scholarly journals Radiofrequency Ablation, TACE and Combined Treatment for Multiple Recurrent HCC Patients Within the Milan Criteria

2021 ◽  
Author(s):  
Bo Zhang ◽  
Juan Wan ◽  
Xi Xu ◽  
Yongkun Li ◽  
Tao Lv ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Combined Treatment ◽  
Survival Rates ◽  
Milan Criteria ◽  
Inclusion Criteria ◽  
West China Hospital ◽  
West China ◽  
Significant Difference ◽  
Tace Group ◽  
Hcc Recurrence

Abstract AimThe aim of this study was to compare radiofrequency ablation ,TACE and their combined treatment in terms of safety and efficacy.MethodsRetrospective analysis was carried out on the medical records of patients who had previously undergone curative hepatic resection and suffered multiple recurrent HCCs within the Milan criteria. The cohort of patients receiving RFA was compared to the cohort of patients receiving TACE and combined treatment. Disease outcome was investigated in terms of survival after recurrence.RESULTSFrom January 2006 to April 2014, 964 patients with recurrent HCC were enrolled in the database of West China Hospital. A total of 360 patients (37.3%) were enrolled in this retrospective study based on the inclusion criteria. In these patients, 177 (49.2%) received TACE, 121 (33.6%) received RFA, and 62 (17.2%) underwent combined treatment (CT). There was a statistically significant difference between the survival rates among the 3 groups: in the TACE group, the median survival time (MST) was 25 months, with 1-, 2-, and 3-year survival rates of 93.1%, 50.0% and 26.4%, respectively; in the RFA group, the MST was 33 months, with 1- ,2- , and 3-year survival rates of 96.7%, 65.7% and 40.1%, respectively; and in the CT group, the MST was 36 months, with 1-, 2-, and 3-year survival rates of 96.8%, 78.1% and 48.6%, respectively.CONCLUSIONCompared with TACE, RFA and combined treatment demonstrated a survival benefit for managing patients who had HCC recurrence with a total of 2-3 tumours.

scholarly journals Radiofrequency ablation, TACE and combined treatment for multiple recurrent HCC patients within the Milan criteria

2021 ◽  
Author(s):  
Bo Zhang ◽  
Juan Wan ◽  
Xi Xu ◽  
Yongkun Li ◽  
Tao Lv ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Combined Treatment ◽  
Survival Rates ◽  
Milan Criteria ◽  
Inclusion Criteria ◽  
West China Hospital ◽  
West China ◽  
Significant Difference ◽  
Tace Group ◽  
Hcc Recurrence

Abstract Aim The aim of this study was to compare radiofrequency ablation ,TACE and their combined treatment in terms of safety and efficacy.Methods Retrospective analysis was carried out on the medical records of patients who had previously undergone curative hepatic resection and suffered multiple recurrent HCCs within the Milan criteria. The cohort of patients receiving RFA was compared to the cohort of patients receiving TACE and combined treatment. Disease outcome was investigated in terms of survival after recurrence.Results From January 2006 to April 2014, 964 patients with recurrent HCC were enrolled in the database of West China Hospital. A total of 360 patients (37.3%) were enrolled in this retrospective study based on the inclusion criteria. In these patients, 177 (49.2%) received TACE, 121 (33.6%) received RFA, and 62 (17.2%) underwent combined treatment (CT). There was a statistically significant difference between the survival rates among the 3 groups: in the TACE group, the median survival time (MST) was 25 months, with 1-, 2-, and 3-year survival rates of 93.1%, 50.0% and 26.4%, respectively; in the RFA group, the MST was 33 months, with 1- ,2-, and 3-year survival rates of 96.7%, 65.7% and 40.1%, respectively; and in the CT group, the MST was 36 months, with 1-, 2-, and 3-year survival rates of 96.8%, 78.1% and 48.6%, respectively.Conclusion Compared with TACE, RFA and combined treatment demonstrated a survival benefit for managing patients who had HCC recurrence with a total of 2–3 tumours.

