The Minimal Ablative Margin of Radiofrequency Ablation of Hepatocellular Carcinoma (&gt; 2 and &lt; 5 cm) Needed to Prevent Local Tumor Progression: 3D Quantitative Assessment Using CT Image Fusion

Kim, Youngsun; Lee, Won Jae; Rhim, Hyunchul; Lim, Hyo Keun; Choi, Dongil; Lee, Ji Young

doi:10.2214/ajr.09.2954

Cited by 242 publications

(238 citation statements)

References 27 publications

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“…To assess the safety margins, the fusion imaging method was used. We used an open source DICOM software (OsiriX Foundation; Geneva, Switzerland) capable of performing imaging fusion of CT images prior to and following RFA, as described previously (23). CT data were acquired from the CT workstation, with a 0.69-mm thickness.…”

Section: Methodsmentioning

confidence: 99%

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

Hirooka

Ochi

Terada

et al. 2013

Molecular and Clinical Oncology

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Abstract. Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. HCC is generally considered to spread via the bloodstream and local recurrence often occurs in the blood drainage area determined by computed tomography during hepatic arteriography (CTHA), despite complete ablation of the primary nodule. This study was conducted in order to prospectively assess the rate of local recurrence in the blood drainage area depicted by delayed-phase CTHA. The participants comprised 364 consecutive patients (260 men and 104 women; mean age, 67.4±8.6 years), enrolled between April, 2002 and December, 2011. The participants were divided into two groups, according to whether the ablation area covered the entire blood drainage area as defined by delayed-phase CTHA (group A) or not (group B). Local tumor progression was compared between the two groups. The median time to recurrence was significantly shorter for group B (434 days) compared to that for group A (1,474 days; P=0.0037). The cumulative local recurrence rates for group A were 0, 0 and 1.5% at 1, 3 and 5 years postoperatively, respectively, whereas the recurrence rates for group B were 3.8, 17.0 and 22.8% at 1, 3 and 5 years, respectively (P<0.0001). In conclusion, the safety margin for radiofrequency ablation should be defined as the blood drainage area and ablation should aim at acquiring adequate safety margins.

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Section: Methodsmentioning

confidence: 99%

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

Hirooka

Ochi

Terada

et al. 2013

Molecular and Clinical Oncology

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“…The likelihood of local progression increases with tumor size as a result of satellite nodules (8), which is why a 5-mm minimum ablation margin is recommended by several studies (9,10). However, some of these studies (9,11,12) used a rigid registration that is not optimal for the liver because of significant deformations by respiratory movements and the ablation zone (13). Moreover, these studies assessed only two-dimensional minimal margins, failing to take into account the heterogeneous shape of the ablative volume around the tumor and that the minimal margin is not necessarily indicative of the margin sizes all around the tumor.…”

mentioning

confidence: 99%

Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

Hocquelet

Trillaud

Frulio

et al. 2016

Journal of Vascular and Interventional Radiology

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“…Thus, possible micro-metastases or microscopic foci can also be destroyed and the risk of local recurrence is minimized. However, data to support precise recommendations regarding the ideal margin size are currently lacking [33,34]. Extension of the desired or intended ablative margin is not always necessary, as this can increase the risk of complications, but an insufficient ablative margin is defined as an independent significant risk factor for local tumor progression [8,33].…”

Section: Assessment Of Technical Effectivenessmentioning

confidence: 99%

Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article

Vogl

Nour-Eldin

Hammerstingl

et al. 2017

Fortschr Röntgenstr

134

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ZUSAMMENFASSUNGHintergrund Der lokoregionale interventionelle onkologische Behandlungsansatz ist eine anerkannte Behandlungsoption bei Lebermalignomen, insbesondere beim hepatozellulären Karzinom (HCC) und oligonodulären Lebermetastasen. Material und Methode ABSTR AC T PurposeThe locoregional interventional oncological treatment approach is an accepted modality for liver neoplasms, especially for hepatocellular carcinoma (HCC) and oligonodular liver metastases. Materials and MethodsThe main aim of ablation therapies like microwave ablation (MWA) is to eradicate all malignant cells in a minimally invasive technique under imaging guidance while preserving the healthy tissue with a sufficient safety margin (at least 5 mm) surrounding the ablated lesion.Results Ablation therapy can be performed via a percutaneous, laparoscopic or intraoperative approach under ultrasound, MRI or CT guidance for adequate localization and monitoring of the ablation process.Conclusion Ablation is the method of choice for oligonodular HCCs ≤ 3 cm. The technical success rate varies from 88 % to This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.98 % and progression-free survival (PFS) at 3 years from 27 % to 91.7 %. The same criteria apply to the therapy of liver metastases. Key Points▪ Careful selection of patients proves to be essential for optimum results of MWA ▪ Interventionists should be familiar with all aspects of complication and rapid assessment of imaging methods in order to evaluate induced damage by thermal ablation ▪ MWA seems to have some advantages over radiofrequency ablation, like shorter ablation time, less pain, less heat sink effect; however, scientific proof is needed

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The Minimal Ablative Margin of Radiofrequency Ablation of Hepatocellular Carcinoma (> 2 and < 5 cm) Needed to Prevent Local Tumor Progression: 3D Quantitative Assessment Using CT Image Fusion

Abstract: When the thickness of the ablative margin is evaluated by CT image fusion, a margin of 3 mm or more appears to be associated with a lower rate of local tumor progression after percutaneous RFA of HCC.

Cited by 242 publications

References 27 publications

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article

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