scholarly journals Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma

2021 ◽  
Vol 28 (2) ◽  
pp. 1034-1044
Author(s):  
Silvia Gaia ◽  
Michela Ciruolo ◽  
Davide Giuseppe Ribaldone ◽  
Emanuela Rolle ◽  
Enrica Migliore ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Recurrence Rate ◽  
Complete Response ◽  
Single Node ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
New Diagnosis ◽  
Enhanced Computed Tomography

Background: Contrasting data are available in the literature regarding the superiority of percutaneous microwave ablation (MWA) or radiofrequency ablation (RFA) in very early or early (BCLA 0 or A) hepatocellular carcinoma (HCC). Aims: The primary outcome was to compare the efficacy of RFA and MWA in achieving complete response in cirrhotic patients with early and very early HCC. The secondary outcomes were to evaluate the overall survival and the recurrence rate. Methods: A retrospective, observational, single-center study was performed. Inclusion criteria were liver cirrhosis, new diagnosis of a single node of HCC measuring a maximum of 50 mm or up to three nodules with diameter up to 35 mm, treatment with RFA or MWA. Radiological response was evaluated with multiphasic contrast-enhanced Computed Tomography or Magnetic Resonance Imaging at 5–7 weeks after thermal ablation. Complete response was defined when no vital tissue was detected after treatment. Results: Overall, 251 HCC patients were included in this study; 81 patients were treated with MWA and 170 with RFA. The complete response rate was similar in MWA and RFA groups (out of 331 nodules, 87.5% (91/104) were treated with MWA and 84.2% (186/221) were treated with RFA, p = 0.504). Interestingly, a subanalysis demonstrated that for 21–35 mm nodules, the probability to achieve a complete response using MWA was almost 5 times higher than for RFA (OR = 4.88, 95% CI 1.37–17.31, p = 0.014). Moreover, recurrence rate in 21–35 mm nodules was higher with RFA with respect to MWA (31.9% versus 13.5%, p = 0.019). Overall survival was 80.4% (45/56) when treated with MWA and 62.2% (56/90) when treated with RFA (p = 0.027). No significant difference was observed between MWA and RFA treatment in the 15–20 mm nodules group. Conclusion: This study showed that MWA is more efficient than RFA in achieving complete response in HCC nodules with 21 to 35 mm diameter.

Use of radiofrequency ablation and stereotactic body radiotherapy for the treatment of hepatocellular carcinoma: An analysis of the SEER-Medicare database.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 463-463 ◽  
Author(s):  
Mary Uan-Sian Feng ◽  
Vincent D. Marshall ◽  
Neehar Parikh
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Stereotactic Body Radiotherapy ◽  
Early Stage ◽  
Rank Test ◽  
The West ◽  
Liver Decompensation ◽  
Significant Difference ◽  
The Us

463 Background: Hepatocellular carcinoma (HCC) is an increasingly common and highly morbid malignancy worldwide, including the US. For early stage patients ablative strategies are important potentially curative treatment options. Stereotactic body radiotherapy (SBRT) has emerged as a promising non-surgical ablative therapy, although it is technically demanding and its comparison with radiofrequency ablation (RFA) remains confined to a single institution retrospective review. We queried the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to assess RFA and SBRT use in the US. Methods: We identified patients greater than 65 years old who were diagnosed from 2004-11 with stage I or II HCC and treated with RFA or SBRT. Survival analysis was conducted using Kaplan-Meier curves and log rank test. Factors associated with overall survival (OS) and early ( ≤ 90 day) hospital admission post-treatment were identified using propensity score (PS) adjusted multivariate analysis. Results: 825 patients were identified, 747 treated with RFA and 78 SBRT. 22 pts received both treatments and were excluded from this analysis. The mean Charlson comorbidity index was 1.0±1.1. Median age was 74, range 66-90. Patients who received RFA were more likely to live in the West and have liver decompensation. Patients who received SBRT were more likely to be white and treated in the Midwest. After using PS matching there were 78 in each cohort. In these patients, mean overall survival (OS) was 2.25 and 2.04 yrs for RFA and SBRT, p = 0.06. Younger age, lack of liver decompensation, treatment in the West, and liver transplantation were associated with longer OS, HR 0.96, p = 0.05; HR 0.37, p = 0.002; HR 0.57, p = 0.04; HR 0.18, p = 0.008, respectively. 90 day hospitalization rates did not differ between treatments; only liver decompensation was predictive of hospitalization, OR 3.33, p = 0.032. Conclusions: In a national cohort of early stage HCC patients, treatment with RFA vs SBRT resulted in no significant difference in OS. SBRT appears to be a comparable ablative strategy to RFA in this population. This highlights the need for a randomized trial comparing these two modalities.

