Iodized oil computed tomography versus ultrasound-guided radiofrequency ablation for early hepatocellular carcinoma

Wu, Cho‐Kai; Liang, Po-Chin; Su, Tung-Hung; Lin, Ming-Chi; Chang, Yu‐Ping; Shih, Tiffany Ting-Fang; Kao, Jia‐Horng

doi:10.1007/s12072-021-10236-0

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…Refer to Figure 1 for experimental procedures. For each patient, CT-guided RFA using iodized oil (Lipiodol, Andre Guerbet, Aulnay-sous-Bois, France) was performed as described in the previous study (24). The tumor size was measured firstly.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound single-phase CBE imaging for monitoring radiofrequency ablation of the liver tumor: A preliminary clinical validation

Wang

Zhou²,

Chang³

et al. 2022

Front. Oncol.

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Radiofrequency ablation (RFA) is an alternative treatment for early-stage hepatocellular carcinoma (HCC). The production of gas bubbles by RFA indicates threshold temperature of tissue necrosis and results in changes in backscattered energy (CBE) when ultrasound monitors RFA. In this study, ultrasound single-phase CBE imaging was used as a means of monitoring RFA of the liver tumor by analyzing the backscattering of ultrasound from gas bubbles in the liver. A total of 19 HCC patients were enrolled in the study. An ultrasound system was used during RFA to monitor the ablation process and acquire raw image data consisting of backscattered signals for single-phase CBE imaging. On the basis of single-phase CBE imaging, the area corresponding to the range of gas bubbles was compared with the tumor sizes and ablation zones estimated from computed tomography. During RFA, ultrasound single-phase CBE imaging enabled improved visualization of gas bubbles. Measured gas bubble areas by CBE were related to tumor size (the Spearman correlation coefficient rs = 0.86; p < 0.05); less dependent on the ablation zone. Approximately 95% of the data fell within the limits of agreement in Bland-Altman plots, and 58% of the data fell within the 95% CI. This study suggests that single-phase CBE imaging provides information about liver tumor size because of the abundant vessels in liver tumors that promote the generation of gas bubbles, which serve as natural contrast agents in RFAs to enhance ultrasound backscattering. Ultrasound single-phase CBE imaging may allow clinicians to determine if the required minimum RFA efficacy level is reached by assessing gas bubbles in the liver tumors.

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Section: Methodsmentioning

confidence: 99%

Ultrasound single-phase CBE imaging for monitoring radiofrequency ablation of the liver tumor: A preliminary clinical validation

Wang

Zhou²,

Chang³

et al. 2022

Front. Oncol.

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“…48 Wu et al reported that CT-guided RFA after intra-arterial iodized oil injection may achieve more prolonged recurrence-free survival than ultrasound-guidance, and that it is more suitable in this clinical context. 49 TACE has served as a first-line treatment for intermediate to advanced HCC for over a decade. 40 Other intra-arterial therapies, such as drug-eluting beads (DEBs), radioembolization, and HAIC, are available in Taiwan.…”

Section: Radiofrequency Ablation Transarterial Chemoembolization and ...mentioning

confidence: 99%

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Taiwan perspective

Su¹,

Wu²,

Liu³

et al. 2023

Clin Mol Hepatol

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Hepatocellular carcinoma (HCC) is the fourth most common cancer and the second leading cause of cancer-related death in Taiwan. The Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan developed and updated the guidelines for HCC management in 2020. In clinical practice, we follow these guidelines and the reimbursement policy of the government. Abdominal ultrasonography, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II (PIVKA-II) tests are performed for HCC surveillance every 6 months, which may be shortened to 3 months for highrisk patients. Dynamic computed tomography, magnetic resonance imaging, and contrast-enhanced ultrasound can be recommended for HCC surveillance in patients with extremely high-risk or poor ultrasonographic visualization results. HCC is usually diagnosed through dynamic imaging, and pathological diagnosis is recommended. The staging of HCC is based on a modified version of the Barcelona Clinic Liver Cancer (BCLC) system, and the HCC management guidelines in Taiwan actively promote curative treatments, including surgery and locoregional therapy for BCLC-B-C patients. Su et al. 4 Transarterial chemoembolization (TACE), drug-eluting bead TACE, radioembolization, and hepatic artery infusion chemotherapy may be administered for patients with BCLC-B-C HCC. Sorafenib and lenvatinib are reimbursed as systemic therapies, and regorafenib and ramucirumab can be reimbursed in cases of sorafenib failure. First-line atezolizumab with bevacizumab are not yet reimbursed but may be administered in clinical practice. Chemotherapy and external beam radiation therapy may be used in specific patients. Early switching to systemic therapy in TACE-refractory patients is a recent paradigm shift in HCC management.

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“…43,44 Iodised oil computed tomography-guided RFA has been shown to provide better tumour control than ultrasound-guided RFA for HCC within Milan criteria. 45 New-generation microwave ablation (MWA) creates larger and more predictable ablation zones more rapidly compared to monopolar RFA. A randomised controlled trial comparing MWA and bipolar RFA in oligonodular HCC ≤5 cm showed that MWA needed fewer ablation durations and applicator punctures than RFA.…”

Section: Key Pointsmentioning

confidence: 99%

“…RFA with multiple applicators extends the ablation zone and provides better tumour control than a single applicator 43,44 . Iodised oil computed tomography‐guided RFA has been shown to provide better tumour control than ultrasound‐guided RFA for HCC within Milan criteria 45 . New‐generation microwave ablation (MWA) creates larger and more predictable ablation zones more rapidly compared to monopolar RFA.…”

Section: Paradigm Shift In Surgery and Locoregional Therapymentioning

confidence: 99%

Paradigm shift in the treatment options of hepatocellular carcinoma

Hsu

Kao

2021

Liver International

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Hepatocellular carcinoma (HCC) is prevalent worldwide with suboptimal therapeutic outcomes. The advancement of therapeutic options and the development of new systemic therapies expand the armamentarium to tackle HCC. Treatment options should be provided based on the hierarchy of efficacy in a multidisciplinary perspective, instead of the traditional stage-guided scheme. In advanced HCC, lenvatinib has a comparable efficacy as sorafenib for the first-line therapy of HCC; while regorafenib, cabozantinib, and ramucirumab have been approved as second-line therapy after the failure of sorafenib. Immune checkpoint inhibitor therapy prolongs response rate and survival and enables long-term cure. Atezolizumab plus bevacizumab is superior to sorafenib as the first-line therapy for advanced HCC. Several emerging regimens by the combination of various systemic therapies are currently under clinical trials. Systemic therapy may be used in the neoadjuvant, adjuvant or even as initial therapy for intermediate-stage HCC. The paradigm shift of HCC treatment will improve patient outcomes.

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Iodized oil computed tomography versus ultrasound-guided radiofrequency ablation for early hepatocellular carcinoma

Cited by 8 publications

References 25 publications

Ultrasound single-phase CBE imaging for monitoring radiofrequency ablation of the liver tumor: A preliminary clinical validation

Ultrasound single-phase CBE imaging for monitoring radiofrequency ablation of the liver tumor: A preliminary clinical validation

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Taiwan perspective

Paradigm shift in the treatment options of hepatocellular carcinoma

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