High-intensity focused ultrasound ablation:An effective bridging therapy for hepatocellular carcinoma patients
�. TanTøCheungSheungTatJunpeng FanChingChanKenneth KennethSh ShChokFerdinandSkChuCaroline CarolineJenkinsRéginaLóJames JamesYyFungAlbertWilliam WilliamSharr
0
Citation
0
Reference
20
Related Paper
Abstract:
AIM:To analyze whether high-intensity focused ultrasound(HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma(HCC).METHODS:From January 2007 to December 2010,49 consecutive HCC patients were listed for liver transplantation(UCSF criteria).The median waiting time for transplantation was 9.5 mo.Twenty-nine patients received transarterial chemoembolization(TACE) as a bringing therapy and 16 patients received no treatment before transplantation.Five patients received HIFU ablation as a bridging therapy.Another five patients with the same tumor staging(within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison.Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores,tumor size and number,and cause of cirrhosis.RESULTS:The HIFU group and TACE group showed no difference in terms of tumor size and tumor number.One patient in the HIFU group and no patient in the TACE group had gross ascites.The median hospital stay was 1 d(range,1-21 d) in the TACE group and two days(range,1-9 d) in the HIFU group(P < 0.000).No HIFU-related complication occurred.In the HIFU group,nine patients(90%) had complete response and one patient(10%) had partial response to the treatment.In the TACE group,only one patient(3%) had response to the treatment while 14 patients(48%) had stable disease and 14 patients(48%) had progressive disease(P = 0.00).Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list(P = 0.559).CONCLUSION:HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis.It may reduce the drop-out rate of liver transplant candidate.Keywords:
High-intensity focused ultrasound
Cite
Objectives: To investigate the efficacy and safety of RFA in treating primary hepatocellular carcinoma. Methods: Eighty-one patients with total 114 tumors were treated with radiofrequency ablation combined with TACE. Preoperative and postprocedural CT scans were taken in all patients. During follow-up patients underwent enhanced CT in every 2-3 month interval. Results: Median following-up duration was 30 ± 10.9months (17~49). The median survival time was 34 monthes (95%CI: 18-49 mo.).1-,2and 3-year survival rate was 96.6%,93.2% and 68.2%,respectively. 57 patients who were still alive when following-up ended. Conclusions: Radiofrequency ablation combined with TACE is effective and reliable in treating primary hepatocellular carcinoma. It may prolong the survival of the patients.
Transcatheter arterial chemoembolization
Cite
Citations (0)
High-intensity focused ultrasound
Cite
Citations (42)
Complete response
Percutaneous ethanol injection
Cite
Citations (62)
Lipiodol
Milan criteria
Transcatheter arterial chemoembolization
Cite
Citations (4)
Microwave ablation
Single Center
Cite
Citations (57)
To retrospectively evaluate possible impact factors of HIFU treatment outcome for unresectable pancreatic cancer patients.A total of 689 patients with unresectable pancreatic cancer were recruited in our center from December 30, 2007 to January 30, 2015. 436 patients with unresectable pancreatic cancers received HIFU treatment; the other 253 patients received non-HIFU treatment. Among these 436 patients, 345 patients received a one-time HIFU treatment, 91 patients received HIFU treatment from 2 to 5 times in the same pancreatic mass; 89 patients received HIFU treatment alone; 347 patients received HIFU-based combined therapies. Complications and overall survivals (OS) data in each group were collected.The median overall survivals (mOS) in HIFU group and non-HIFU group were 7.1 vs. 5 months (P=0.005): 9.3 vs. 7.3 months (P=0.202) for patients with stage II disease, 8.3 vs. 7.3 months (P=0.783) for patients with stage III disease, and 6.4 vs. 4.2 months (P<0.0001) for patients with stage IV disease, respectively. Furthermore, there was a significant difference between repeated HIFU and one-time HIFU (mOS: 8.6 vs. 6.8 months, P=0.011). Time of HIFU treatment (P=0.0027), chemotherapy (P<0.0001), radiotherapy (P=0.0006), regional intra-arterial chemotherapy (RIAC) (P<0.0001), and stage (P<0.0001) were independent prognostic factors for the patients who received HIFU treatment. Cox analysis on the relative risk of prognostic factors showed that repeated HIFU vs. one-time HIFU (HR=0.729: 95% CI=0.576-0.924), chemotherapy vs. non-chemotherapy (HR=0.664: 95% CI=0.576-0.766), radiotherapy vs. non-radiotherapy (HR=0.580: 95% CI=0.427-0.789), RIAC vs. non-RIAC (HR=0.737: 95% CI=0.648-0.837), and stage (HR=1.386, 95% CI=1.187-1.619) were associated with significantly inferior survival. Overall, adverse events occurred in 23.2% (101/436) in the HIFU group, which included increase of serum or urinary amylase levels, incomplete intestinal obstruction, mild fever, etc. There were no severe adverse events such as skin burns or GI perforation related to HIFU therapy in any of the patients treated.This retrospective analysis revealed that the use of a multimodal treatment approach (the combined therapy of HIFU, RIAC, and chemotherapy, with or without radiotherapy) could improve survival of patients with unresectable pancreatic cancer, and repeated HIFU presented a survival benefit and did not increase risk.
