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Image-guided percutaneous ablation therapies for hepatocellular carcinoma

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Abstract

Image-guided percutaneous ablation therapies have been playing important roles in the treatment of hepatocellular carcinoma (HCC). In our department, we have treated 90% of previously untreated patients with ablation therapies. Among various local ablation therapies, radiofrequency ablation has been replacing ethanol injection as a standard therapy for patients who have unresectable HCC or who do not want surgery. Our randomized controlled trials and those of others proved that radiofrequency ablation is superior to ethanol injection. Radiofrequency ablation is potentially curative, minimally invasive, and easily repeated for recurrence. Long-term survival is notably high, and mortality and morbidity are low, in radiofrequency ablation. Further investigations are necessary to determine whether radiofrequency ablation can replace surgery for resectable hepatocellular carcinoma. In such trials, the primary endpoint must be overall survival. Recurrence-free survival can be misleading and cannot be a surrogate endpoint. There are still effective therapies after recurrence, and the first recurrence does not cause death in most cases. Furthermore, hepatectomy has theoretically better disease-free survival than radiofrequency ablation because it removes a larger amount of liver tissue. The better cure rate of resection can be canceled, however, by deterioration of liver function.

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References

  1. El-Serag HB. Hepatocellular carcinoma: an epidemiologic view. J Clin Gastroenterol 2002;35:S72–S78.

    Article  PubMed  Google Scholar 

  2. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 1999;340:745–750.

    Article  PubMed  CAS  Google Scholar 

  3. Taylor-Robinson SD, Foster GR, Arora S, Hargreaves S, Thomas HC. Increase in primary liver cancer in the UK, 1979-94. Lancet 1997;350:1142–1143.

    Article  PubMed  CAS  Google Scholar 

  4. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001;35:421–430.

    Article  PubMed  CAS  Google Scholar 

  5. Ryder SD. British Society of Gastroenterology. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut 2003;52(suppl 3):iii1–iii8.

    PubMed  Google Scholar 

  6. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003;362:1907–1917.

    Article  PubMed  Google Scholar 

  7. Balsells J, Charco R, Lazaro JL, Murio E, Vargas V, Allende E, et al. Resection of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 1996;83:758–761.

    Article  PubMed  CAS  Google Scholar 

  8. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693–699.

    Article  PubMed  CAS  Google Scholar 

  9. Sarasin FP, Giostra E, Mentha G, Hadengue A. Partial hepatectomy or orthotopic liver transplantation for the treatment of resectable hepatocellular carcinoma? A cost-effectiveness perspective. Hepatology 1998;28:436–442.

    Article  PubMed  CAS  Google Scholar 

  10. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999;30:1434–1440.

    Article  PubMed  CAS  Google Scholar 

  11. Sugiura N, Takara K, Ohto M, Okuda K, Hirooka N. Percutaneous intratumoral injection of ethanol under ultrasound imaging for treatment of small hepatocellular carcinoma. Acta Hepatol Jpn 1983;24:920.

    Google Scholar 

  12. Livraghi T, Festi D, Monti F, Salmi A, Vettori C. US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology 1986;161:309–312.

    PubMed  CAS  Google Scholar 

  13. Shiina S, Yasuda H, Muto H, Tagawa K, Unuma T, Ibukuro K, et al. Percutaneous ethanol injection in the treatment of liver neoplasms. AJR Am J Roentgenol 1987;149:949–952.

    PubMed  CAS  Google Scholar 

  14. Seki T, Wakabayashi M, Nakagawa T, Itho T, Shiro T, Kunieda K, et al. Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer (Phila) 1994;74:817–825.

    Article  CAS  Google Scholar 

  15. Rossi S, Di Stasi M, Buscarini E, Cavanna L, Quaretti P, Squassante E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am 1995;1:73–81.

    PubMed  CAS  Google Scholar 

  16. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 1999;210:655–661.

    PubMed  CAS  Google Scholar 

  17. Shiina S, Teratani T, Obi S, Hamamura K, Koike Y, Omata M. Nonsurgical treatment of hepatocellular carcinoma: from percutaneous ethanol injection therapy and percutaneous microwave coagulation therapy to radiofrequency ablation. Oncology 2002;62:64–68.

    Article  PubMed  CAS  Google Scholar 

  18. Shiina S, Teratani T, Obi S, Sato S, Tateishi R, Fujishima T, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 2005;129:122–130.

    Article  PubMed  Google Scholar 

  19. Lencioni RA, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003;228:235–240.

    Article  PubMed  Google Scholar 

  20. Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma ≤4 cm. Gastroenterology 2004;127:1714–1723.

