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

  • Interventional
  • Published:
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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

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References

  1. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

  2. 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 234:63–70

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Livraghi T, Meloni F (2002) Treatment of hepatocellular carcinoma by percutaneous interventional methods. Hepatogastroenterology 49:62–71

    PubMed  Google Scholar 

  4. Shiina S, Tateishi R, Imamura M et al (2012) Percutaneous ethanol injection for hepatocellular carcinoma: 20-year outcome and prognostic factors. Liver Int 32:1434–1442

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Shiina S, Teratani T, Obi S et al (2005) A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 129:122–130

    Article  PubMed  Google Scholar 

  6. 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 234:961–967

    Article  PubMed  Google Scholar 

  7. 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 47:82–89

    Article  PubMed  Google Scholar 

  8. 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 242:158–171

    Article  PubMed Central  PubMed  Google Scholar 

  9. 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 253:552–561

    Article  PubMed  Google Scholar 

  10. 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 232:260–271

    Article  PubMed  Google Scholar 

  11. Goldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235:728–739

    Article  PubMed Central  PubMed  Google Scholar 

  12. 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 127:1714–1723

    Article  PubMed  Google Scholar 

  13. 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 11:914–921

    Article  CAS  PubMed  Google Scholar 

  14. 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 238:346–353

    Article  PubMed  Google Scholar 

  15. Livraghi T, Goldberg SN, Lazzaroni S et al (2000) Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 214:761–768

    Article  CAS  PubMed  Google Scholar 

  16. Giorgio A, Tarantino L, de Stefano G et al (2003) Percutaneous sonographically guided saline-enhanced radiofrequency ablation of hepatocellular carcinoma. AJR Am J Roentgenol 181:479–484

    Article  PubMed  Google Scholar 

  17. 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 13:717–724

    Article  PubMed  Google Scholar 

  18. 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 13:1225–1232

    Article  PubMed  Google Scholar 

  19. 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 95:2353–2360

    Article  PubMed  Google Scholar 

  20. 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 217:827–831

    Article  CAS  PubMed  Google Scholar 

  21. 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 21:841–846

    CAS  PubMed  Google Scholar 

  22. 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 242:914–924

    Article  PubMed  Google Scholar 

  23. Liu Y, Zheng Y, Li S, Li B, Zhang Y, Yuan Y (2013) Percutaneous microwave ablation of larger hepatocellular carcinoma. Clin Radiol 68:21–26

    Article  CAS  PubMed  Google Scholar 

  24. 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 115:1914–1923

    Article  CAS  PubMed  Google Scholar 

  25. Qian J, Feng GS, Vogl T (2003) Combined interventional therapies of hepatocellular carcinoma. World J Gastroenterol 9:1885–1891

    PubMed  Google Scholar 

  26. 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 14:248–258

    Article  PubMed Central  PubMed  Google Scholar 

  27. 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 116:5452–5460

    Article  PubMed  Google Scholar 

  28. Lu MD, Yin XY, Xie XY et al (2005) Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy. Br J Surg 92:1393–1398

    Article  PubMed  Google Scholar 

  29. 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 59:432–441

    Article  CAS  PubMed  Google Scholar 

  30. 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 188:480–488

    Article  PubMed  Google Scholar 

  31. 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 177:777–782

    Article  PubMed  Google Scholar 

  32. Kudo M (2004) Local ablation therapy for hepatocellular carcinoma: current status and future perspectives. J Gastroenterol 39:205–214

    Article  PubMed  Google Scholar 

  33. Shi M, Zhang CQ, Zhang YQ, Liang XM, Li JQ (2004) Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin. World J Surg 28:376–381

    Article  PubMed  Google Scholar 

  34. 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 37:658–672

    Article  PubMed  Google Scholar 

  35. 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

    Google Scholar 

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Acknowledgements

The scientific guarantor of this publication is Xiaoyan Xie. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in ECIO 2012. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China

    Guangliang Huang, Manxia Lin, Xiaoyan Xie, Baoxian Liu & Zuofeng Xu

  2. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China

    Mingde Lu & Ming Kuang

  3. Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China

    Manxia Lin, Xiaoyan Xie, Mingde Lu & Ming Kuang

  4. Division of Diagnostic and Interventional Radiology, Department of Oncology, Transplant and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy

    Riccardo Lencioni

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  1. Guangliang Huang
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  2. Manxia Lin
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Correspondence to Xiaoyan Xie or Ming Kuang.

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Huang, G., Lin, M., Xie, X. et al. Combined radiofrequency ablation and ethanol injection with a multipronged needle for the treatment of medium and large hepatocellular carcinoma. Eur Radiol 24, 1565–1571 (2014). https://doi.org/10.1007/s00330-014-3151-8

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  • DOI: https://doi.org/10.1007/s00330-014-3151-8

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