High-intensity focused ultrasound ablation:An effective bridging therapy for hepatocellular carcinoma patients
�. TanTøCheungSheungTatJunpeng FanChingChanKenneth KennethSh ShChokFerdinandSkChuCaroline CarolineJenkinsRéginaLóJames JamesYyFungAlbertWilliam WilliamSharr
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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
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Objective: To investigate the clinical role of transcatheter arterial chemoembolization ( TACE) combined with percutaneous radiofrequency ablation(RFA) in the treatment of large hepatic tumors. Methods: All of 42 patients with hepatocellular carcinomas were divided into three groupsCombination group consisted of14 patients ,received a combination therapy of TACE and RFA ;Fifteen patients were given the second TACE therapy only . And 13 patients with RFA therapy were the third group. The tumor necrosis rate and mean survival duration were observed. Results: Tumor necrosis rate was 78.6% in combination group , which was significantly higher than those in TACE group and RFA group (26.7%、46.2% ,P 0.05).Tumor local recurrence was 21.4%、46.7% and 38.5% in the combination group、 TACE group and RFA group . And there was no significant difference among the three groups(P0.05). Mean survival duration of combination group was 25.1 months, which was higher than that in TACE group (14.6 months)(P0.05).But it was similar to RFA group (19.9months)(P0.05). Conclusions: Compared with TACE or RFA therapy ,the combination therapy improved tumor necrosis rate and prolonged the patients′survival duration.
Transcatheter arterial chemoembolization
Combination therapy
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// Duan Feng 1 , Bai Yan-Hua 1 , Cui Li 1 , Li Xiao-Hui 1 and Yan Jie-Yu 1 1 Department of Interventional Radiology, The General Hospital of Chinese People’s Liberation Army, Beijing 100853, China Correspondence to: Duan Feng, email: duanfeng@vip.sina.com Keywords: chemoembolization; radiofrequency; hepatocellular carcinoma; simultaneous combination Received: August 21, 2017 Accepted: November 16, 2017 Epub: January 02, 2018 ABSTRACT Aims : To evaluate the recurrence and mid-term survival in patients with large hepatocellular carcinoma (HCC, diameter ≥ 8 cm) after simultaneous transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA). Materials and Methods : From March 2010 to Nov 2013, 46 consecutive patients of HCC with large HCC (8.17 – 8.80 cm; 8.40 ± 2.62 cm) were treated by simultaneous TACE combined with RFA, with single tumor in 35 of 46 patients. Progressive free survival (PFS) and overall survival (OS) were retrospectively analyzed. Results : 46 sessions of simultaneous TACE combined with RFA were performed successfully without significant complications. The PFS and OS median survival time were 9.40 ± 1.31 or 18.43 ± 1.34 months at 2-year, 10.21 ± 1.58 or 26.44 ± 2.26 months at 3-year, respectively. Patient survival rates were 67.50% at 2 year and 55.67% at 3years, respectively. Of patients with progression, comprehensive treatment including TACE and sorafenib was performed. Conclusions : Simultaneous TACE combined with RFA is a safe and effective treatment modality in patients with large HCCs, the preliminary data make it a promising treatment modality.
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To study high intensity focused ultrasound (HIFU) therapy combined with transcatheter arterial chemoembolization (TACE) in the treatment of patients with advanced hepatocellular carcinoma (HCC).Fifty patients with unresectable HCC (TNM stage IV) were randomized into a TACE (T) group and a TACE plus HIFU (T + H) group. Twenty-six patients underwent TACE alone, and 24 HIFU ablation 2 - 3 weeks after TACE. The mean follow-up time for all patients was 8.16 +/- 2.79 months (range 3 to 24 months). The median survival, 6-month-, 1-year survival rates and average survival of patients who died were calculated by Kaplan-Meier method and Fisher exact test.The median survival time, 6-month and 1-year survival rates were 11.3 months, 80.4 - 85.4% and 42.9% in T + H group, in contrast to 4 months, 13.2% and 0% in T group with significant differences (P < 0.01). The average survival time of patients who died was 10.21 +/- 4.12 months in T + H group, as compared with 4.35 +/- 2.39 months in T group also with significant differences (P < 0.01).High intensity focused ultrasound therapy (HIFU) combined with transcatheter arterial chemoembolization (TACE), being better than TACE alone, may become one of the most effective treatments for patients with unresectable HCC.
Transcatheter arterial chemoembolization
High-intensity focused ultrasound
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Objective: To explore the Clinical treatment effect of TACE combined with Focused Ultrasound Knife in advanced liver cancer. Method: Sixty patients with advanced hepatocellular carcinoma admitted to the Second Hospital of Suichang County from October 2011 to October 2017 were selected as study subjects (all patients had no TACE), divided into control group and observation group according to random number table with 30 cases in each group. The control group was treated with single TACE, as well as the observation group plus Focused Ultrasound Knife. The curative effect and adverse reactions of the two groups were compared. Results :After 3 months’ follow-up, the tumor shrinkage > 50% and the complete necrosis rate in the observation group were higher than those in the control group ( P 0.05). Conclusion: Combination of TACE and Focused Ultrasound Knife can increase the necrosis rate in the clinical treatment of advanced hepatocellular carcinoma.
