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Radiofrequency Ablation Combined with Chemoembolization for Intermediate-Sized (3-5 cm) Hepatocellular Carcinomas Under Dual Guidance of Biplane Fluoroscopy and Ultrasonography

  • Min, Ji Hye (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Min Woo (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cha, Dong Ik (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeon, Yong Hwan (Department of Radiology, Kangwon National University College of Medicine) ;
  • Shin, Sung Wook (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Sung Ki (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Rhim, Hyunchul (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Hyo K. (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 발행 : 2013.04.01

초록

Objective: To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US). Materials and Methods: Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method. Results: Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively. Conclusion: RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment.

키워드

참고문헌

  1. Rossi, S, Ravetta, V, Rosa, L, Ghittoni, G, Viera, FT, Garbagnati, F,Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study, Hepatology, 53, 1, 136-147(2011) https://doi.org/10.1002/hep.23965
  2. Livraghi, T, Meloni, F, Di Stasi, M, Rolle, E, Solbiati, L, Tinelli, C,Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?, Hepatology, 47, 2, 82-89(2008)
  3. Llovet, JM, Bruix, J,Novel advancements in the management of hepatocellular carcinoma in 2008, J Hepatol, 48, 3, S20-S37(2008)
  4. Sasaki, A, Kai, S, Iwashita, Y, Hirano, S, Ohta, M, Kitano, S,Microsatellite distribution and indication for locoregional therapy in small hepatocellular carcinoma, Cancer, 103, 4, 299-306(2005) https://doi.org/10.1002/cncr.20798
  5. Bruix, J, Sherman, M,Management of hepatocellular carcinoma: an update, Hepatology, 53, 5, 1020-1022(2011) https://doi.org/10.1002/hep.24199
  6. Kudo, M, Okanoue, T,Management of hepatocellular carcinoma in Japan: consensus-based clinical practice manual proposed by the Japan Society of Hepatology, Oncology, 72, 6, 2-15(2007)
  7. Takaki, H, Yamakado, K, Nakatsuka, A, Fuke, H, Murata, K, Shiraki, K,Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinomas 5 cm or smaller: risk factors for local tumor progression, J Vasc Interv Radiol, 18, 7, 856-861(2007) https://doi.org/10.1016/j.jvir.2007.04.022
  8. Yamakado, K, Nakatsuka, A, Takaki, H, Yokoi, H, Usui, M, Sakurai, H,Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy, Radiology, 247, 8, 260-266(2008) https://doi.org/10.1148/radiol.2471070818
  9. Kim, JH, Won, HJ, Shin, YM, Kim, SH, Yoon, HK, Sung, KB,Medium-sized (3.1-5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone, Ann Surg Oncol, 18, 9, 1624-1629(2011) https://doi.org/10.1245/s10434-011-1673-8
  10. Morimoto, M, Numata, K, Kondou, M, Nozaki, A, Morita, S, Tanaka, K,Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization, Cancer, 116, 10, 5452-5460(2010) https://doi.org/10.1002/cncr.25314
  11. Goldberg, SN, Hahn, PF, Tanabe, KK, Mueller, PR, Schima, W, Athanasoulis, CA,Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis?, J Vasc Interv Radiol, 9, 11, 101-111(1998) https://doi.org/10.1016/S1051-0443(98)70491-9
  12. Patterson, EJ, Scudamore, CH, Owen, DA, Nagy, AG, Buczkowski, AK,Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size, Ann Surg, 227, 12, 559-565(1998) https://doi.org/10.1097/00000658-199804000-00018
  13. Gasparini, D, Sponza, M, Marzio, A, Zanardi, R, Bazzocchi, M, Cemal, Y,Combined treatment, TACE and RF ablation, in HCC: preliminary results, Radiol Med, 104, 13, 412-420(2002)
  14. Livraghi, T, Goldberg, SN, Lazzaroni, S, Meloni, F, Ierace, T, Solbiati, L,Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions, Radiology, 214, 14, 761-768(2000) https://doi.org/10.1148/radiology.214.3.r00mr02761
