Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC)

Veltri, Andrea; Moretto, Paolo; Doriguzzi, Andrea; Pagano, Eva; Carrara, Giovanna; Gandini, Giovanni

doi:10.1007/s00330-005-0029-9

Cited by 206 publications

(126 citation statements)

References 39 publications

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“…15,30,31 In contrast, in this study, we performed the combination therapy on the same day, and the resultant local tumor progression rates were significantly lower than those achieved with RFA monotherapy. Yu et al evaluated the biodistribution properties of the transarterial Lipiodol-based therapeutic regimens in HCC patients.…”

Section: Discussionmentioning

confidence: 77%

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Morimoto

Numata

Kondou

et al. 2010

Cancer

283

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BACKGROUND:To improve the efficacy of radiofrequency ablation (RFA) for the treatment of intermediate-sized hepatocellular carcinomas (HCCs), the authors compared RFA combined with transcatheter arterial chemoembolization (TACE) to RFA alone. METHODS: The authors randomly assigned 37 patients with solitary HCCs (diameter, 3.1-5.0 cm in the greatest dimension) to 2 groups: the TACE-RFA group, in which the patients received TACE followed by RFA on the same day, and the RFA group, in which the patients received only RFA. RESULTS: Technical success was achieved after 1.4 AE 0.5 RFA sessions in the RFA group and after 1.1 AE 0.2 RFA sessions in the TACE-RFA group (P < .01). The mean diameters of the longer and shorter axes of the RFA-induced ablated areas were 50 AE 8.0 mm and 41 AE 7.1 mm, respectively, in the RFA group and 58 AE 13.2 mm and 50 AE 11.3 mm, respectively, in the TACE-RFA group; the mean diameters of the shorter axes were significantly different (P ¼ .012). The rates of local tumor progression at the end of the third year in the RFA and TACE-RFA groups were 39% and 6%, respectively (P ¼ .012). The 3-year survival rates of the patients in the RFA and TACE-RFA groups were 80% and 93%, respectively (P ¼ .369). CONCLUSIONS: In patients with intermediate-sized HCCs, RFA combined with TACE is more effective than RFA alone for extending the ablated area in fewer treatment sessions and for decreasing the local tumor progression rate. Cancer 2010;116:5452-60.

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Section: Discussionmentioning

confidence: 77%

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Morimoto

Numata

Kondou

et al. 2010

Cancer

283

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“…12 Thus, to improve local tumor control for larger nodules, the combination of RFA with TACE is increasingly advocated. 24 The impact of multinodular forms on longterm outcomes after RFA has been reported by Lencioni et al, 5 but many series include a low percentage, if any. 1,12 Data regarding the prognostic impact of iterative RFA remain scarce.…”

mentioning

confidence: 93%

Radiofrequency ablation of hepatocellular carcinoma: Long-term results and prognostic factors in 235 Western patients with cirrhosis

N’Kontchou¹,

Mahamoudi²,

Aout³

et al. 2009

Hepatology

410

303

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For the treatment of small hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is in some centers considered a first-line therapeutic option. However, such a strategy is still under debate with regard to tumor and patient characteristics. In this single-center study we assessed the 5-year survival and prognosis factors in 235 consecutive patients with cirrhosis (Child-Pugh A/B: 205/30) who received RFA as first-line treatment for up to three HCC <5 cm (307 tumors; mean diameter: 29 ؎ 10 mm; 53 multinodular forms). Among these patients, 67 satisfied the criteria for resection according to the Barcelona Clinic Liver Cancer. Complete ablation was obtained in 222 patients (94%). Overall, 337 RFA sessions were performed including iterative RFA for recurrence. Major complications occurred in three patients (0.9%), including one treatmentrelated death. After 27 ؎ 20 months of mean follow-up, local or distant, or both, tumor recurrence occurred in 16, 88, and 11 patients, respectively. Twenty-nine patients underwent transplantation and were removed from the study at this point. Overall 5-year, recurrence-free, and tumor-free (including results of iterative RFA) survival rates were, respectively, 40%, 17%, and 32%. The overall 5-year survival rate was 76% for operable patients. Factors associated with overall survival were prothrombin activity (hazard ratio [HR] ‫؍‬ 0.97, 0.96-0.98; P < 0.0001) and serum levels of ␣-fetoprotein (AFP) (HR ‫؍‬ 1.02, 1.02-1.02; P < 0.0001), and factors associated with tumor recurrence were multinodular forms (HR ‫؍‬ 2.34; 1.52-3.6; P ‫؍‬ 0.0001) and serum AFP levels (HR ‫؍‬ 1.015, 1.014-1.016; P ‫؍‬ 0.015). Tumor size was associated with local recurrence but not with overall and tumor-free survival. Conclusion: RFA is a safe and effective first-line treatment of HCC up to 5 cm in diameter, especially for patients with a single tumor, a low serum AFP level, and well-preserved liver function.

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“…By contrast, ex vivo bovine liver was not perfused with blood flow (17)(18)(19). Previous studies have demonstrated that a reduction in blood supply, such as in transcatheter arterial chemoembolization, results in enlarged ablative volume (20)(21)(22). The cooling effect of the blood perfusion in the clinical cases may have disclosed the advantage of the CoAccess electrode masked in the ex vivo experiments.…”

Section: Discussionmentioning

confidence: 99%

Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study

Koda

Tokunaga

Matono

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. The purpose of the present study was to compare the size and configuration of the ablation zones created by SuperSlim and CoAccess electrodes, using various ablation algorithms in ex vivo bovine liver and in clinical cases. In the experimental study, we ablated explanted bovine liver using 2 types of electrodes and 4 ablation algorithms (combinations of incremental power supply, stepwise expansion and additional low-power ablation) and evaluated the ablation area and time.In the clinical study, we compared the ablation volume and the shape of the ablation zone between both electrodes in 23 hepatocellular carcinoma (HCC) cases with the best algorithm (incremental power supply, stepwise expansion and additional low-power ablation) as derived from the experimental study. In the experimental study, the ablation area and time by the CoAccess electrode were significantly greater compared to those by the SuperSlim electrode for the single-step (algorithm 1, p=0.0209 and 0.0325, respectively) and stepwise expansion algorithms (algorithm 2, p=0.0002 and <0.0001, respectively; algorithm 3, p= 0.006 and 0.0407, respectively). However, differences were not significant for the additional low-power ablation algorithm. In the clinical study, the ablation volume and time in the CoAccess group were significantly larger and longer, respectively, compared to those in the SuperSlim group (p=0.0242 and 0.009, respectively). Round ablation zones were acquired in 91.7% of the CoAccess group, while irregular ablation zones were obtained in 45.5% of the SuperSlim group (p= 0.0428). In conclusion, the CoAccess electrode achieves larger and more uniform ablation zones compared with the SuperSlim electrode, though it requires longer ablation times in experimental and clinical studies.

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Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC)

Cited by 206 publications

References 39 publications

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Radiofrequency ablation of hepatocellular carcinoma: Long-term results and prognostic factors in 235 Western patients with cirrhosis

Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study

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