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Erschienen in: European Radiology 7/2014

01.07.2014 | Interventional

Combined radiofrequency ablation and ethanol injection with a multipronged needle for the treatment of medium and large hepatocellular carcinoma

verfasst von: Guangliang Huang, Manxia Lin, Xiaoyan Xie, Baoxian Liu, Zuofeng Xu, Riccardo Lencioni, Mingde Lu, Ming Kuang

Erschienen in: European Radiology | Ausgabe 7/2014

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Abstract

Objective

To evaluate the efficacy and safety of combined radiofrequency ablation (RFA) and ethanol injection with a multipronged needle in the treatment of medium (3.1–5.0 cm) and large (5.1–7.0 cm) hepatocellular carcinoma (HCC).

Methods

A total of 65 patients with 67 HCC nodules were enrolled in this prospective study. All of them received the treatment of combined RFA and multipronged ethanol injection percutaneously.

Results

The average volume of injected ethanol was 14.4 ± 4.1 ml (range, 9–30 ml). The average number of RFA electrode insertions was 1.7 ± 0.8 (range, 1–4). The rate of initial local complete response (CR) was 94.0 % (63/67). After additional treatment, technical success was achieved in all HCC nodules. There were no treatment-related deaths, and major complications were observed in 3 (4.6 %) patients. After a mean follow-up of 20.0 ± 7.6 months, local tumour progression was observed in 10 (10/67, 14.9 %) tumours, whereas distant recurrence developed in 32 (32/65, 49.2 %) patients. The 1-year and 2-year survival rates were 93.1 % and 88.1 %, respectively.

Conclusion

The combination of RFA and multipronged ethanol injection in the treatment of medium and large HCC is safe and effective with a high rate of local tumour control.