scholarly journals The Expression of Snail, Galectin-3, and IGF1R in the Differential Diagnosis of Benign and Malignant Pheochromocytoma and Paraganglioma

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Liling Deng ◽  
Tao Chen ◽  
Huan Xu ◽  
Yuanmei Li ◽  
Mingyan Deng ◽  
...  
Keyword(s):  
Survival Time ◽  
Tumor Tissue ◽  
Malignant Pheochromocytoma ◽  
Positive Staining ◽  
West China Hospital ◽  
West China ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Galectin 3 ◽  
Potentially Malignant

Objective. The aim of this study was to investigate the expression of Snail, galectin-3, and IGF1R in benign and malignant pheochromocytoma and paraganglioma (PPGL) and explore their role in the diagnosis of malignant PPGL. Methods. We retrospectively collected and analyzed surgical tumor tissue from 226 patients initially diagnosed with PPGL who underwent surgery from Jan. 2009 to Jan. 2016 at West China Hospital, Sichuan University. We observed and quantified the expression of Snail, galectin-3, and IGF1R in paraffin-embedded samples by immunohistochemical staining. Results. The significant difference in survival time among the three groups (benign PHEO, benign PGL, and potentially malignant PPGL) was compared by Kaplan-Meier survival analysis. The positive staining of Snail, galectin-3, and IGF1R in the benign PHEO group was significantly lower than that in the other three groups (P<0.001). The Kaplan-Meier survival plots indicated that the survival time of the patients with intense positive staining was significantly lower than that of the patients with weak positive staining. Conclusion. The intense expression of Snail, galectin-3, and IGF1R may be valuable indicators for the diagnosis of malignant PPGL.

Radiofrequency Ablation vs Electrocautery Blinded Randomized Trial: Impact on Clinically Meaningful Outcomes

2020 ◽  
pp. 019459982096473
Author(s):  
Aaron J. Prussin ◽  
Eric Babajanian ◽  
Marc Error ◽  
J. Fredrik Grimmer ◽  
Jessica Ku ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Adverse Events ◽  
Medical Center ◽  
Academic Medical Center ◽  
Normal Activity ◽  
Inclusion Criteria ◽  
Pain Scores ◽  
Significant Difference ◽  
Monopolar Electrocautery ◽  
Daily Pain

Objective To analyze patients’ return to normal activity, pain scores, narcotic use, and adverse events after undergoing tonsillectomy or adenotonsillectomy with monopolar electrocautery or radiofrequency ablation. Study Design Randomized double-blinded clinical trial based on prospective parallel design. Setting Academic medical center and tertiary children’s hospital between March 2018 and July 2019. Methods Inclusion criteria included patients aged ≥3 years with surgical indication of recurrent tonsillitis or airway obstruction/sleep-disordered breathing. Patients were randomly assigned to monopolar electrocautery or radiofrequency ablation. Patients were blinded to treatment assignment. Survey questions answered via text or email were collected daily until postoperative day 15. The primary outcome was the patient’s return to normal activity. Secondary outcomes included daily pain score, total amount of postoperative narcotic use, and adverse events. Results Of the 236 patients who met inclusion criteria and were randomly assigned to radiofrequency ablation or monopolar electrocautery, 230 completed the study (radiofrequency ablation, n = 112; monopolar electrocautery, n = 118). There was no statistically significant difference between the groups in the number of days for return to normal activity ( P = .89), daily pain scores over 15 postoperative days ( P = .46), postoperative narcotic use ( P = .61), or return to hospital for any reason ( P = .60), including bleeding as an adverse event ( P = .13). Conclusions As one of the largest randomized controlled trials examining instrumentation in tonsillectomy, our data do not show a difference between monopolar electrocautery and radiofrequency ablation with regard to return to normal activity, daily pain scores, total postoperative narcotic use, or adverse events.