  15. Lee, MW, Kim, YJ, Park, SW, Yu, NC, Choe, WH, Kwon, SY,Biplane fluoroscopy-guided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience, Br J Radiol, 84, 15, 691-697(2011) https://doi.org/10.1259/bjr/27559204
  16. Yamakado, K, Nakatsuka, A, Takaki, H, Sakurai, H, Isaji, S, Yamamoto, N,Subphrenic versus nonsubphrenic hepatocellular carcinoma: combined therapy with chemoembolization and radiofrequency ablation, AJR Am J Roentgenol, 194, 16, 530-535(2010) https://doi.org/10.2214/AJR.09.2917
  17. Kang, SG, Yoon, CJ, Jeong, SH, Kim, JW, Lee, SH, Lee, KH,Single-session combined therapy with chemoembolization and radiofrequency ablation in hepatocellular carcinoma less than or equal to 5 cm: a preliminary study, J Vasc Interv Radiol, 20, 17, 1570-1577(2009) https://doi.org/10.1016/j.jvir.2009.09.003
  18. Bruix, J, Sherman, M,Management of hepatocellular carcinoma, Hepatology, 42, 18, 1208-1236(2005) https://doi.org/10.1002/hep.20933
  19. Rhim, H, Choi, D, Kim, YS, Lim, HK, Choe, BK,Ultrasonography-guided percutaneous radiofrequency ablation of hepatocellular carcinomas: a feasibility scoring system for planning sonography, Eur J Radiol, 75, 19, 253-258(2010) https://doi.org/10.1016/j.ejrad.2009.04.014
  20. Song, I, Rhim, H, Lim, HK, Kim, YS, Choi, D,Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients, Eur Radiol, 19, 20, 2630-2640(2009) https://doi.org/10.1007/s00330-009-1463-x
  21. Rhim, H, Lim, HK,Radiofrequency ablation for hepatocellular carcinoma abutting the diaphragm: the value of artificial ascites, Abdom Imaging, 34, 21, 371-380(2009) https://doi.org/10.1007/s00261-008-9408-4
  22. Shibata, T, Isoda, H, Hirokawa, Y, Arizono, S, Shimada, K, Togashi, K,Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment?, Radiology, 252, 22, 905-913(2009) https://doi.org/10.1148/radiol.2523081676
  23. Goldberg, SN, Grassi, CJ, Cardella, JF, Charboneau, JW, Dodd, GD, Dupuy, DE,Image-guided tumor ablation: standardization of terminology and reporting criteria, J Vasc Interv Radiol, 20, 23, S377-S390(2009) https://doi.org/10.1016/j.jvir.2009.04.011
  24. Lee, MW, Kim, YJ, Park, HS, Yu, NC, Jung, SI, Ko, SY,Targeted sonography for small hepatocellular carcinoma discovered by CT or MRI: factors affecting sonographic detection, AJR Am J Roentgenol, 194, 24, W396-W400(2010) https://doi.org/10.2214/AJR.09.3171
  25. Kang, TW, Rhim, H, Kim, EY, Kim, YS, Choi, D, Lee, WJ,Percutaneous radiofrequency ablation for the hepatocellular carcinoma abutting the diaphragm: assessment of safety and therapeutic efficacy, Korean J Radiol, 10, 25, 34-42(2009) https://doi.org/10.3348/kjr.2009.10.1.34
  26. Lee, MW, Kim, YJ, Park, SW, Yu, NC, Park, HS, Jung, SI,Sequential changes in echogenicity and conspicuity of small hepatocellular carcinoma on gray scale sonography after transcatheter arterial chemoembolization, J Ultrasound Med, 29, 26, 1305-1312(2010) https://doi.org/10.7863/jum.2010.29.9.1305
  27. Shibata, T, Shibata, T, Maetani, Y, Kubo, T, Itoh, K, Togashi, K,Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome, J Vasc Interv Radiol, 15, 27, 1323-1327(2004) https://doi.org/10.1097/01.RVI.0000132297.97113.C4
  28. Toyoda, M, Kakizaki, S, Horiuchi, K, Katakai, K, Sohara, N, Sato, K,Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome, World J Gastroenterol, 12, 28, 608-611(2006) https://doi.org/10.3748/wjg.v12.i4.608
  29. Kato, T, Yamagami, T, Hirota, T, Matsumoto, T, Yoshimatsu, R, Nishimura, T,Transpulmonary radiofrequency ablation for hepatocellular carcinoma under real-time computed tomography-fluoroscopic guidance, Hepatogastroenterology, 55, 29, 1450-1453(2008)
  30. Lee, J, Lee, JM, Yoon, JH, Lee, JY, Kim, SH, Lee, JE,Percutaneous radiofrequency ablation with multiple electrodes for medium-sized hepatocellular carcinomas, Korean J Radiol, 13, 30, 34-43(2012) https://doi.org/10.3348/kjr.2012.13.1.34

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