Key Points

Combined radiofrequency ablation and multipronged ethanol injection is a new therapeutic strategy
Treatment is safe and effective for medium and large hepatocellular carcinoma (HCC)
A multipronged needle allows for a homogeneous ethanol distribution
Literatur
1.
Zurück zum Zitat Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRef Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRef
2.
Zurück zum Zitat Poon RT, Fan ST, Lo CM et al (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70PubMedCentralPubMedCrossRef Poon RT, Fan ST, Lo CM et al (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70PubMedCentralPubMedCrossRef
3.
Zurück zum Zitat Livraghi T, Meloni F (2002) Treatment of hepatocellular carcinoma by percutaneous interventional methods. Hepatogastroenterology 49:62–71PubMed Livraghi T, Meloni F (2002) Treatment of hepatocellular carcinoma by percutaneous interventional methods. Hepatogastroenterology 49:62–71PubMed
4.
Zurück zum Zitat Shiina S, Tateishi R, Imamura M et al (2012) Percutaneous ethanol injection for hepatocellular carcinoma: 20-year outcome and prognostic factors. Liver Int 32:1434–1442PubMedCentralPubMedCrossRef Shiina S, Tateishi R, Imamura M et al (2012) Percutaneous ethanol injection for hepatocellular carcinoma: 20-year outcome and prognostic factors. Liver Int 32:1434–1442PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Shiina S, Teratani T, Obi S et al (2005) A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 129:122–130PubMedCrossRef Shiina S, Teratani T, Obi S et al (2005) A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 129:122–130PubMedCrossRef
6.
Zurück zum Zitat Lencioni R, Cioni D, Crocetti L et al (2005) Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234:961–967PubMedCrossRef Lencioni R, Cioni D, Crocetti L et al (2005) Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234:961–967PubMedCrossRef
7.
Zurück zum Zitat Livraghi T, Meloni F, Di Stasi M et al (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 47:82–89PubMedCrossRef Livraghi T, Meloni F, Di Stasi M et al (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 47:82–89PubMedCrossRef
8.
Zurück zum Zitat Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171PubMedCentralPubMedCrossRef Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171PubMedCentralPubMedCrossRef
9.
Zurück zum Zitat Kuang M, Lu MD, Xie XY et al (2009) Ethanol ablation of hepatocellular carcinoma up to 5.0 cm by using a multipronged injection needle with high-dose strategy. Radiology 253:552–561PubMedCrossRef Kuang M, Lu MD, Xie XY et al (2009) Ethanol ablation of hepatocellular carcinoma up to 5.0 cm by using a multipronged injection needle with high-dose strategy. Radiology 253:552–561PubMedCrossRef
10.
Zurück zum Zitat Chen MH, Yang W, Yan K et al (2004) Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients–mathematic model, overlapping mode, and electrode placement process. Radiology 232:260–271PubMedCrossRef Chen MH, Yang W, Yan K et al (2004) Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients–mathematic model, overlapping mode, and electrode placement process. Radiology 232:260–271PubMedCrossRef
11.
Zurück zum Zitat Goldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235:728–739PubMedCentralPubMedCrossRef Goldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235:728–739PubMedCentralPubMedCrossRef
12.
Zurück zum Zitat Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC (2004) Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology 127:1714–1723PubMedCrossRef Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC (2004) Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology 127:1714–1723PubMedCrossRef
13.
Zurück zum Zitat Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A (2001) Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results. Eur Radiol 11:914–921PubMedCrossRef Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A (2001) Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results. Eur Radiol 11:914–921PubMedCrossRef
14.
Zurück zum Zitat Shibata T, Maetani Y, Isoda H, Hiraoka M (2006) Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode. Radiology 238:346–353PubMedCrossRef Shibata T, Maetani Y, Isoda H, Hiraoka M (2006) Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode. Radiology 238:346–353PubMedCrossRef
15.
Zurück zum Zitat Livraghi T, Goldberg SN, Lazzaroni S et al (2000) Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 214:761–768PubMedCrossRef Livraghi T, Goldberg SN, Lazzaroni S et al (2000) Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 214:761–768PubMedCrossRef
16.
Zurück zum Zitat Giorgio A, Tarantino L, de Stefano G et al (2003) Percutaneous sonographically guided saline-enhanced radiofrequency ablation of hepatocellular carcinoma. AJR Am J Roentgenol 181:479–484PubMedCrossRef Giorgio A, Tarantino L, de Stefano G et al (2003) Percutaneous sonographically guided saline-enhanced radiofrequency ablation of hepatocellular carcinoma. AJR Am J Roentgenol 181:479–484PubMedCrossRef
17.
Zurück zum Zitat Ahmed M, Lobo SM, Weinstein J et al (2002) Improved coagulation with saline solution pretreatment during radiofrequency tumor ablation in a canine model. J Vasc Interv Radiol 13:717–724PubMedCrossRef Ahmed M, Lobo SM, Weinstein J et al (2002) Improved coagulation with saline solution pretreatment during radiofrequency tumor ablation in a canine model. J Vasc Interv Radiol 13:717–724PubMedCrossRef
18.
Zurück zum Zitat Yamakado K, Nakatsuka A, Ohmori S et al (2002) Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology. J Vasc Interv Radiol 13:1225–1232PubMedCrossRef Yamakado K, Nakatsuka A, Ohmori S et al (2002) Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology. J Vasc Interv Radiol 13:1225–1232PubMedCrossRef
19.
Zurück zum Zitat Yamasaki T, Kurokawa F, Shirahashi H, Kusano N, Hironaka K, Okita K (2002) Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Comparison with standard percutaneous radiofrequency ablation therapy. Cancer 95:2353–2360PubMedCrossRef Yamasaki T, Kurokawa F, Shirahashi H, Kusano N, Hironaka K, Okita K (2002) Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Comparison with standard percutaneous radiofrequency ablation therapy. Cancer 95:2353–2360PubMedCrossRef