Liver Cancer
Focused Ultrasound
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Transcatheter arterial chemoembolization
Group B
Group A
Therapeutic effect
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Radiofrequency ablation (RFA) followed by transarterial chemoembolization (TACE) for unresectable primary liver cancer (PLC) has not been widely discussed. In this study, the outcome of the combination of RFA with TACE was retrospectively evaluated.From May 2003 to March 2008, 127 consecutive PLC patients with a median age of 56.4 +/- 8.8 years underwent RFA plus TACE. All patients were deemed to have unresectable PLC based on their tumor characteristics. The maximal diameter of the tumor was between 1.5 cm and 10.0 cm. Twenty-six cases with small ( 5.0 cm) tumors were included in this study. RFA was performed using a RITA Medical Systems expandable electrode device, which was followed by first-time TACE administration one to two months later.Technical success of RFA was achieved in all 127 patients with no severe treatment-related complications. RFA was performed percutaneously in 16 (13.5%) cases, by laparoscopic approach in 19 (15.7%), and through laparotomy in the remaining 92 (72.4%). RFA response was classified as complete ablation in 48 cases, nearly complete ablation in 28, and partial ablation in 51. The total 1-, 2-, and 3-year survival rates after RFA were 83.1%, 55.7%, and 43.7%, respectively. The survival rates at 3 years were 78.6%, 28.1%, and 0 for complete ablation, nearly complete ablation, or partial ablation groups, respectively. Three-year disease-free survival rates for the complete ablation and nearly complete ablation groups were 50.3% and 21.3%, respectively. RFA response and liver function were significant variables influencing survival time as analyzed using the Cox regression model.RFA could be the first-line exterminate treatment for unresectable PLC, and TACE following RFA may assist in eradicating the peripheral viable tissue and micro-metastasis.
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Purpose To compare radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC). Patients and Methods A randomized controlled trial was conducted on 189 patients with HCC less than 7 cm at a single tertiary referral center between October 2006 and June 2009. Patients were randomly asssigned to receive TACE combined with RFA (TACE-RFA; n = 94) or RFA alone (n = 95). The primary end point was overall survival. The secondary end point was recurrence-free survival, and the tertiary end point was adverse effects. Results At a follow-up of 7 to 62 months, 34 patients in the TACE-RFA group and 48 patients in the RFA group had died. Thirty-three patients and 52 patients had developed recurrence in the TACE-RFA group and RFA group, respectively. The 1-, 3-, and 4-year overall survivals for the TACE-RFA group and the RFA group were 92.6%, 66.6%, and 61.8% and 85.3%, 59%, and 45.0%, respectively. The corresponding recurrence-free survivals were 79.4%, 60.6%, and 54.8% and 66.7%, 44.2%, and 38.9%, respectively. Patients in the TACE-RFA group had better overall survival and recurrence-free survival than patients in the RFA group (hazard ratio, 0.525; 95% CI, 0.335 to 0.822; P = .002; hazard ratio, 0.575; 95% CI, 0.374 to 0.897; P = .009, respectively). There were no treatment-related deaths. On logistic regression analyses, treatment allocation, tumor size, and tumor number were significant prognostic factors for overall survival, whereas treatment allocation and tumor number were significant prognostic factors for recurrence-free survival. Conclusion TACE-RFA was superior to RFA alone in improving survival for patients with HCC less than 7 cm.
Transcatheter arterial chemoembolization
Clinical endpoint
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Objective To evaluate the efficacy of tanscatheter arterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) in treatment of large hepatocellular carcinoma.Methods A retrospective analysis was performed of 66 patients with hepatocellular carcinoma who received different treatments during April 2006-July 2008.The patients were divided into 3 groups:19 patients in TACE + RFA group,24 patients in TACE group,and 23 patients in RFA group.Results The complete necrosis rate of tumor accounted for 73.68% in TACE + RFA group which was significantly higher than that of TACE group and RFA group(50.00%,and 52.17%,respectively,P 0.01,P 0.05).The local recurrence rates of tumor in TACE + RFA group,TACE group,and RFA group were 26.32%,37.5% and 30.43%(P 0.05).Mean survival time of patients in TACE + RFA group was 28.3 months,which was higher than that of TACE group and RFA group(13.6 months,21.7 months,P 0.01,P 0.05).Conclusion Percutaneous transcatheter arterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) in primary large hepatocellular carcinoma could improve tumor complete necrosis rate and extend the patient's survival time.
Transcatheter arterial chemoembolization
Group B
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Objective:To compare radiofrequency ablation(RFA) or microwave ablation(MWA) and transcatheter arterial chemoembolization(TACE) with RFA or MWA monotherapy in hepatocellular carcinoma(HCC).Methods:A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA(combined treatment group) and the RFA-alone or MWA-alone groups(control group).The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results:Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months(range,29 to 62 months).The 1-,3- and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6%,68.1% and 61.7%,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months(range,28 to 62 months).The 1-,3- and 5-year overall survival for the RFA or MWA group was 85.1%,59.6% and 44.7%,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio(HR),0.526;95% confidence interval(95% CI),0.334-0.823;P=0.002],and showed better recurrence-free survival than the RFA or MWA group(HR,0.582;95% CI,0.368-0.895;P=0.008).Conclusions:RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA.
Microwave ablation
Transcatheter arterial chemoembolization
Clinical endpoint
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Objective To discuss the effect of transcatheter arterial chemoembolization(TACE) combined with CT guided by radio frequency ablation(RFA) as a comprehensive treatment for liver cancer.Methods According to principle of odd or even,45 patients from Xiangyang Hospital of Traditional Chinese Medicine during July 2008 and February 2011 were selected and divided into two groups:combined therapy group(20 cases) and TACE group(25 cases).The tumor necrosis degree,AFP index change,tumor recurrence rate and the one-year survival rate two-year survival rate were assessed.Results The combined therapy group was better than TACE group with significant differences(P0.05).One-year and two-year survival rate(95% and 70%) of combined therapy group were both higher than that of TACE group(60% and 40%),and the first relapse rate(10%) was significantly lower than TACE group(48%)(P0.05).Conclusion TACE combination with CT guided RFA is a safe and effective method for treating liver cancer,with a better curative effect than the simple TACE.
Transcatheter arterial chemoembolization
Liver Cancer
Combination therapy
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