Percutaneous Sonographically Guided Radiofrequency Ablation with Artificial Pleural Effusion for Hepatocellular Carcinoma Located Under the Diaphragm

Koda, Masahiko; Ueki, Minoru; Maeda, Yoshiko; Mimura, K.; Okamoto, Kinya; Matsunaga, Yoshiko; Kawakami, Manri; Hosho, Keiko; Murawaki, Yoshikazu

doi:10.2214/ajr.183.3.1830583

Cited by 101 publications

(58 citation statements)

References 9 publications

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“…The artificial pleural effusion technique, which is easier to perform than the artificial ascites technique, is used in numerous institutions to prevent lung obstruction and avoid complications (27,28).…”

Section: Discussionmentioning

confidence: 99%

Effect of treatment support on preventing local recurrence of hepatocellular carcinoma directly adjacent to the diaphragm

Ishikawa

Imai

et al. 2017

Molecular and Clinical Oncology

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Abstract. Treatment support is anticipated to improve the results of radiofrequency ablation (RFA) treatment in cases in which visualization of tumors using the conventional B-mode is unclear. In the present study, the effectiveness of treatment support for RFA reducing the local recurrence rate of hepatocellular carcinoma (HCC) that are located directly adjacent to the diaphragm, and which are difficult to visualize with B-mode ultrasound imaging, was investigated. A total of 103 HCC tumors measuring <5 cm, which were located abutting the diaphragm, and which were difficult to visualize using the B-mode, were treated using RFA. Thirty-three of those HCC tumors were treated using RFA without treatment support, whereas the remaining 70 HCC tumors were treated using RFA with treatment support, including artificial pleural effusion, contrast-enhanced ultrasonography (CEUS) with the contrasting agent, Sonazoid™, and fusion imaging, either alone or in combination to improve the visualization of the tumors. The rate of local recurrence, and factors affecting local recurrence, were analyzed. Local recurrences were confirmed in 17 of the 103 nodules (16.50%). The overall rate of local recurrence was 13.1% at 6 months, and 20.2% at 12 months. The rate of local recurrence using RFA with artificial pleural effusion was significantly lower compared with those cases of HCC tumors treated without artificial pleural effusion (P=0.008). Similarly, the rate of local recurrence for CEUS RFA with Sonazoid™ was significantly lower compared with those cases of HCC tumors treated without Sonazoid™ (P=0.00081). In a multivariate analysis, CEUS RFA with Sonazoid™ and artificial pleural effusion contributed to the decrease in the rate of local recurrence (hazard ratios, 0.075 and 0.143, respectively). Based on these results, it is possible to conclude that CEUS with Sonazoid™ as a treatment support was the most effective method for reducing the rate of local recurrences abutting the diaphragm that are difficult to visualize using B-mode ultrasonography. IntroductionHepatocellular carcinoma (HCC) is the fifth most common cancer in men, and the seventh most common cancer in women worldwide, and it is the most common cause of cancer-associated mortality (1). Radiofrequency ablation (RFA) was first described by Rossi et al (2) as a local thermal ablation therapy for HCC. It has been endorsed as a curative treatment modality by several clinical management guidelines for early-stage, unresectable HCC (3-9). However, to further improve the treatment outcomes of RFA for HCC, it is important to accurately identify the position of tumors on performing ultrasonography. Even in cases for which the visualization of tumors is difficult with the conventional B-mode ultrasound imaging, performing RFA using treatment support such as artificial pleural effusion, fusion imaging, and contrast-enhanced ultrasound with Sonazoid™ (Perflubutane; Daiichi Sankyo Co., Ltd., Tokyo, Japan), is expected to improve treatment outcomes in clinical settings (10).The aim...

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Section: Discussionmentioning

confidence: 99%

Effect of treatment support on preventing local recurrence of hepatocellular carcinoma directly adjacent to the diaphragm

Ishikawa

Imai

et al. 2017

Molecular and Clinical Oncology

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“…The route was selected so as not to injure the lung, gastrointestinal tract, gall bladder, portal vein, IVC, and bile duct. When the targeted nodule was close to the diaphragm, we used an artificial pleural effusion method with 5% glucose to separate the lung, 32 when it was close to the gastrointestinal tract, we infused 5% glucose (250-3000 mL) as an artificial ascites into the abdominal cavity to separate the gastrointestinal tract to Before ablation, a fluid space using 5% glucose was prepared to function as an insulator between the nodule and the stomach. Energy was applied for 6 minutes by an electrode with a 2-cm tip.…”

Section: Methodsmentioning

confidence: 99%

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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“…Fluid can be put into the pleural space to visualization of peridiaphragmatic hepatic tumors. 17,18 This method have risk of respiratory compromise which may be already co-morbidity with liver cancer. and unable to separate the diaphragm from the liver.…”

Section: Resultsmentioning

confidence: 99%

Artificial Ascites in Radiofrequency Ablation for Liver Cancer

Gani¹

2020

InaJGHE

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Percutaneous Sonographically Guided Radiofrequency Ablation with Artificial Pleural Effusion for Hepatocellular Carcinoma Located Under the Diaphragm

Abstract: Radiofrequency ablation with artificial pleural effusion is a safe and beneficial treatment option that offers excellent local control through visualization of hepato-cellular carcinomas under the diaphragm.

Cited by 101 publications

References 9 publications

Effect of treatment support on preventing local recurrence of hepatocellular carcinoma directly adjacent to the diaphragm

Effect of treatment support on preventing local recurrence of hepatocellular carcinoma directly adjacent to the diaphragm

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

Artificial Ascites in Radiofrequency Ablation for Liver Cancer

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