20.
Zurück zum Zitat Goldberg SN, Kruskal JB, Oliver BS, Clouse ME, Gazelle GS (2000) Percutaneous tumor ablation: increased coagulation by combining radio-frequency ablation and ethanol instillation in a rat breast tumor model. Radiology 217:827–831PubMedCrossRef Goldberg SN, Kruskal JB, Oliver BS, Clouse ME, Gazelle GS (2000) Percutaneous tumor ablation: increased coagulation by combining radio-frequency ablation and ethanol instillation in a rat breast tumor model. Radiology 217:827–831PubMedCrossRef
21.
Zurück zum Zitat Kurokohchi K, Watanabe S, Masaki T et al (2002) Combined use of percutaneous ethanol injection and radiofrequency ablation for the effective treatment of hepatocelluar carcinoma. Int J Oncol 21:841–846PubMed Kurokohchi K, Watanabe S, Masaki T et al (2002) Combined use of percutaneous ethanol injection and radiofrequency ablation for the effective treatment of hepatocelluar carcinoma. Int J Oncol 21:841–846PubMed
22.
Zurück zum Zitat Kuang M, Lu MD, Xie XY et al (2007) Liver cancer: increased microwave delivery to ablation zone with cooled-shaft antenna–experimental and clinical studies. Radiology 242:914–924PubMedCrossRef Kuang M, Lu MD, Xie XY et al (2007) Liver cancer: increased microwave delivery to ablation zone with cooled-shaft antenna–experimental and clinical studies. Radiology 242:914–924PubMedCrossRef
23.
Zurück zum Zitat Liu Y, Zheng Y, Li S, Li B, Zhang Y, Yuan Y (2013) Percutaneous microwave ablation of larger hepatocellular carcinoma. Clin Radiol 68:21–26PubMedCrossRef Liu Y, Zheng Y, Li S, Li B, Zhang Y, Yuan Y (2013) Percutaneous microwave ablation of larger hepatocellular carcinoma. Clin Radiol 68:21–26PubMedCrossRef
24.
Zurück zum Zitat Yin XY, Xie XY, Lu MD et al (2009) Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer 115:1914–1923PubMedCrossRef Yin XY, Xie XY, Lu MD et al (2009) Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer 115:1914–1923PubMedCrossRef
25.
Zurück zum Zitat Qian J, Feng GS, Vogl T (2003) Combined interventional therapies of hepatocellular carcinoma. World J Gastroenterol 9:1885–1891PubMed Qian J, Feng GS, Vogl T (2003) Combined interventional therapies of hepatocellular carcinoma. World J Gastroenterol 9:1885–1891PubMed
26.
Zurück zum Zitat Min JH, Lee MW, Cha DI et al (2013) Radiofrequency ablation combined with chemoembolization for intermediate-sized (3–5 cm) hepatocellular carcinomas under dual guidance of biplane fluoroscopy and ultrasonography. Korean J Radiol 14:248–258PubMedCentralPubMedCrossRef Min JH, Lee MW, Cha DI et al (2013) Radiofrequency ablation combined with chemoembolization for intermediate-sized (3–5 cm) hepatocellular carcinomas under dual guidance of biplane fluoroscopy and ultrasonography. Korean J Radiol 14:248–258PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Morimoto M, Numata K, Kondou M, Nozaki A, Morita S, Tanaka K (2010) 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 116:5452–5460PubMedCrossRef Morimoto M, Numata K, Kondou M, Nozaki A, Morita S, Tanaka K (2010) 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 116:5452–5460PubMedCrossRef
28.
Zurück zum Zitat Lu MD, Yin XY, Xie XY et al (2005) Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy. Br J Surg 92:1393–1398PubMedCrossRef Lu MD, Yin XY, Xie XY et al (2005) Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy. Br J Surg 92:1393–1398PubMedCrossRef
29.
Zurück zum Zitat Kim YS, Rhim H, Cho OK, Koh BH, Kim Y (2006) Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol 59:432–441PubMedCrossRef Kim YS, Rhim H, Cho OK, Koh BH, Kim Y (2006) Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol 59:432–441PubMedCrossRef
30.
Zurück zum Zitat Nakazawa T, Kokubu S, Shibuya A et al (2007) Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol 188:480–488PubMedCrossRef Nakazawa T, Kokubu S, Shibuya A et al (2007) Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol 188:480–488PubMedCrossRef
31.
Zurück zum Zitat Dodd GD 3rd, Frank MS, Aribandi M, Chopra S, Chintapalli KN (2001) Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations. AJR Am J Roentgenol 177:777–782PubMedCrossRef Dodd GD 3rd, Frank MS, Aribandi M, Chopra S, Chintapalli KN (2001) Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations. AJR Am J Roentgenol 177:777–782PubMedCrossRef
32.
Zurück zum Zitat Kudo M (2004) Local ablation therapy for hepatocellular carcinoma: current status and future perspectives. J Gastroenterol 39:205–214PubMedCrossRef Kudo M (2004) Local ablation therapy for hepatocellular carcinoma: current status and future perspectives. J Gastroenterol 39:205–214PubMedCrossRef
33.
Zurück zum Zitat Shi M, Zhang CQ, Zhang YQ, Liang XM, Li JQ (2004) Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin. World J Surg 28:376–381PubMedCrossRef Shi M, Zhang CQ, Zhang YQ, Liang XM, Li JQ (2004) Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin. World J Surg 28:376–381PubMedCrossRef
34.
Zurück zum Zitat Zytoon AA, Ishii H, Murakami K et al (2007) Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome. Jpn J Clin Oncol 37:658–672PubMedCrossRef Zytoon AA, Ishii H, Murakami K et al (2007) Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome. Jpn J Clin Oncol 37:658–672PubMedCrossRef
35.
Zurück zum Zitat Nishikawa H, Osaki Y, Iguchi E et al (2012) Percutaneous radiofrequency ablation for hepatocellular carcinoma: clinical outcome and safety in elderly patients. J Gastrointest Liver Dis 21:397–405 Nishikawa H, Osaki Y, Iguchi E et al (2012) Percutaneous radiofrequency ablation for hepatocellular carcinoma: clinical outcome and safety in elderly patients. J Gastrointest Liver Dis 21:397–405
Metadaten
Titel
Combined radiofrequency ablation and ethanol injection with a multipronged needle for the treatment of medium and large hepatocellular carcinoma
verfasst von
Guangliang Huang
Manxia Lin
Xiaoyan Xie
Baoxian Liu
Zuofeng Xu
Riccardo Lencioni
Mingde Lu
Ming Kuang
Publikationsdatum
01.07.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 7/2014
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3151-8

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