    Article  PubMed  Google Scholar 

  21. Shiina S, Imamura M, Omata M. Percutaneous ethanol injection therapy (PEIT) for malignant liver neoplasms. Semin Interventional Radiol 1997;14:295–303.

    Google Scholar 

  22. Livraghi T, Giorgio A, Marin G, Salmi A, de Sio I, Bolondi L, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology 1995;197:101–108.

    PubMed  CAS  Google Scholar 

  23. Shiina S, Tagawa K, Unuma T, Takanashi R, Yoshiura K, Komatsu Y, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study. Cancer (Phila) 1991;68:1524–1530.

    Article  CAS  Google Scholar 

  24. Castells A, Bruix J, Bru C, Fuster J, Vilana R, Navasa M, et al. Treatment of small hepatocellular carcinoma in cirrhotic patients: a cohort study comparing surgical resection and percutaneous ethanol injection. Hepatology 1993;18:1121–1126.

    PubMed  CAS  Google Scholar 

  25. Livraghi T, Bolondi L, Buscarini L, Cottone M, Mazziotti A, Morabito A, et al. No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. Italian Cooperative HCC Study Group. J Hepatol 1995;22:522–526.

    Article  PubMed  CAS  Google Scholar 

  26. Lencioni R, Pinto F, Armillotta N, Bassi AM, Moretti M, Di Giulio M, et al. Long-term results of percutaneous ethanol injection therapy for hepatocellular carcinoma in cirrhosis: a European experience. Eur Radiol 1997;7:514–519.

    Article  PubMed  CAS  Google Scholar 

  27. Orlando A, D’Antoni A, Camma C, Albanese M, Livraghi T, Torzilli G, et al. Treatment of small hepatocellular carcinoma with percutaneous ethanol injection: a validated prognostic model. Am J Gastroenterol 2000;95:2921–2927.

    Article  PubMed  CAS  Google Scholar 

  28. Ikai I, Arii S, Okazaki M, Okita K, Omata M, Kojiro M, et al. Report of the 17th follow-up survey of primary liver cancer. Hepatol Res 2007;37:676–691.

    Article  PubMed  Google Scholar 

  29. Omata M, Tateishi R, Yoshida H, Shiina S. Treatment of hepatocellular carcinoma by percutaneous tumor ablation methods: ethanol injection therapy and radiofrequency ablation. Gastroenterology 2004;127:S159–S166.

    Article  PubMed  Google Scholar 

  30. Huang GT, Lee PH, Tsang YM, Lai MY, Yang PM, Hu RH, et al. Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma: a prospective study. Ann Surg 2005;242:36–42.

    Article  PubMed  Google Scholar 

  31. Ikai I, Itai Y, Okita K, Omata M, Kojiro M, Kobayashi K, et al. Report of the 15th follow-up survey of primary liver cancer. Hepatol Res 2004;28:21–29.

    Article  PubMed  Google Scholar 

  32. Curley SA, Izzo F, Ellis LM, Nicolas Vauthey J, Vallone P. Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg 2000;232:381–391.

    Article  PubMed  CAS  Google Scholar 

  33. Siperstein A, Garland A, Engle K, Rogers S, Berber E, String A, et al. Laparoscopic radiofrequency ablation of primary and meta-static liver tumors. Technical considerations. Surg Endosc 2000;14:400–405.

    Article  PubMed  CAS  Google Scholar 

  34. Ishikawa T, Kohno T, Shibayama T, Fukushima Y, Teratani T, Shiina S, et al. Thoracoscopic thermal ablation therapy for hepatocellular carcinoma located beneath the diaphragm. Endoscopy 2001;33:697–702.

    Article  PubMed  CAS  Google Scholar 

  35. Goldberg SN. Radiofrequency tumor ablation: principles and techniques. Eur J Ultrasound 2001;13:129–147.

    Article  PubMed  CAS  Google Scholar 

  36. Teratani T, Yoshida H, Shiina S, Obi S, Sato S, Tateishi R, et al. Radiofrequency ablation for hepatocellular carcinoma in socalled high-risk locations. Hepatology 2006;43:1101–1108.

    Article  PubMed  Google Scholar 

  37. Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 2005;54:1151–1156.

    Article  PubMed  CAS  Google Scholar 

  38. Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006;243:321–328.

    Article  PubMed  Google Scholar 

  39. Kondo Y, Yoshida H, Shiina S, Tateishi R, Teratani T, Omata M. Artificial ascites technique for percutaneous radiofrequency ablation of liver cancer adjacent to the gastrointestinal tract. Br J Surg 2006;93:1277–1282.

