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  Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 52  |  Issue : 6  |  Page : 102-104
 

Ultrasonic guided percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas


1 Department of Ultrasound Imaging, Jingmen No. 1 People's Hospital, Hubei Province 448000, PR, China
2 Department of Hepatobiliary Surgery, Jingmen No. 1 People's Hospital, Hubei Province 448000, PR, China
3 Department of Ultrasound Imaging, Huangshi Central Hospital, Hubei Province 435000, PR, China

Date of Web Publication24-Dec-2015

Correspondence Address:
Y Lei
Department of Ultrasound Imaging, Huangshi Central Hospital, Hubei Province 435000
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.172503

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 » Abstract 

Objective: The aim of this retrospective study was to evaluate whether radiofrequency ablation (RFA) combined percutaneous ethanol injection (PEI) in the management of hepatocellular carcinoma (HCC) improves treatment outcomes. Patients and Methods: We retrospectively included 66 HCC patients who received RFA or RFA plus PEI from February 2011 to January 2014 in Jingmen No. 1 People's Hospital. Moreover, 31 cases received RFA plus PEI as the experiment group and 35 subjects treated with RFA aloe as the control group. The overall survival and treatment related complications were compared between the two groups. Results: For RFA group, the 1-year, 2-year, and 3-year survival rate were 82.0%, 69.3%, and 30.7%, respectively, with the median survival time of 27.1 months. For RFA plus PEI group, the 1-year, 2-year, and 3-year survival rate were 97.1%, 73.9%, and 37.5%, respectively, with the median survival time of 33.6 months. The overall survival of the two groups was not statistical different with the hazard ratio of 1.48 (P > 0.05); three cases of treatment associated complications were found in RFA group with 1 abscess, 1 pleural effusion, and 1 portal vein thrombosis. Moreover, 2 cases of complication were recorded in RFA plus PEI group with 1 pleural effusion and 1 portal vein thrombosis. The complicated incidence rate was not statistical different between the two groups (P < 0.05). Conclusion: The combination treatment of HCC was safe and had a slightly higher primary effectiveness rate than RFA alone.


Keywords: Clinical efficacy, hepatocellular carcinoma, percutaneous ethanol injection, radiofrequency ablation


How to cite this article:
Kai L, Jia L, Zhi-Gang W, Lei Y. Ultrasonic guided percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas. Indian J Cancer 2015;52, Suppl S2:102-4

How to cite this URL:
Kai L, Jia L, Zhi-Gang W, Lei Y. Ultrasonic guided percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas. Indian J Cancer [serial online] 2015 [cited 2019 Oct 19];52, Suppl S2:102-4. Available from: http://www.indianjcancer.com/text.asp?2015/52/6/102/172503



 » Introduction Top


Radiofrequency ablation (RFA) is a medical procedure, in which part of the electrical conduction system of tumor or other dysfunctional tissue is ablated using the heat generated from high frequency alternating current (in the range of 350–500 kHz).[1],[2] RFA may be performed to treat tumors in the lung,[3],[4] liver,[5] kidney,[6] and breast,[7] as well as other body organs less commonly. Once the diagnosis of tumor is confirmed, a needle-like RFA probe is placed inside the tumor. The radiofrequency waves passing through the probe increase the temperature within tumor tissue and results in destruction of the tumor. In 1983, the FRA was first introduced for hepatocellular carcinoma (HCC) treatment.[8] And then, the procedure has steadily become first-line ablative management of small to intermediate sized (ct cm) HCC at many centers.[9] RFA has a primary effectiveness rate of 88–99% in the management of HCC. Moreover, the RFA treatment was also combined with other treatment such as transcatheter arterial chemoembolization and chemotherapy. However, the FRA combined with percutaneous ethanol injection (PEI) was seldom reported. Here, we retrospectively analyzed 66 HCC patients who received RFA or RFA plus PEI from February 2011 to January 2014 in our hospital to discuss its clinical efficacy and safety.


 » Patients and Methods Top


We retrospectively included 66 HCC patients who received RFA or RFA plus PEI from February 2011 to January 2014 in our hospital. Moreover, 31 cases received RFA plus PEI as the experiment group and 35 subjects treated with RFA aloe as the control group. Thirty five patients were included in RFA group with 28 male and 7 female cases. The mean age of RFA group patients was 56.3 ± 8.7 years old, and the mean tumor size was (2.3 ± 1.1) cm in diameter for RFA group; for RFA plus PEI group, there was 26 male and 5 female cases with the mean age of (55.1 ± 9.6) years old, and the mean tumor size was (2.6 ± 0.8) cm in diameter. The general characteristics of the patients in the two groups were demonstrated in [Table 1].
Table 1: The general characteristics of included patients

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RFA was performed percutaneously under real-time sonographic guidance by Liu Kai who had several years of experience in performing sonographically guided interventional procedures for liver tumors. For PEI procedure, a 21- to 22-gauge, 15- to 20-cm long needle was used to inject 1–10 mL of 99.5% ethanol into the tumor closest to the blood vessel or vital structure, while the RFA electrode was positioned 5–10 mm away from the PEI needle and activated immediately after PEI [9] [Figure 1].
Figure 1: Histology confirmation of hepatocellular carcinoma and computed tomography scan. (a) Hepatocellular carcinoma (H and E, ×200); (b) hepatocellular carcinoma before radiofrequency ablation; (c) hepatocellular carcinoma after radiofrequency ablation

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Statistical analysis

All the data were analyzed by SPSS 19.0 statistical software (SPSS Inc., Chicago, IL, USA). Chi-square test was used to analyze the category variables, and Student's t-test was used to analyze the continuous data. Kaplan–Meier survival analysis was used to evaluate the prognostic significance of two groups. P <0.05 was considered statistically significant.