High-intensity focused ultrasound
Cite
Citations (13)
Objective To compare the efficacy and adverse effects of transcatheter hepatic arterial chem oembolization(TACE) combined with high intensity focused ultrasound(HIFU) and TACE combined with three-dimensional conformal radiotherapy(3-DCRT) on patients with portal vein tumor thrombosis(PVTT). Methods Data of hospitalized 65 patients with hepatocellular carcinoma(HCC) combined with PVTT were retrospectively analyzed. They were divided into two groups randomly, Group A, 34 cases received TACE combined with HIFU, and Group B, 31 cases received TACE combined with 3-DCRT. Response rate, overall survival and adverse effects were evaluated between two groups. Results The total response rate was 70.59%(24/34) in Group A and 67.74%(21/31) in Group B, with no significant difference(P=0.804). The overall survival rates at 0.5, 1 and 2 years were 91.12%(31/34), 61.76%(21/34) and 20.59%(7/34) in Group A, and 87.10%(27/31), 64.52%(20/31) and 16.13%(5/31) in Group B. The median survival time were 13.4 months(range: 3.8-25.6) in Group A and 12.6 months(range: 4.3-24.8) in Group B, with no significant difference(P=0.167). The occurance rates of adverse effects in Group B were much higher than those in Group A. Conclusion TACE combined with HIFU and 3-DCRT separately are both safe and effective approaches in the treatment of PVTT patients, while HIFU was superior to 3-DCRT on adverse effects.
High-intensity focused ultrasound
Portal vein thrombosis
Group B
Group A
Cite
Citations (0)
Transcatheter arterial chemoembolization
High-intensity focused ultrasound
Cite
Citations (14)
Interventional radiology
Neuroradiology
Cite
Citations (37)
To study on the efficacy, prognosis and security of high-intensity focused ultrasound (HIFU) combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC).Totally 72 HCC patients treated by HIFU from December 2009 to January 2011 were divided into two groups according to treatment methods: 40 cases in HIFU group, 32 cases in TACE + HIFU treatment group (combined group). Then set up a control group include 40 cases treated by only TACE in the same period (TACE group). The improvement of clinical symptoms, AFP, reduce rate of tumor volume, survival rate of 1 year after operation and postoperative complications in front and behind the treatment were analyzed.There was no significant statistical difference on the improvement of clinical symptoms in all these three groups (P > 0.05) after treatment for HCC. There is no significant statistical difference also on reduce rate of tumor volume and decrease rate of AFP in both HIFU group (35.0%, 41.4%) and TACE group (37.5%, 41.9%) (χ² = 0.054, P = 0.816; χ² = 0.002, P = 0.965). Both reduce rate of tumor volume (62.5%) and decrease rate of AFP (72.0%) in combined group were better than HIFU group (χ² = 5.394, P = 0.020; χ² = 5.098, P = 0.024) and TACE group (37.5%, 41.9%) (χ² = 4.448, P = 0.035; χ² = 5.062, P = 0.024). Kaplan-Meier survival curve showed that there was no significant statistical difference on short-term survival rate in the 3 groups. But the long-term survival rate of combined group was better than TACE group and HIFU group.TACE combined with HIFU is a effective, safe and noninvasive treatment method to HCC.
High-intensity focused ultrasound
Transcatheter arterial chemoembolization
Focused Ultrasound
Cite
Citations (5)