conclusion: Consolidation XRT had equivalent waitlist dropout rates, recurrence free survival, and overall post-transplant survival. There was a significantly increased peri-transplant blood product requirement in this group, albeit, ultimate outcomes were similar in all groups. Prospective studies comparing various treatment regimens with well-defined endpoints are warranted for transplant candidates with HCC.

LB-S&T-28 GLYCINE TRANSPORTER TYPE 2 (GLYT2) INHIBITOR AMELIORATES AUTONOMIC DYSREFLEXIA DURING BLADDER HYDRODISTENTION AND DETRUSOR OVERACTIVITY IN IC/BPS RAT MODEL

RFA. In this cohort, local recurrence-free survival (p 1⁄4 0.76) and metastases-free survival (p 1⁄4 0.51) were similar between PN and RFA. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival (p < 0.001 for all). In the RFA group, all patients have been biopsy before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlated to PADUA score. 13 patients were under local anesthesia, the other were under IVGA by anesthesiologist. Only one patient presented mild pneumothorax after RFA without intervention treatment. Renal function deterioration after procedure did not reveal clinical significance. Tumor recurrence was recognized by CT scan in 3 patients during followup, who repeated RFA treatment without recurrence. CONCLUSIONS: For carefully selected patients, RFA represent a less invasive alternative associated with less morbidity and fewer complications and a promising treatment compared with partial nephrectomy. However, the long-term efficacy of these approaches remains to be established.

Efficacy for artery chemoembolization combined with radiofrequency ablation in the treatment of advanced non-small cell lung cancer

To investigate efficacy and safety of artery chemoembolization combined with radiofrequency ablation for advanced non-small cell lung cancer. A total of 138 cases of Sichuan Cancer Hospital of patients with advanced non-small cell lung cancer were retrospectively analyzed from January 2011 to November 2014.All cases were divided into three groups, 61 cases were treated by artery chemoembolization (ACB group), 43 cases were treated by artery chemoembolization combined with radiofrequency ablation (Joint group), 34 cases were treated by radiofrequency ablation (RFA group). Recent efficiency, overall survival time, adverse reactions and complications of three groups were analyzed. The risk factors related to survival time of 138 patients were analyzed. The recent efficiency of ACB group, Joint group and RFA group were 73.8%(45/61), 93.0%(40/43), 85.3%(29/34), respectively, and the difference was statistically significant (χ(2)=18.499, P=0.005). 1, 2, 3-year survival rates of Joint group were 90.7%(39/43), 58.1%(25/43), 20.9%(9/43), respectively that were better than ACB group(57.4%(35/61), 24.6%(15/61), 11.5%(7/61)) and RFA group(58.8%(20/34), 32.4%(11/34), 11.8%(4/34)), (χ(2) value were respectively 8.242 and 4.934, P values were 0.004 and 0.026). Chemotherapy side effects and complications of ablation were of no significant difference (P>0.05). Chemotherapy side effects and complications of ablation were of no significant difference (P>0.05). The number of tumors, tumor size, TNM staging, eastern cooperative oncology group (ECOG) score were independent risk factors which impact on survival time for non-small cell lung cancer. The artery chemoembolization combined with radiofrequency ablation treatment can improve survival time of patients with advanced non-small cell lung cancer. Artery chemoembolization combined with radiofrequency ablation is a safe, effective, minimally-invasive treatment for advanced non-small cell lung cancer.

Is radiofrequency ablation applicable for recurrent hepatocellular carcinoma after liver transplantation?

BackgroundRadiofrequency ablation (RFA) is a radical treatment for both primary and recurrent small hepatocellular carcinoma (HCC) with an optimistic outcome which is comparable with surgery. For localized recurrence of HCC after liver transplantation (LTx), surgical resection is considered the most favorable treatment. When surgical resection is contraindicated or technically infeasible, whether RFA is as efficient after transplantation as in nontransplant settings remains unclear. Materials and methodsA cohort study was undertaken in a population of patients that had a recurrence of HCC after LTx to evaluate the outcomes of different modalities (surgery, RFA, and conservative therapy) on long-term survival. ResultsSeventy-eight of the 486 HCC patients who received LTx had a recurrence (16%). Fifteen patients underwent surgical resection, and 11 patients were treated with RFA. The remaining 52 patients received conservative therapy (17 patients with sirolimus plus sorafenib regimen; the others were treated with conventional supportive therapy). The 1-, 3-, and 5-y overall survival rates were 92%, 51%, and 35% for the patients treated with surgery and 87%, 51%, and 28% for the patients that received RFA. The corresponding 1-, 3-, and 5-y rerecurrence-free survival rates were 83%, 16%, and 16% for the patients treated with surgery and 76%, 22%, and 0% for the patients that received RFA, respectively. There was no significant difference in overall survival or rerecurrence-free survival between the surgical resection group and the RFA group (P = 0.879, P = 0.745). ConclusionsFor HCC recurrence after LTx, RFA is preferable when surgical resection is contraindicated or technically infeasible and provides comparable long-term survival compared with surgery.