The Role of Contrast-Enhanced Ultrasound in Guiding Radiofrequency Ablation of Hepatocellular Carcinoma

2015 ◽  
Vol 66 (2) ◽  
pp. 171-178 ◽  
Author(s):  
Andy K.W. Chan ◽  
Chris Hegarty ◽  
Darren Klass ◽  
Eric Yoshida ◽  
Stephen Chung ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Complete Response ◽  
Term Treatment ◽  
Contrast Enhanced Ultrasound ◽  
Short Term ◽  
Short Term Treatment ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography

Purpose The objective of the study was to determine the efficacy of contrast-enhanced ultrasound (CEUS) using ultrasound (US)-specific microbubbles in guiding radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Methods A retrospective analysis of 50 patients with HCC treated with CEUS guided RFA using perflutren at our institution was performed. CEUS images were first compared to B-mode US images performed at the same RFA session to determine the ability of CEUS to increase the conspicuity of lesions. A qualitative score (1 = poor, 2 = fair, 3 = excellent) was used to grade the ability to visualize the lesions. The preprocedure CEUS images were then evaluated using the most recent prior contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The efficacy of the treatment was evaluated with short-term follow-up imaging (median 1 month) for presence of residual or recurrent disease. Results CEUS allows at least fair visualization (score ≥2) in 78% (reader 1) and 80% (reader 2) of the lesions not visualized by B-mode US, and 50% (reader 1) and 42% (reader 2) of the lesions poorly visualized by B-mode US. Lesion appearances on CEUS are largely concordant with those on CT or MRI: 88% for reader 1, 96% for reader 2. With CEUS-guided RFA, complete response was achieved in the vast majority of the lesions at short-term follow-up: 82% for reader 1, 94% for reader 2. Conclusions CEUS increases the conspicuity and provides better characterization of hypervascular HCC that are either not seen or poorly seen on B-mode US, and CEUS provides real-time guidance of RFA with good short-term treatment responses.

scholarly journals Dynamic Three-Dimensional Contrast-Enhanced Ultrasound to Predict Therapeutic Response of Radiofrequency Ablation in Hepatocellular Carcinoma: Preliminary Findings

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Jiaying Cao ◽  
Yi Dong ◽  
Feng Mao ◽  
Wenping Wang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Therapeutic Response ◽  
Three Dimensional ◽  
Residual Tumor ◽  
Complete Response ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Mean Size

Background & Aims. To investigate the value of dynamic three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the assessment of therapeutic response of hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA).Methods. Forty-two patients (31 men and 11 women; mean age (52.1 ± 13.1 years)) with 42 clinical diagnosed HCC lesions (size range 14-48 mm; mean size 28.4 ± 9.9 mm) treated by RFA were included. All patients underwent two-dimensional contrast-enhanced ultrasound (2D-CEUS) and 3D-CEUS 1 month after treatment. Two radiologists assessed the absence (complete response, CR) or presence (residual tumor, RT) of any arterially hyperenhancing nodules within or along the margin of the treated HCC lesions. Complete response on magnetic resonance (MR) imaging acted as standard of reference (SOR).Results. After RFA treatment, 3D-CEUS was successfully conducted in 34 HCC lesions. CR was observed on both 2D-CEUS and 3D-CEUS in 25/42 (59.5%) HCC and RT in 6/42 (14.3%) HCC lesions. In 3/42 (7.1%) HCC lesion, RT was documented by SOR and 3D-CEUS, but it was not appreciable at 2D-CEUS. In 3/42 (7.1%) HCC lesion, the presence of peripheral RT was suspected by both 2D-CEUS and 3D-CEUS, but it was not confirmed by SOR. No statistically significant difference between 2D-CEUS and 3D-CEUS in depicting either CR or RT was found (P= 0.25). Combined with dynamic 3D-CEUS, the diagnostic accuracy was improved from 85.7% to 92.9%.Conclusions. 3D-CEUS might be helpful in better diagnostic performance in the assessment of therapeutic response of HCC treated after RFA.