Radiofrequency Ablation and Radiation Therapy Improve Local Control in Spinal Metastases Compared to Radiofrequency Ablation Alone

2018 ◽  
Vol 36 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Kavitha M. Prezzano ◽  
Dheerendra Prasad ◽  
Gregory M. Hermann ◽  
Ahmed N. Belal ◽  
Ronald A. Alberico
Keyword(s):  
Radiation Therapy ◽  
Radiofrequency Ablation ◽  
Local Control ◽  
Combined Treatment ◽  
Spinal Metastases ◽  
Significant Benefit ◽  
Unequal Distribution ◽  
Common Location ◽  
Significant Difference

Purpose: The spinal column is the most common location for osseous metastases and is associated with pain and decreased quality of life. This study evaluated combined radiofrequency ablation (RFA) with radiation therapy (RT) compared to RFA alone for improving pain and local control. Methods: This was a single-institution retrospective review of patients who underwent RFA of spinal metastases between 2016 and 2017, with or without RT to the same vertebral level. Pain was measured with visual analog scale at initial presentation and at 3 and 12 weeks of follow-up. Local failure (LF), distant failure, and overall survival (OS) were compared and Kaplan-Meier statistics were calculated. Results: Twenty-six patients with 28 spinal metastases were treated with RFA. Ten patients with 11 metastases were treated with RFA + RT. More patients with lung primaries were treated with RFA alone and more patients with breast primaries were treated with combination RFA+RT. There was no significant difference in pain scores between groups ( P = .96). At a median follow-up of 8.2 months, LF was noted in 8 of 17 metastases treated with RFA alone compared to 1 of 11 metastases treated with RFA+RT ( P = .049). There was a significant benefit in time to LF favoring RFA+RT ( P = .02) and a significant benefit in OS ( P = .0045). Conclusion: This study demonstrates a benefit in local control with RFA+RT versus RFA alone. Palliation of pain was effective using both regimens. This study was limited by a nearly unequal distribution of primary tumor histologies between groups. Literature regarding combined treatment of RFA and RT for spinal metastases is scarce and prospective protocols are warranted.

Therapeutic Efficacy of Transcatheter Arterial Chemoembolization as Compared With Hepatic Resection in Hepatocellular Carcinoma Patients With Compensated Liver Function in a Hepatitis B Virus–Endemic Area: A Prospective Cohort Study

2002 ◽  
Vol 20 (22) ◽  
pp. 4459-4465 ◽  
Author(s):  
Hyo-Suk Lee ◽  
Kang Mo Kim ◽  
Jung-Hwan Yoon ◽  
Tae-Rim Lee ◽  
Kyung Suk Suh ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Survival Rate ◽  
Liver Function ◽  
Hepatic Resection ◽  
Transcatheter Arterial Chemoembolization ◽  
Survival Rates ◽  
Tumor Stage ◽  
Significant Difference ◽  
Tace Group ◽  
Arterial Chemoembolization

PURPOSE: Identifying a special subgroup of hepatocellular carcinoma (HCC) patients who may benefit from transcatheter arterial chemoembolization (TACE) when compared with the standard treatment of hepatic resection (HR) warrants research in Asian countries. PATIENTS AND METHODS: From January 1993 to December 1994, 182 patients with operable HCC (Child-Pugh class A and International Union Against Cancer [UICC] stage T1-3N0M0) were enrolled. After initial TACE and lipiodol computed tomography, 91 received HR and 91, who refused the operation, received repeated sessions of TACE. After stratification according to the tumor stage (UICC and Cancer of the Liver Italian Program [CLIP]) and lipiodol retention pattern, the survival rates of the two treatment groups were compared. The median follow-up period was 83 months. RESULTS: As of December 31, 2000, 48 patients who underwent HR and 68 patients who underwent TACE had died. In a subgroup analysis according to tumor stage, the HR group survival rate was significantly higher than the TACE group in both UICC T1-2N0M0 (P = .0058) and CLIP 0 (P = .0027) subgroups. However, there was no significant difference in either UICC T3N0M0 (P = .7512) or CLIP 1-2 (P = .5366) subgroups. Even in patients with UICC T1-2N0M0 HCC, when lipiodol was compactly retained, the survival rate of the HR group was comparable to that of the TACE group (P = .0596). CONCLUSION: TACE proved to be as effective as HR in the subpopulations with UICC T3N0M0 or CLIP 1-2 HCC and adequate liver function, and even with UICC T1-2N0M0 HCC when lipiodol was compactly retained in the tumor. In such cases, the choice of treatment modality between TACE and HR may be left to the patient’s preference.