 » Results Top


Overall survival

For RFA group, the 1-year, 2-year, and 3-year survival rate were 82.0%, 69.3%, and 30.7%, respectively, with the median survival time of 27.1 months. For RFA plus PEI group, the 1-year, 2-year, and 3-year survival rate were 97.1%, 73.9%, and 37.5%, respectively, with the median survival time of 33.6 months. The overall survival of the two groups were not statistical different with the hazard ratio (HR) of 1.48 (P > 0.05) [Figure 2].
Figure 2: The overall survival of the two groups

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Complications

Three cases of treatment associated complications were found in RFA group with 1 abscess, 1 pleural effusion, and 1 portal vein thrombosis. And 2 cases of complication were recorded in RFA plus PEI group with 1 pleural effusion and 1 portal vein thrombosis. The complicated incidence rate were not statistical different between the two groups (P < 0.05) [Table 2].
Table 2: The treatment associated complication between the two groups

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 » Discussion Top


HCC is one of the most diagnosed malignant tumors in the world, and its incidence on the raise worldwide.[10],[11] Surgical resection is the major treatment for HCC patients with early stage. But recently, the nonsurgical locoregional therapies, such as RFA and PEI, have been used worldwide for its minor invasive. Several prospective randomized controlled trails have discussed the outcomes of RFA and PEI which indicated that the FRA treatment procedure had lower local tumor progression rates and higher survival rates.[12] However, outcomes of RFA combined with PEI versus RFA were seldom reported. Cha et al.[13] performated a retrospective study reporting the therapeutic efficacy and safety of PEI with or without combined RFA for HCCs in high risk locations. The results indicated that combined PEI and RFA treatment has a tendency to be more effective than PEI alone for managing HCCs in high risk locations, although the difference is not statistically significant. Even though PEI is generally accepted as a safe procedure, it may cause major biliary complications for managing HCCs adjacent to the portal vein.[13]

In our retrospective study, we retrospectively included 66 HCC patients who received RFA or RFA plus PEI. The results indicated that the overall survival of the two groups were not statistical different with the HR of 1.48. The combination treatment in the management of HCC was safe and had a slightly higher primary effectiveness rate than RFA alone. However, due to the small number cases included in this study and retrospective study design, the conclusion should be confirmed by prospective randomized control trials.

 
 » References Top

1.
Lencioni R, Crocetti L. Radiofrequency ablation of liver cancer. Tech Vasc Interv Radiol 2007;10:38-46.  Back to cited text no. 1
    
2.
Joosten J, Ruers T. Local radiofrequency ablation techniques for liver metastases of colorectal cancer. Crit Rev Oncol Hematol 2007;62:153-63.  Back to cited text no. 2
    
3.
Nam SJ, Oak CH, Jang TW, Jung MH, Chun BK. Successful treatment of a tracheal squamous cell carcinoma with a combination of cryoablation and photodynamic therapy. Thoracic Cancer 2013;4:191–4.  Back to cited text no. 3
    
4.
Ambrogi MC, Dini P, Melfi F, Mussi A. Radiofrequency ablation of inoperable non-small cell lung cancer. J Thorac Oncol 2007;2 5 Suppl: S2-3.  Back to cited text no. 4
    
5.
di Francesco F, di Sandro S, Doria C, Ramirez C, Iaria M, Navarro V, et al. Diaphragmatic hernia occurring 15 months after percutaneous radiofrequency ablation of a hepatocellular cancer. Am Surg 2008;74:129-32.  Back to cited text no. 5
    
6.
Krokidis M, Spiliopoulos S, Jarzabek M, Fotiadis N, Sabharwal T, O'Brien T, et al. Percutaneous radiofrequency ablation of small renal tumours in patients with a single functioning kidney: Long-term results. Eur Radiol 2013;23:1933-9.  Back to cited text no. 6
    
7.
Bland KL, Gass J, Klimberg VS. Radiofrequency, cryoablation, and other modalities for breast cancer ablation. Surg Clin North Am 2007;87:539-50, xii.  Back to cited text no. 7
    
8.
Moffat FL, Gilas T, Calhoun K, Falk M, Dalfen R, Rotstein LE, et al. Further experience with regional radiofrequency hyperthermia and cytotoxic chemotherapy for unresectable hepatic neoplasia. Cancer 1985;55:1291-5.  Back to cited text no. 8
    
9.
Wong SN, Lin CJ, Lin CC, Chen WT, Cua IH, Lin SM. Combined percutaneous radiofrequency ablation and ethanol injection for hepatocellular carcinoma in high-risk locations. AJR Am J Roentgenol 2008;190:W187-95.  Back to cited text no. 9
    
10.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.  Back to cited text no. 10
    
11.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29.  Back to cited text no. 11
    
12.
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;129:122-30.  Back to cited text no. 12
    
13.
Cha DI, Lee MW, Rhim H, Choi D, Kim YS, Lim HK. Therapeutic efficacy and safety of percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas in high risk locations. Korean J Radiol 2013;14:240-7.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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