Hepatocellular Carcinoma: Radio-frequency Ablation of Medium and Large Lesions

Livraghi, Tito; Goldberg, S. Nahum; Lazzaroni, Sergio; Meloni, Franca; Ierace, Tiziana; Solbiati, Luigi; Gazelle, G. Scott

doi:10.1148/radiology.214.3.r00mr02761

Cited by 940 publications

(632 citation statements)

References 19 publications

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“…Complete ablation was achieved in 229 of 231 nodules in high-risk locations and all of the 1,188 nodules found elsewhere. The treatment success rate, higher than those reported by others, 16,34,35 was probably the result of our accumulated experience in percutaneous ablation procedures with ethanol, microwave, and RF, amounting to a total of 4,000 cases. 33 We have perfected techniques for inserting an electrode into tumors almost anywhere in the liver without puncturing large vessels or bile ducts by, for example, changing the patient's position and selecting the insertion site.…”

Section: Discussionmentioning

confidence: 58%

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

et al. 2006

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We evaluated the efficacy and safety of radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) in presumably high-risk locations. Between February 1999 and December 2001, we performed RF ablation on 1,419 nodules in 636 consecutive HCC patients, of which 231 nodules in 207 patients were in high-risk locations, defined as less than 5 mm from a large vessel or an extrahepatic organ. Eighty-one patients had a nodule adjacent to a large vessel, 145 patients had a nodule adjacent to an extrahepatic organ, of whom 19 also had one adjacent to a large vessel. Early complications and local tumor progression were analyzed with regard to the location of each nodule. The mean nodule diameter and average number per patient were 27 mm and 2.3, respectively. Early complications, within 30 days after ablation, occurred in 12 of 207 patients (5.8 %) with a nodule in a high-risk location and in 15 of 429 patients (3.5 %) without (P ‫؍‬ .1776). There was no significant difference in local tumor progression rate between nodules in high-risk locations (1 year: 2.1%, 2 years: 3.1%, 3 years: 3.1%) and those elsewhere (1 year: 0.6%, 2 years: 1.7%, 3 years: 2.5%) (P ‫؍‬ .2745). In conclusion, HCC nodules adjacent to a large vessel or extrahepatic organ were treated with RF ablation without compromising the efficacy of the procedure. However, even though without significant difference, some complications occurred at risky locations and need to be carefully considered.

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Section: Discussionmentioning

confidence: 58%

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

et al. 2006

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“…Predictability of radiofrequency ablation-induced thermal lesions is somewhat variable, dependent on ablation system, operator, and dielectric properties of the tissues. The insulating nature of cirrhotic livers, commonly referred to as the "oven effect," has been shown to protect adjacent organs while promoting a more concentrated sphere of thermally induced tissue destruction [10]. In this case, a tumor in direct contact with the gallbladder was ablated without subsequent cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation Treatment in Proximity to the Gallbladder Without Subsequent Acute Cholecystitis

Patti

Neeman

Wood

2003

CardioVascular and Interventional Radiology

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Initial reports have suggested that proximity of liver tumors to the gallbladder may increase the risk for cholecystitis after radiofrequency ablation. A colon adenocarcinoma metastasis to the liver in contact with the gallbladder was successfully treated with radiofrequency ablation without subsequent cholecystitis. KeywordsCholecystitis; Radiofrequency ablation; RFA; Gallbladder; Liver Radiofrequency ablation is quickly becoming a valuable option in the treatment of certain unresectable liver tumors. Recent studies have shown the cost effectiveness [1], relatively low complication rates [2] and short hospital stays associated with thermal ablation. Early results suggest a high rate of local control of small or isolated liver lesions [3,4]. Local application of radiofrequency to tissue can create a controlled and predictable area of coagulation necrosis with little collateral damage. Currently, pre-procedural imaging studies are used to determine the spatial relationship of the tumor to organs such as gallbladder, diaphragm, major vessels and bowel. Proximity of tumor to adjacent structures often influences the treatment plan. Although no controlled clinical studies have directly assessed the risk of cholecystitis after ablations adjacent to the gallbladder, reports of post-ablative cholecystitis have been influential in planning the treatment of liver tumors [3,4]. Some have noted that when treating tumors adjacent to the gallbladder and bowel, an open or laparoscopic technique provides the ability to mobilize adjacent vital structures away from the treatment area, thus decreasing the risk [4][5][6]. A more recent report by Chopra et al. [5], demonstrated in 8 patients who were followed for a mean of 8 months, that radiofrequency ablation near the gallbladder is feasible and appears to be safe. Case ReportA 58-year-old man with a history of T3N1M1 adenocarcinoma of the colon presented with metastases to the liver 10 months after diagnosis and subsequent right hemicolectomy. Surgical history included a left thoracotomy for the repair of a hiatal hernia and duodenal ulcer 33 years prior to admission. The patient had no history of liver disease or alcoholism. MRI and CT of the liver revealed a small (1 cm) hypervascular enhancing lesion adjacent to the gallbladder within the right lobe of the liver (Fig. 1) and a smaller (>1 cm) lesion in the posterior aspect of the right lobe of the liver.

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“…Therefore, a variety of imaging-guided tumor ablation therapies such as ethanol injection, microwave coagulation, percutaneous radiofrequency ablation (RFA) and laser ablation are often considered as alternative options [3][4][5][6] . Among them, RFA has been used increasingly as a safe technique for treating hepatic tumors [7][8][9] . However, for hypervascular HCC, RFA appears less effective because of a blood-flow-induced heat sink effect, which might cause incomplete ablation or recurrence [10] .…”

Section: Introductionmentioning

confidence: 99%

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

Hou¹,

Chen²,

Yan³

et al. 2009

WJG

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AIM:To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA. METHODS:A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 ± 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 ± 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo. RESULTS:In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04).CONCLUSION: PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC. INTRODUCTIONHepatocellular carcinoma (HCC) is the fifth most common cancer in the world (564 000 cases per year) and the third most frequent cause of cancer-related death [1] . Surgical resection is considered to be potentially curative therapy. However, only about 20% of HCC patients are eligible for resection [1,2] ; the remainder are ineligible because of multifocal tumors, advanced tumors, tumor location precluding complete resection, or poor hepatic functional reserve. Therefore, a variety of imaging-guided tumor ablation therapies such as ethanol injection, microwave coagulation, percutaneous radiofrequency ablation (RFA) and laser ablation are often considered as alternative options [3][4][5][6] . Among them, RFA has been used increasingly as a safe technique for treating hepatic tumors [7][8][9] . However, for hypervascular HCC, RFA appears less effective because of a blood-flow-induced heat sink effect, which might BRIEF ARTICLESwww.wjgnet.com cause incomplete ablation or recurrence [10] . Transcatheter arterial chemoembolization (TACE) can reduce blood supply of HCC by occlusion of tumor arteries, and the efficacy of combination TACE and RFA has been confirmed [11,12] . Treatment difficulty remains for those patients who cannot tolerate or are ineligible for TACE because of liver cirrhosis or difficulty in manipulation of vessels with abnormal curvature that have resulted from surgical resection and liver ...

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Hepatocellular Carcinoma: Radio-frequency Ablation of Medium and Large Lesions

Abstract: RF ablation appears to be an effective, safe, and relatively simple procedure for the treatment of medium and large HCCs.

Cited by 940 publications

References 19 publications

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

Radiofrequency Ablation Treatment in Proximity to the Gallbladder Without Subsequent Acute Cholecystitis

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

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