Randomized clinical trial of transcatheter arterial chemoembolization plus radiofrequency ablation versus transcatheter arterial chemoembolization for hepatocellular carcinoma with intermediate stage (BCLC stage B) hepatocellular carcinoma beyond Milan criteria.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4077-4077
Author(s):  
Xin Yin ◽  
Bei Tang ◽  
Yu-Hong Gan ◽  
Yan-hong Wang ◽  
Yi Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Clinical Trial ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Randomized Clinical Trial ◽  
Transcatheter Arterial Chemoembolization ◽  
Intermediate Stage ◽  
Milan Criteria ◽  
Tace Group ◽  
Arterial Chemoembolization

4077 Background: To determine treatment efficacy and safety of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) (hereafter, TACE+RFA) in patients with intermediate stage (BCLC stage B) hepatocellular carcinoma (HCC) beyond Milan criteria. Methods: In this randomized clinical trial, 110 patients with intermediate stage HCC beyond Milan criteria (single tumor with diameter 5-7cm, median; 3-5 multiple nodules with diameter less than 5cm) were included and randomly assigned to TACE+RFA group (n=55) and TACE group (n=55) at liver cancer institute, Zhongshan hospital. The primary endpoint was overall survival (OS). The secondary end point was progression-free survival (PFS) , time to progress (TTP) and best objective response (BOR). Results: The median OS in TACE+RFA and TACE group were 29 and 18 months, respectively. The median TTP and BOR were 15.7 months and 69.1 % in TACE+RFA group and 12.4 months and 40.0 % in TACE group (P=0.004). The 1-, 3-, and 4-year overall survivals for TACE+RFA group and TACE group were 97.2%, 67.9% and 59.4% versus 84.0%, 46.7% and 37.3% , respectively (P = 0.008). The corresponding PFS were 47.3%, 27.2% and 21.7% versus 35.6%,15.3% and 11.4% , respectively (P = 0.04).The incidences of major complications in TACE+RFA group were comparable to those in TACE group (P=0.14). Conclusions: TACE+RFA was superior to TACE in improving tumor response and overall survival for patients with intermediate stage (BCLC stage B) hepatocellular carcinoma beyond Milan criteria. Clinical trial information: NCT03636620.

scholarly journals Effect of Radiofrequency Ablation with Interventional Therapy of Hepatic Artery on the Recurrence of Primary Liver Cancer and the Analysis of Influencing Factors

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Sishuo Zhang ◽  
Ge Zhao ◽  
Honglin Dong
Keyword(s):  
Radiofrequency Ablation ◽  
Treatment Group ◽  
Liver Cancer ◽  
Hepatic Artery ◽  
Primary Liver Cancer ◽  
Combined Treatment ◽  
Interventional Therapy ◽  
Control Group ◽  
Tumor Diameter ◽  
Significant Difference

