Comparison between combination therapy of percutaneous ethanol injection and radiofrequency ablation and radiofrequency ablation alone for patients with hepatocellular carcinoma

Abstract

These results suggest that, compared to RFA alone, PEI-RFA enables to induce comparable coagulated necrosis with smaller energy requirement, and that PEI-RFA is likely to be less invasive than RFA alone irrespective of inducing enhanced coagulated necrosis. Thus, simple prior injection of ethanol may make RFA treatment more effective and less invasive for the treatment of patients with HCC.

Thoracoscopic ethanol injection and radiofrequency ablation for the treatment of hepatocellular carcinoma located immediately under the diaphragm

“…As one of the optional combination therapies, we have shown that injection of ethanol prior to RFA (PEI-RFA) markedly enlarged the induced coagulated necrosis in human (20,21) and in bovine livers (33). Furthermore, we showed that PEI-RFA is a less invasive treatment modality from the standpoint of energy requirement for inducing coagulated necrosis (24). In the present study, we thoracoscopically applied this combination therapy for the treatment of HCC located immediately under the diaphragm.…”

“…However, several limitations of RFA have been pointed out, such as limited coagulated necrosis and relatively frequent local tumor recurrences. To overcome these weaknesses, we have developed a novel combination therapy of percutaneous ethanol injection (PEI) and RFA and showed that combined use of PEI prior to RFA was able to enhance the therapeutic effect with smaller energy requirement compared with RFA alone (20)(21)(22)(23)(24). Although PEI-RFA was shown to enlarge the area of coagulated necrosis, there are cases with HCC that are difficult to treat with a percutaneous approach due to the location of HCC.…”

A combination therapy of ethanol injection and radiofrequency ablation under general anesthesia for the treatment of hepatocellular carcinoma

“…We previously showed that the amount of ethanol was positively correlated with the volume of coagulated necrosis in patients treated with P-EI-RFA using an RFA instrument equipped with a straight electrode (Cool-tip RF system) [19] . In the present study, the relationship between the amount of ethanol or applied energy and the volume of induced coagulated necrosis were evaluated in patients treated with EI-RFA under general anesthesia.…”

“…After visualizing the tumor by US, an RFA electrode was inserted into the tumor through the channel along the End-fire laparoscopic probe. A 21-gauge PEI needle was inserted and pure ethanol or lipiodol containing ethanol was injected [19] .…”

“…However, in contrast to its efficacy, several disadvantages have been pointed out, such as the limited coagulated necrosis induced by RFA and frequent local tumor recurrences [13,14] . To overcome these weaknesses, we have developed a novel combination therapy of percutaneous ethanol injection and radiofrequency ablation (PEI-RFA) and showed that combined use of ethanol prior to RFA was able to enhance the therapeutic effects with a smaller energy requirement compared with RFA alone [15][16][17][18][19][20] . Although PEI-RFA was shown to enlarge the area of coagulated necrosis, there are HCC cases that are difficult to treat with percutaneous RFA due to the location of the HCC.…”