Radiofrequency ablation using a 10‐mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: A prospective randomized trial

Liao, Mingheng; Zhong, Xiaofei; Zhang, Jingyi; Liu, Yangyang; Zhu, Zexin; Wu, Hong; Zeng, Yong; Huang, Jiwei

doi:10.1002/jso.24607

Cited by 38 publications

(30 citation statements)

References 40 publications

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“…According to a study by Kim et al ( 10 ), a margin of 3 mm or more was associated with a lower rate of LTP after RFA of HCC. However, according to a recent prospective study, RFA treatment targeting 10 mm margins for a small solitary HCC (< 3 cm) may reduce the risk of tumor recurrence in cirrhotic patients with a single, small HCC ( 35 ). In our study, the estimated cumulative incidence of LTP was 27.0% at 5-year follow-up in the group with sufficient ablative margins (> 3 mm) in registration software assessment.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Local Tumor Progression after Radiofrequency Ablation (RFA) of Hepatocellular Carcinoma by Assessment of Ablative Margin Using Pre-RFA MRI and Post-RFA CT Registration

et al. 2018

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ObjectiveTo evaluate the clinical impact of using registration software for ablative margin assessment on pre-radiofrequency ablation (RFA) magnetic resonance imaging (MRI) and post-RFA computed tomography (CT) compared with the conventional side-by-side MR-CT visual comparison.Materials and MethodsIn this Institutional Review Board-approved prospective study, 68 patients with 88 hepatocellulcar carcinomas (HCCs) who had undergone pre-RFA MRI were enrolled. Informed consent was obtained from all patients. Pre-RFA MRI and post-RFA CT images were analyzed to evaluate the presence of a sufficient safety margin (≥ 3 mm) in two separate sessions using either side-by-side visual comparison or non-rigid registration software. Patients with an insufficient ablative margin on either one or both methods underwent additional treatment depending on the technical feasibility and patient's condition. Then, ablative margins were re-assessed using both methods. Local tumor progression (LTP) rates were compared between the sufficient and insufficient margin groups in each method.ResultsThe two methods showed 14.8% (13/88) discordance in estimating sufficient ablative margins. On registration software-assisted inspection, patients with insufficient ablative margins showed a significantly higher 5-year LTP rate than those with sufficient ablative margins (66.7% vs. 27.0%, p = 0.004). However, classification by visual inspection alone did not reveal a significant difference in 5-year LTP between the two groups (28.6% vs. 30.5%, p = 0.79).ConclusionRegistration software provided better ablative margin assessment than did visual inspection in patients with HCCs who had undergone pre-RFA MRI and post-RFA CT for prediction of LTP after RFA and may provide more precise risk stratification of those who are treated with RFA.

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Section: Discussionmentioning

confidence: 99%

Prediction of Local Tumor Progression after Radiofrequency Ablation (RFA) of Hepatocellular Carcinoma by Assessment of Ablative Margin Using Pre-RFA MRI and Post-RFA CT Registration

et al. 2018

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“…During a laparoscopic thermoablation treatment, laparoscopic IOUS permits to identify MI‐HCC tumours: in these cases, a microwave ablation instead of RFA could lead to a further clearance of possible residues of vascular microinfiltration and satellite micronodules by ablating more viable tumour containing liver parenchyma and decrease probability of metastasis of the residual tumour cell by intrahepatic portal vein …”

Section: Discussionmentioning

confidence: 99%

Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

Santambrogio¹,

Claudia

Barabino³

et al. 2017

Liver International

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Background & Aims Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. The aim of this study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histological features of the primary resected tumour. Methods All patients with single, small hepatocellular carcinoma that underwent hepatic resection were included in this prospective double‐blind study: the intraoperative ultrasound patterns of nodule were registered and compared with similar histological features. Results A total of 179 patients were enclosed in this study: 97 (54%) patients (34% in HCC ≤2 cm) had a microinvasive hepatocellular carcinoma at ultrasound examination, while 82 (46%) patients (41% in HCC ≤2 cm) at histological evaluation. Statistical analysis showed that diameters ≤2 cm, presence of satellites and microinvasive hepatocellular carcinoma at ultrasound examination were the variables with the strongest association with the histological findings. In the multivariate analysis, the vascular microinfiltration and infiltrative hepatocellular carcinoma aspect were independent predictors for grading. Conclusions In patients with cirrhosis and hepatocellular carcinoma, the prevalence of microinvasive hepatocellular carcinoma is high, even in cases of HCC ≤2 cm. Intraoperative ultrasound findings strongly correlated with histopathological criteria in detecting microinvasive patterns and are useful to predict neoplastic differentiation. The knowledge of these features prior to treatment are highly desired (this can be obtained by an intraoperative ultrasound examination), as they could help in providing optimal management of patients with hepatocellular carcinoma.

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“…Liao et al conducted an RCT to compare the outcomes following a wide margin (ablative margin ≥10 mm) and narrow margin (ablative margin, 5-10 mm). 21 Patients with solitary HCC less than 3 cm were randomized to receive a wide margin (n = 48) or narrow margin ablation (n = 48). Forty patients in the former group achieved the target of ≥10 mm ablative margin.…”

Section: Evidence and Rationalementioning

confidence: 99%

Indian Society of Vascular and Interventional Radiology Expert Consensus Statements for Ablation in Hepatocellular Carcinoma: Part I

Gupta

Kalra

Keshava

et al. 2020

Journal of Clinical Interventional Radiology ISVIR

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Locoregional therapies play an important role in the management of hepatocellular carcinoma (HCC). Percutaneous ablation is one of the most commonly employed nonsurgical methods for treating very early and early HCC. For small HCCs, ablation is potentially curative and competes with surgical resection. The widespread availability and the spectrum of ablative techniques mandate uniform approach among interventional radiologists. Thus, it is desirable to have a consensus regarding various aspects of liver ablation. This article represents a consensus document of the experts from the Indian Society of Vascular and Interventional Radiology involved in the care of patients with HCC. The statements are presented in two parts.

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Radiofrequency ablation using a 10‐mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: A prospective randomized trial

Abstract: RFA treatment targeting 10-mm margin may reduce the risk of tumor recurrence in cirrhotic patients with a single small HCC.

Cited by 38 publications

References 40 publications

Prediction of Local Tumor Progression after Radiofrequency Ablation (RFA) of Hepatocellular Carcinoma by Assessment of Ablative Margin Using Pre-RFA MRI and Post-RFA CT Registration

Prediction of Local Tumor Progression after Radiofrequency Ablation (RFA) of Hepatocellular Carcinoma by Assessment of Ablative Margin Using Pre-RFA MRI and Post-RFA CT Registration

Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

Indian Society of Vascular and Interventional Radiology Expert Consensus Statements for Ablation in Hepatocellular Carcinoma: Part I

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