Changes in CD4 and CD8 after Interventional Management of Hepatocellular Carcinoma

Background and study aim : Hepato-cellular carcinoma (HCC) has many curative choices which in some circumstances are equal to or even better than surgery. These strategies for treatment of HCC may induce certain local effects which trigger distinct immunological responses that may have a systemic impact on the natural history of the tumour itself. These responses are validated through the measurement of specific immune cells in the systemic circulation. In this study, we tried to observe and analyze changes in the peripheral immune cells that accompany and follow HCC ablation by different procedures of radiological intervention and compare our results with literature. So, this study may be useful with other criteria in the guidelines for the selection of the optimal therapeutic strategy for each patient. . Patients and Methods: This study was conducted on about 50patients diagnosed with HCC who were referred to Tropical Medicine Department at Mansoura University Hospital, Egypt and 20 healthy volunteers as a control. The therapeutic strategy was selected according to the tumor stage and general condition. RFA was performed for12 cases, PEI for 13, MWA for12 and TACE for 13 cases. All Patients were subjected to full history taking, clinical examination, liver function tests, anti HCV antibodies and HBS antigen by 3rd generation ELISA, serum alpha fetoprotein, abdominal ultrasonography, triphasic abdominal computerized tomo-graphy and lymphocyte subset assay by flow cytometry 1 day before, and 3 weeks after the treatment. Results: Regarding the immunological status between control and HCC patients, there was a demonstrable difference in the number of cells in both groups, as the control group had higher levels of CD4+ and CD8+ values. In the RFA group, CD4+ cells and CD4/CD8 ratio remarkably increased after treatment (P <0.001), and the CD8+ cells significantly decreased (P <0.002) with concomitant increase in the CD4+/CD8+ ratio (P<0.001). In the PEI group, CD4+ cells markedly increased after treatment (P<0.001), but there were no significant differences in CD8+ cells and CD4/CD8 ratio. In the MWA group, CD4+ cells markedly increased after treatment (P<0.001), with increase in CD4/CD8 ratio (P<0.007) but there were no significant differences in CD8+ cells. In the TACE group, the CD4+ cells and CD4/CD8 ratio dramatically decreased after treatment (P<0.001), and the CD8+ cells increased significantly (P<0.001). Conclusion: Our study has proved to find a relationship between immunity and different models of therapy in HCC patients and demonstrated a positive attitude towards increasing immune cells following ablation technique.

Local Recurrence after Radiofrequency Ablation of Hepatocellular Carcinoma: Treatment Choice and Outcome

Background/aimsRadiofrequency ablation (RFA) has been proven effective for treating small hepatocellular carcinoma (HCC) nodules. However, post-RFA local recurrence is a major factor limiting prognosis. Up to now, there is no consensus on a standardized treatment strategy for these local recurrences. The aim of this study is to evaluate the outcomes of salvage treatments for RFA-related local recurrence. MethodsFrom May 2008 to June 2013, a total of 112 patients with HCC were detected with local recurrence after RFA. Among them, 94 patients received sequential treatments in our hospital, including salvage resection (SR) (n = 24), salvage liver transplantation (n = 2), repeated RFA (n = 62), and transarterial chemoembolization (TACE) (n = 6). We evaluated the treatment outcomes of patients by salvage surgery (SS), RFA, and TACE. ResultsThe median follow-up time was 32 months. After treatment, local recurrence was eradicated in 82 of 94 patients (87.2 %). The complete response (CR) rate in the RFA group was 90.3 % (56/62), while it was 100 % (26/26) in the SS group (P = 0.175) and 0 % (0/6) in the TACE group. When analysis confined to patients with CR, the 1- and 3-year disease-free survival (DFS) rates were 57.7 and 20.2 % in the SS group, and 41.7 and 28.6 % in the RFA group, respectively (P = 0.640). The 1- and 3-year overall survival (OS) rates were 93.3 and 69.1 % in the SS group, and 78.6 and 57.5 % in the RFA group, respectively (P = 0.251). ConclusionRepeated RFA is the first treatment choice for patients with post-RFA local recurrence. SS should be considered when RFA failed or is inapplicable.

Salvage treatment for local recurrence of hepatocellular carcinoma after local ablation therapy

Local recurrence of hepatocellular carcinoma (HCC) after local ablation therapy (LAT) is a serious problem; however, the optimal treatment strategy remains unclear. A retrospective analysis was conducted of 50 patients with local recurrence of HCC after LAT that underwent either salvage hepatectomy (n = 23) or radiofrequency ablation (RFA; n = 27). Their background characteristics, intraoperative data, and postoperative short- and long-term outcome were analyzed. The RFA group was found to be significantly associated with an impaired liver functional reserve, smaller number and size of tumors. The hepatectomy group showed a significantly longer operation time, greater intraoperative blood loss and more frequent red blood cell transfusion. In-hospital stay mortality and morbidity rate did not significantly differ. The disease-free and overall survival showed no significant difference between the groups. Although local recurrence after salvage treatment was found in zero (0%) for hepatectomy and in seven (25.9%) for RFA, that did not affect the overall survival. The tumor size at the prior LAT was identified as an independent prognostic factor for disease-free survival and serum albumin for overall survival. Whereas salvage hepatectomy for local recurrent HCC is recommended for selected patients in terms of its good local control effect, salvage RFA is also acceptable because it is less invasive and also has a reasonable long-term outcome.

