Ablation plus Transarterial Embolic Therapy for Hepatocellular Carcinoma Larger than 3 cm: Science, Evidence, and Future Directions

Lewis, Armand F.; Padula, Carlos A.; McKinney, J. Mark; Toskich, Beau B.

doi:10.1055/s-0039-1697641

Cited by 6 publications

(11 citation statements)

References 68 publications

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“…This technical development may provide a unique strategy to eliminate the tumor cells at or near the surgical margins of ablated tumors, which are difficult to treat in medium and large-sized tumors by current thermal ablation techniques ( 34 ). To ensure full chemotherapeutic coverage of the tumor margins, doxorubicin was infused at the distal, central and proximal portions of the tumor using the same thermal electrode under ultrasound imaging guidance.…”

Section: Discussionmentioning

confidence: 99%

Image-Guided Peri-Tumoral Radiofrequency Hyperthermia-Enhanced Direct Chemo-Destruction of Hepatic Tumor Margins

et al. 2021

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PurposeTo validate the feasibility of using peri-tumoral radiofrequency hyperthermia (RFH)-enhanced chemotherapy to obliterate hepatic tumor margins.Method and MaterialsThis study included in vitro experiments with VX2 tumor cells and in vivo validation experiments using rabbit models of liver VX2 tumors. Both in vitro and in vivo experiments received different treatments in four groups (n=6/group): (i) RFH-enhanced chemotherapy consisting of peri-tumoral injection of doxorubicin plus RFH at 42°C; (ii) RFH alone; (iii) doxorubicin alone; and (iv) saline. Therapeutic effect on cells was evaluated using different laboratory examinations. For in vivo experiments, orthotopic hepatic VX2 tumors in 24 rabbits were treated by using a multipolar radiofrequency ablation electrode, enabling simultaneous delivery of both doxorubicin and RFH within the tumor margins. Ultrasound imaging was used to follow tumor growth overtime, correlated with subsequent histopathological analysis.ResultsIn in vitro experiments, MTS assay demonstrated the lowest cell proliferation, and apoptosis analysis showed the highest apoptotic index with RFH-enhanced chemotherapy, compared with the other three groups (p<0.01). In in vivo experiments, ultrasound imaging detected the smallest relative tumor volume with RFH-enhanced chemotherapy (p<0.01). The TUNEL assay further confirmed the significantly increased apoptotic index and decreased cell proliferation in the RFH-enhanced therapy group (p<0.01).ConclusionThis study demonstrates that peri-tumoral RFH can specifically enhance the destruction of tumor margins in combination with peri-tumoral injection of a chemotherapeutic agent. This new interventional oncology technique may address the critical clinical problem of frequent marginal tumor recurrence/persistence following thermal ablation of large (>3 cm) hepatic cancers.

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Section: Discussionmentioning

confidence: 99%

Image-Guided Peri-Tumoral Radiofrequency Hyperthermia-Enhanced Direct Chemo-Destruction of Hepatic Tumor Margins

et al. 2021

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“…TACE combined with other local therapies: In a RCT comparing CA + drug-eluting bead (DEB)-TACE to CA monotherapy in large tumors (mean: 7.2 ± 4.5 cm and 6.5 ± 3.8 cm, respectively), the combination group demonstrated superior OS [16.8 mo vs 13.4 mo, respectively ( P = 0.0493)] and significantly increased PFS [8.1 mo vs 6.0 mo, respectively ( P = 0.0089)]. Interstitial laser therapy (ILT) uses optical fibers to create cytotoxic temperatures via the conversion of absorbed infrared light to heat with consequent coagulative necrosis[ 68 ]. TACE followed by ILT was used in patients with tumors up to 8 cm that has obtained a median OS of 36 mo (95%CI: 29.3–42.6)[ 69 ].…”

Section: Combined Treatment To Facilitate Curementioning

confidence: 99%

“…Stereotactic body radiation therapy (SBRT) can provide satisfactory local control with a low incidence of radiation-induced liver disease in patients with unresectable HCC that are not amenable to thermal ablation[ 68 ]. Via radiosensitization of tissue TACE/TAE may serve as targeting fiducials for SBRT.…”

Section: Combined Treatment To Facilitate Curementioning

confidence: 99%

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Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

Spârchez¹,

Radu²,

Bartoș³

et al. 2021

WJGO

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The time for battling cancer has never been more suitable than nowadays and fortunately against hepatocellular carcinoma (HCC) we do have a far-reaching arsenal. Moreover, because liver cancer comprises a plethora of stages-from very early to advanced disease and with many treatment options–from surgery to immunotherapy trials–it leaves the clinician a wide range of options. The scope of our review is to throw light on combination treatments that seem to be beyond guidelines and to highlight these using evidence-based analysis of the most frequently used combination therapies, discussing their advantages and flaws in comparison to the current standard of care. One particular combination therapy seems to be in the forefront: Transarterial chemoembolization plus ablation for medium-size non-resectable HCC (3-5 cm), which is currently at the frontier between Barcelona Clinic Liver Cancer classification A and B. Not only does it improve the outcome in contrast to each individual therapy, but it also seems to have similar results to surgery. Also, the abundance of immune checkpoint inhibitors that have appeared lately in clinical trials are bringing promising results against HCC. Although the path of combination therapies in HCC is still filled with uncertainty and caveats, in the following years the hepatology and oncology fields could witness an HCC guideline revolution.

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“…Several methods with RFA for tumors lying near critical organs or vessels have recently been reported that achieve complete ablation and reduce complications [5][6][7]. Hence, this review article provides technical tips on how to enhance therapeutic effects and avoid complications due to RFA for liver tumors.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Radiofrequency Ablation for Liver Tumors: Technical Tips

Sato

Hasegawa

Chatani

et al. 2020

Interventional Radiology

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Percutaneous radiofrequency ablation (RFA) has been accepted as a minimally invasive therapeutic treatment for liver malignancies. Although RFA is usually applied for the treatment of small liver tumors (<3 cm), several technical developments have expanded the use of RFA. RFA is now used for the treatment of large liver tumors, and the number of complications associated with this treatment has decreased. These refinements may ultimately lead to better long-term prognosis. Here, we review recent refinements of liver RFA and provide technical tips.

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Ablation plus Transarterial Embolic Therapy for Hepatocellular Carcinoma Larger than 3 cm: Science, Evidence, and Future Directions

Cited by 6 publications

References 68 publications

Image-Guided Peri-Tumoral Radiofrequency Hyperthermia-Enhanced Direct Chemo-Destruction of Hepatic Tumor Margins

Image-Guided Peri-Tumoral Radiofrequency Hyperthermia-Enhanced Direct Chemo-Destruction of Hepatic Tumor Margins

Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

Percutaneous Radiofrequency Ablation for Liver Tumors: Technical Tips

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