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Year : 2015  |  Volume : 52  |  Issue : 6  |  Page : 102--104

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

L Kai1, L Jia1, W Zhi-Gang2, Y Lei3,  
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

Correspondence Address:
Y Lei
Department of Ultrasound Imaging, Huangshi Central Hospital, Hubei Province 435000
China

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.



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;52:102-104


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 Sep 15 ];52:102-104
Available from: http://www.indianjcancer.com/text.asp?2015/52/6/102/172503


Full Text

 Introduction



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



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}

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}

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



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}

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}

 Discussion



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.

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