scholarly journals Transarterial Chemoembolization Combined With Radiofrequency Ablation Versus Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma After Curative Resection: A 10-Year Single-Center Comparative Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Xin Zheng ◽  
Yanqiao Ren ◽  
Hanqing Hu ◽  
Kun Qian
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Transarterial Chemoembolization ◽  
Curative Resection ◽  
Progression Free Survival ◽  
Repeat Hepatectomy ◽  
Tumor Diameter ◽  
Recurrent Hepatocellular Carcinoma ◽  
Significant Difference ◽  
Hepatectomy Group

BackgroundThe purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) in combination with radiofrequency ablation (RFA) (TACE-RFA) and repeat hepatectomy in the treatment of recurrent hepatocellular carcinoma (HCC) after curative resection.MethodsThis retrospective study evaluated consecutive medical records of patients who received either TACE-RFA or repeat hepatectomy between January 2010 and May 2021. Overall survival (OS), progression-free survival (PFS), and complications were compared.ResultsOf the 2672 patients who received either TACE-RFA or repeat hepatectomy, 111 eligible patients were included in our study, 63 in the TACE-RFA group and 48 in the repeat hepatectomy group. The median OS was 38 months in the TACE-RFA group and 42 months in the repeat hepatectomy group, with no statistically difference between the two groups (P=0.45). Meanwhile, there was also no statistically significant difference in PFS between the two groups (P=0.634). Although both groups achieved similar outcomes, the rate of major complications was significantly higher in the repeat hepatectomy group (P=0.003).ConclusionsPatients with recurrent HCC in the TACE-RFA group and the repeat hepatectomy group had similar OS and PFS regardless of the patient’s tumor diameter, but the TACE-RFA group was safer and more minimally invasive.

scholarly journals Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

2022 ◽  
Vol 14 (1) ◽  
pp. 43-55
Author(s):  
Cristina Micali ◽  
Ylenia Russotto ◽  
Grazia Caci ◽  
Manuela Ceccarelli ◽  
Andrea Marino ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cancer Staging ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Liver Cancers ◽  
Significant Difference ◽  
Cancer Specific Mortality ◽  
Living With Hiv ◽  
Hiv Negative

Hepatocellular carcinoma (HCC) accounts for approximately 75–90% of primary liver cancers and is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide. In the HIV-positive population, the risk of HCC is approximately four times higher than in the general population, with higher cancer-specific mortality than in HIV-negative patients. In most cases, HCC diagnosis is made in patients younger than the HIV-negative population and in the intermediate-advanced stage, thus limiting the therapeutic possibilities. Treatment choice in HIV-positive patients with HCC is subject to cancer staging, liver function and health status, as for HIV-negative and non-HIV-negative HCC patients. There are relatively few studies on the efficacy and safety in HIV-positive patients to date in loco-regional treatments for HCC. So far, literature shows that curative treatments such as radiofrequency ablation (RFA) have no significant differences in overall survival between HIV-positive and HIV-negative patients, as opposed to palliative treatments such as TACE, where there is a significant difference in overall survival. Although it can be assumed that the most recently discovered loco-regional therapies are applicable to HIV-positive patients with HCC in the same way as HIV-negative patients, further studies are needed to confirm this hypothesis. The purpose of our review is to evaluate these treatments, their efficacy, effectiveness, safety and their applicability to HIV-positive patients.

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