Background. The probability of liver cancer recurring in patients after surgery is a serious threat to liver cancer patients. Radiofrequency ablation is widely employed in liver cancer cases. We explored the therapeutic effects and influencing factors of radiofrequency ablation combined with hepatic artery intervention in patients with recurrence of primary liver cancer surgery. Methods. 90 patients with primary liver cancer postoperative recurrence admitted to our hospital from January 2014 to February 2017 were selected as the research objects. The patients were randomly divided into the control group (n = 45) and combined treatment group (n = 45). The combined treatment group received radiofrequency ablation combined with hepatic artery interventional therapy, and the control group received hepatic artery interventional therapy. The short-term efficacy, AFP levels before and after treatment, and long-term survival results of the two groups were compared. Single-factor and multifactor analyses of the clinical information of the combined treatment group were carried out to find out the factors affecting the therapeutic effect of radiofrequency ablation combined with hepatic artery intervention on patients with recurrence of primary liver cancer. Results. The total effective rate of short-term curative effect of the combined treatment group was higher than the control group, and there was a statistically significant difference existing ( P  < 0.05). After treatment, two groups of patients’ AFP levels were greatly lower than before treatment, the AFP levels of the combined treatment group were significantly lower than the control group, and there was a statistically significant difference ( P  < 0.05). The survival rates of patients in the combined treatment group at the sixth month, the first year, and the second year after treatment were significantly higher than those of the control group, and there was a statistically significant difference ( P  < 0.05). The univariate results showed that, in the combined treatment group, there were statistically significant differences between the effective group and the ineffective group in tumor diameter, intact capsule, liver cirrhosis, intrahepatic spread, and tumor adjacent to large blood vessels ( P  < 0.05). The outcomes of multivariate analysis indicated that tumor diameter ≥ 3 cm, incomplete capsule, intrahepatic spread, and tumor adjacent to large blood vessels were risk factors for ineffective recurrence of patients with primary liver cancer after radiofrequency ablation combined with hepatic artery intervention ( P  < 0.05). Discussion. Tumor diameter ≥ 3 cm, incomplete capsule, intrahepatic spread, and tumor adjacent to large blood vessels are risk factors for the ineffectiveness of radiofrequency ablation combined with hepatic artery interventional therapy for patients with recurrence of primary liver cancer. It is necessary to increase the range of radiofrequency treatment, increase the temperature of the radiofrequency needle, and strengthen postoperative follow-up interventions based on the specific conditions of the patient's tumor.

scholarly journals Meta-analysis of Percutaneous vs. Surgical Approaches Radiofrequency Ablation in Hepatocellular Carcinoma

2022 ◽  
Vol 8 ◽  
Author(s):  
Xiaozhun Huang ◽  
Yibin Liu ◽  
Lin Xu ◽  
Teng Ma ◽  
Xin Yin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Perioperative Complications ◽  
Meta Analysis ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Analysis Data ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Significant Difference

Background: Radiofrequency ablation (RFA) is a curative modality for hepatocellular carcinoma (HCC) patients who are not suitable for resection. It remains controversial whether a surgical or percutaneous approach is more appropriate for HCC.Method: A search was performed on the PubMed, Web of Science, Embase, and Cochrane Library databases from the date of database inception until April 17, 2021. Studies reporting outcomes of comparisons between surgical RFA (SRFA) and percutaneous RFA (PRFA) were included in this study. The meta-analysis was performed using the Review Manager 5.3 and Stata 12.0 software.Result: A total of 10 retrospective studies containing 12 cohorts, involving 740 patients in the PRFA group and 512 patients in the SRFA group, were selected. Although the tumor size in PRFA group was smaller than the SRFA group (p = 0.007), there was no significant difference in complete ablation rate between the SRFA and PRFA groups (95.63% and 97.33%, respectively; Odds ratio [OR], 0.56; 95% confidence intervals [CI], 0.26–1.24; p = 0.15). However, the SRFA group showed a significantly lower local tumor recurrence than the PRFA group in the sensitivity analysis (28.7% in the PRFA group and 21.79% in the SRFA group, respectively; OR, 1.84; 95% CI, 1.14–2.95; p = 0.01). Pooled analysis data showed that the rate of severe perioperative complications did not differ significantly between the PRFA and SRFA groups (14.28% and 12.11%, respectively; OR, 1.30; 95% CI, 0.67-2.53; p = 0.44). There was no significant difference in the 1-, 3-, and 5-year overall survival rates, as well as the 1- and 3-year disease-free survival (DFS) between the PRFA and SRFA groups. The 5-year DFS of the PRFA group was significantly lower than the SRFA group (hazard ratio 0.73; 95% CI 0.54–0.99).Conclusion: Based on our meta-analysis, the surgical route was superior to PRFA in terms of local control rate. Furthermore, the surgical approach did not increase the risk of major complications.

scholarly journals Tumor characteristics and surgical outcome in incidentally discovered pheochromocytomas and paragangliomas