    Article  PubMed  CAS  Google Scholar 

  40. Llovet JM, Vilana R, Bru C, Bianchi L, Salmeron JM, Boix L, et al. Barcelona Clinic Liver Cancer (BCLC) Group. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001;33:1124–1129.

    Article  PubMed  CAS  Google Scholar 

  41. Koda M, Ueki M, Maeda Y, Mimura K, Okamoto K, Matsunaga Y, et al. Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm. AJR Am J Roentgenol 2004;183:583–588.

    PubMed  Google Scholar 

  42. Ono K, Kokubu S, Hidaka H, Watanabe M, Nakazawa T, Saigenji K. Risk factors of delay in restoration of hepatic reserve capacity and local recurrence after radiofrequency ablation therapy for hepatocellular carcinoma (HCC). Hepatol Res 2005;31:172–177.

    Article  PubMed  CAS  Google Scholar 

  43. Hori T, Nagata K, Hasuike S, Onaga M, Motoda M, Moriuchi A, et al. Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol 2003;38:977–981.

    Article  PubMed  Google Scholar 

  44. Komorizono Y, Oketani M, Sako K, Yamasaki N, Shibatou T, Maeda M, et al. Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer (Phila) 2003;97:1253–1262.

    Article  Google Scholar 

  45. Rossi S, Di Stasi M, Buscarini E, Quaretti P, Garbagnati F, Squassante L, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. AJR Am J Roentgenol 1996;167:759–768.

    PubMed  CAS  Google Scholar 

  46. Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A. Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results. Eur Radiol 2001;11:914–921.

    Article  PubMed  CAS  Google Scholar 

  47. Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J, et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 2005;234:961–967.

    Article  PubMed  Google Scholar 

  48. Machi J, Bueno RS, Wong LL. Long-term follow-up outcome of patients undergoing radiofrequency ablation for unresectable hepatocellular carcinoma. World J Surg 2005;29:1364–1373.

    Article  PubMed  Google Scholar 

  49. Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer (Phila) 2005;103:1201–1209.

    Article  Google Scholar 

  50. Cabassa P, Donato F, Simeone F, Grazioli L, Romanini L. Radiofrequency ablation of hepatocellular carcinoma: long-term experience with expandable needle electrodes. AJR Am J Roentgenol 2006;186:S316–S321.

    Article  PubMed  Google Scholar 

  51. Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, et al. Complications of radiofrequency coagulation of liver tumors. Br J Surg 2002;89:1206–1222.

    Article  PubMed  CAS  Google Scholar 

  52. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003;226:441–451.

    Article  PubMed  Google Scholar 

  53. Rhim H, Yoon KH, Lee JM, Cho Y, Cho JS, Kim SH, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics 2003;23:123–134.

    Article  PubMed  Google Scholar 

  54. Kasugai H, Osaki Y, Oka H, Kudo M, Seki T. Osaka Liver Cancer Study Group. Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3891 ablations in 2614 patients. Oncology 2007;72:S72–S75.

    Article  Google Scholar 

  55. Makuuchi M, Kokudo N, Arii S, Futagawa S, Kaneko S, Kawasaki S, et al. Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. Hepatol Res 2008;38:37–51.

    Article  PubMed  Google Scholar 

  56. Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, et al. Results of surgical and nonsurgical treatment for smallsized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 2000;32:1224–1229

    Article  PubMed  CAS  Google Scholar 

  57. Ryu M, Shimamura Y, Kinoshita T, Konishi M, Kawano N, Iwasaki M, et al. Therapeutic results of resection, transcatheter arterial embolization and percutaneous transhepatic ethanol injection in 3225 patients with hepatocellular carcinoma: a retrospective multicenter study. Jpn J Clin Oncol 1997;27:251–257.

    Article  PubMed  CAS  Google Scholar 

  58. Livraghi T, Bolondi L, Buscarini L, Cottone M, Mazziotti A, Morabito A, et al. No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. Italian Cooperative HCC Study Group. J Hepatol 1995;22:522–526.

    Article  PubMed  CAS  Google Scholar 

  59. Castells A, Bruix J, Bru C, Fuster J, Vilana R, Navasa M, et al. Treatment of small hepatocellular carcinoma in cirrhotic patients: a cohort study comparing surgical resection and percutaneous ethanol injection. Hepatology 1993;18:1121–1126.

    PubMed  CAS  Google Scholar 

  60. Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005;42:1208–1236.

    Article  PubMed  Google Scholar 

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  1. Department of Gastroenterology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Shuichiro Shiina

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Shiina, S. Image-guided percutaneous ablation therapies for hepatocellular carcinoma. J Gastroenterol 44 (Suppl 19), 122–131 (2009). https://doi.org/10.1007/s00535-008-2263-9

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