Nationwide Study of 4741 Patients With Non-B Non-C Hepatocellular Carcinoma With Special Reference to the Therapeutic Impact

To examine the prognostic factors and outcomes after several types of treatments in patients with hepatocellular carcinoma (HCC) negative for hepatitis B surface antigen and hepatitis C antibody, so-called "non-B non-C HCC" using the data of a nationwide survey. The proportion of non-B non-C HCC is rapidly increasing in Japan. A total of 4741 patients with non-B non-C HCC, who underwent hepatic resection (HR, n = 2872), radiofrequency ablation (RFA, n = 432), and transcatheter arterial chemoembolization (TACE, n = 1437) as the initial treatment, were enrolled in this study. The exclusion criteria included extrahepatic metastases and/or Child-Pugh C. Significant prognostic variables determined by a univariate analysis were subjected to a multivariate analysis using a Cox proportional hazard regression model. The degree of liver damage in the HR group was significantly lower than that in the RFA and TACE groups. The HR and TACE groups had significantly more advanced HCC than the RFA group. The 5-year survival rates after HR, RFA, and TACE were 66%, 49%, and 32%, respectively. Stratifying the survival rates, according to the TNM stage and the Japan Integrated Staging (JIS) score, showed the HR group to have a significantly better prognosis than the RFA group in the stage II and in the JIS scores "1" and "2." The multivariate analysis showed 12 independent prognostic factors. HR offers significant prognostic advantages over TACE and RFA. The findings of this large prospective cohort study indicated that HR may be recommended, especially in patients with TNM stage II and JIS scores "1" and "2" of non-B non-C HCC.

Sono-Guided Endostripping: An Appropriate Alternative for Endovascular Varice Procedures

Objective: This article is aimed at introducing Sono-Guided Endostripping Technique of the Great Saphenous vein and comparing it with radiofrequency ablation in 104 patients. Methods: 52 patients underwent Sono-Guided Endostripping and 52 patients had radiofrequency ablation with Celon Olympus device. They were followed for 3 months with physical examination and Doppler Sonography for possible complications and recanalization. Results: Recanalization rate was 11.5% in RFAs while it was 0.0% in the Endostripping group. There were no significant differences for other complications (hematoma, DVT, paresthesia) but pain, which had 1.21 and 3.15 VAS scores for RFA and Endostripping groups, respectively. Recanalization rate was more in RFA comparing with the Endostripping group (11.5% vs. 0.0%, P < 0.013). RFA was more expensive. Conclusion: Sono-Guided Endostripping is a safe and cost-effective method (due to no need for using RFA probe); however, the patient must be admitted to the hospital and take appropriate anesthesia. Cosmetic result of the technique is fairly comparable with RFA scars in the thigh and leg.

Influence of atrial ultrastructural remodeling on its early mechanical transport following surgery for atrial fibrillation and mitral insufficiency

Methods We enrolled 32 patients operated for severe mitral regurgitation. Half of the patients had no history of AF constituting the SR group. The remaining half had concomitant RFA for longstanding persistent AF, the RFA group. Intraoperative transesophageal echocardiography was used for tissue Doppler indices (TDI) data acquisition at the left atrial (LA) lateral wall. During post-procedural data acquisition all patients were in SR. LA biopsies were obtained during surgery and quantified for fibrosis after Mallory’s trichrome staining.

Gd-EOB-DTPA-Enhanced MRI is Better than MDCT in Decision Making of Curative Treatment for Hepatocellular Carcinoma

We assessed the change in the therapeutic decision among curative treatments after adding Gd-EOB-DTPA-enhanced MRI to triple-phase MDCT for patients with early-stage HCC. This study retrospectively investigated two groups: 33 pathologically confirmed HCC patients after liver transplantation in group 1; 34 HCC patients without pathology in group 2. In group 1, we simulated the therapeutic decision-making process by pretransplant MDCT and Gd-EOB-DTPA-enhanced MRI. In group 2, including the 34 early-stage HCC patients consecutively enrolled, we investigated the change of therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT. In the simulation from group 1, after adding Gd-EOB-DTPA-enhanced MRI, 33.3% (11/33 patients) of treatment decisions were changed from the decision based on MDCT alone. Among 22 patients considered eligible for resection and 33 patients for radiofrequency ablation, the therapeutic decision was changed for 10 patients in the surgical group and 4 patients for the RFA group (45.5 and 12.1%). In group 2, the rate of change in the therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT was 41.2% (14/34 patients). In group 1 with explants pathology, the median diameter of HCCs not detected by MDCT but detected by Gd-EOB-DTPA-enhanced MRI was 1.15 cm (0.3-3.0 cm). The median diameter of HCCs seen only in the explanted liver was 1.0 cm (0.3-1.7 cm), and 60.7% of them were well-differentiated HCCs. This study suggests that performing Gd-EOB-DTPA-enhanced MRI before deciding on curative treatment for early-stage HCC may improve the accuracy of treatment decision for early-stage HCC.