2018 ◽  
Vol 7 (11) ◽  
pp. 1142-1149 ◽  
Author(s):  
Xinlei Chen ◽  
Liru Hu ◽  
Caojie Liu ◽  
Guangcheng Ni ◽  
Yuwei Zhang
Keyword(s):  
Blood Pressure ◽  
Surgical Outcome ◽  
Incidental Findings ◽  
Incidental Finding ◽  
Tumor Characteristics ◽  
West China Hospital ◽  
West China ◽  
Medical Preparation ◽  
Significant Difference ◽  
Study Population

Objective The proportion of incidentally discovered pheochromocytomas and paragangliomas (PPGL) has increased over time. However, our knowledge of them is quite limited. The purpose of this retrospective study is to generalize the commonalities in incidentally discovered PPGL, offer evidence for clinical diagnosis and management. Methods Five hundred twenty-six patients were included in our study after filtration from the database of West China Hospital of Sichuan University between May, 2007 and December, 2016. Among the patients, 148 of them were incidental findings and 378 of them were suspected findings. All patients’ demography and tumor characteristics were recorded in detail, especially hemodynamic records and hormonal assays. The reasons for taking radiography were also collected. Most patients received preoperative medical preparation. Intraoperative and postoperative courses as well as surgical outcomes were also analyzed to identify differences between incidental findings and suspected findings. Results Incidentally discovered PPGL took up 28.1% of the study population. Suspected PPGLs had a higher prevalence of hypertension, lower proportion of non-functioning PPGL, higher prevalence of MEN2 and better post-surgical blood pressure recovery than incidental finding group. However, patients in the incidental finding group showed no significant difference in preoperative blood pressure and hormonal assays with suspected findings in metaphrine and normetaphrine in plasma and urine (P > 0.05). Conclusions Due to the development of technology, more PPGLs are discovered incidentally. Considering the tumor characteristics and surgical outcome, surgical decisions should be made more cautiously.

scholarly journals Clinical characteristics and outcome of 55 cases of hepatoblastoma relapses

2021 ◽  
Author(s):  
Wei-ling Zhang ◽  
Hui-min Hu ◽  
Yi-zhuo Wang ◽  
Yi Zhang ◽  
Jing Li ◽  
...  
Keyword(s):  
Survival Rate ◽  
Complete Remission ◽  
Clinical Characteristics ◽  
Combined Treatment ◽  
Survival Rates ◽  
Disease Free Survival ◽  
The Body ◽  
Free Survival ◽  
Liver Recurrence ◽  
Significant Difference

IntroductionThis study aimed to analyse and summarize the clinical characteristics and prognosis of children with hepatoblastoma (HB) recurrence.Material and methodsFrom January 2009 to June 2018, the clinical data of 55 children with HB, who had recurrence after complete remission (CR), were collected and analysed.ResultsOf the 55 patients, the median duration of follow-up was 65 months, the median interval from CR to the first recurrence was 3 months, and the event-free survival (EFS) times were 42.00 ±4.72 months. For sites of recurrence, 24 patients had lung recurrence only, 6 patients had liver recurrence only, 18 patients had recurrence in both the liver and lung, and 7 patients had recurrence in other sites of the body (6 cases of brain and 1 case of mediastinum). The overall 5-year survival rate of 55 cases was 47.4% and the 5-year disease-free survival rate was 37.3%. According to the treatment after recurrence, the patients were divided into the combined treatment group (chemotherapy combined with surgery, 41 cases) and the chemotherapy alone group (14 cases). The 3-year overall survival rates were 75.2% and 17.1%, respectively, with statistical difference 2 = 28.441, p < 0.001. The EFS time and the 3-year EFS rate of the 2 groups was 55.04 ±4.10 months vs. 32.63 ±4.34 months; 70% vs. 55.7%, with significant difference 2 = 3.328, p = 0.0068.ConclusionsThe prognosis of recurrent HB is poor. The main sites of recurrence were lung and liver. After recurrence, chemotherapy combined with surgery can improve prognosis, and complete remission can be achieved.

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