DOI QR코드

DOI QR Code

Therapeutic Efficacy and Safety of Percutaneous Ethanol Injection with or without Combined Radiofrequency Ablation for Hepatocellular Carcinomas in High Risk Locations

  • Cha, Dong Ik (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Min Woo (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Rhim, Hyunchul (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Dongil (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Young-sun (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Hyo K. (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 발행 : 2013.04.01

초록

Objective: To evaluate the therapeutic efficacy and safety of percutaneous ethanol injection (PEI) alone and combined with radiofrequency ablation (RFA) for hepatocellular carcinomas (HCCs) in high risk locations. Materials and Methods: We performed PEI for HCCs in RFA-high risk locations, either alone or in combination with RFA. There were 20 HCCs (1.7 ${\pm}$ 0.9 cm) in 20 patients (PEI group: n = 12; PEI + RFA group: n = 8). We evaluated technical success, local tumor progression and complications in both groups. Results: Technical success was achieved in all HCCs in both groups. During follow-up, local tumor progression was found in 41.7% (5/12) in the PEI group, whereas 12.5% (1/8) for the PEI + RFA group (p = 0.32). Bile duct dilatation was the most common complication, especially when the tumors were in periportal locations; 55% (5/9) in the PEI group and 50% (2/4) in the PEI + RFA group (p = 1.00). One patient in the PEI group developed severe biliary stricture and upstream dilatation that resulted in atrophy of the left hepatic lobe. One patient treated with PEI + RFA developed cholangitis and an abscess. Conclusion: 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.

키워드

참고문헌

  1. Deuffic, S, Poynard, T, Buffat, L, Valleron, AJ,Trends in primary liver cancer, Lancet, 351, 1, 214-215(1998)
  2. El-Serag, HB, Mason, AC,Rising incidence of hepatocellular carcinoma in the United States, N Engl J Med, 340, 2, 745-750(1999) https://doi.org/10.1056/NEJM199903113401001
  3. Taylor-Robinson, SD, Foster, GR, Arora, S, Hargreaves, S, Thomas, HC,Increase in primary liver cancer in the UK, 1979-94, Lancet, 350, 3, 1142-1143(1997)
  4. Teratani, T, Yoshida, H, Shiina, S, Obi, S, Sato, S, Tateishi, R,Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations, Hepatology, 43, 4, 1101-1108(2006) https://doi.org/10.1002/hep.21164
  5. Shiina, S, Teratani, T, Obi, S, Sato, S, Tateishi, R, Fujishima, T,A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma, Gastroenterology, 129, 5, 122-130(2005) https://doi.org/10.1053/j.gastro.2005.04.009
  6. Lin, SM, Lin, CJ, Lin, CC, Hsu, CW, Chen, YC,Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm, Gastroenterology, 127, 6, 1714-1723(2004) https://doi.org/10.1053/j.gastro.2004.09.003
  7. Shiina, S, Tagawa, K, Unuma, T, Takanashi, R, Yoshiura, K, Komatsu, Y,Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study, Cancer, 68, 7, 1524-1530(1991) https://doi.org/10.1002/1097-0142(19911001)68:7<1524::AID-CNCR2820680711>3.0.CO;2-O
  8. Galandi D, Antes G. Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma. Cochrane Database Syst Rev 2002:CD003046
  9. Lu, DS, Yu, NC, Raman, SS, Limanond, P, Lassman, C, Murray, K,Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver, Radiology, 234, 9, 954-960(2005) https://doi.org/10.1148/radiol.2343040153
  10. Livraghi, T,Radiofrequency ablation, PEIT, and TACE for hepatocellular carcinoma, J Hepatobiliary Pancreat Surg, 10, 10, 67-76(2003)
  11. 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, 190, 11, W187-W195(2008) https://doi.org/10.2214/AJR.07.2537
  12. Kurokohchi, K, Watanabe, S, Masaki, T, Hosomi, N, Funaki, T, Arima, K,Combination therapy of percutaneous ethanol injection and radiofrequency ablation against hepatocellular carcinomas difficult to treat, Int J Oncol, 21, 12, 611-615(2002)
  13. Bruix, J, Sherman, M,Management of hepatocellular carcinoma: an update, Hepatology, 53, 13, 1020-1022(2011) https://doi.org/10.1002/hep.24199
  14. Kuang, M, Lu, MD, Xie, XY, Xu, HX, Xu, ZF, Liu, GJ,Ethanol ablation of hepatocellular carcinoma Up to 5.0 cm by using a multipronged injection needle with high-dose strategy, Radiology, 253, 14, 552-561(2009) https://doi.org/10.1148/radiol.2532082021
  15. Rhim, H, Lim, HK,Radiofrequency ablation for hepatocellular carcinoma abutting the diaphragm: the value of artificial ascites, Abdom Imaging, 34, 15, 371-380(2009) https://doi.org/10.1007/s00261-008-9408-4
  16. Goldberg, SN, Grassi, CJ, Cardella, JF, Charboneau, JW, Dodd, GD, Dupuy, DE,Image-guided tumor ablation: standardization of terminology and reporting criteria, J Vasc Interv Radiol, 20, 16, S377-S390(2009) https://doi.org/10.1016/j.jvir.2009.04.011
  17. Kondo, Y, Shiina, S, Tateishi, R, Arano, T, Uchino, K, Enooku, K,Intrahepatic bile duct dilatation after percutaneous radiofrequency ablation for hepatocellular carcinoma: impact on patient's prognosis, Liver Int, 31, 17, 197-205(2011) https://doi.org/10.1111/j.1478-3231.2010.02415.x
  18. Orlando, A, Leandro, G, Olivo, M, Andriulli, A, Cottone, M,Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials, Am J Gastroenterol, 104, 18, 514-524(2009) https://doi.org/10.1038/ajg.2008.80
  19. Bouza, C, Lopez-Cuadrado, T, Alcazar, R, Saz-Parkinson, Z, Amate, JM,Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma, BMC Gastroenterol, 9, 19, 31(2009) https://doi.org/10.1186/1471-230X-9-31
  20. 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, 54, 20, 1151-1156(2005) https://doi.org/10.1136/gut.2004.045203
  21. Livraghi, T, Meloni, F, Di Stasi, M, Rolle, E, Solbiati, L, Tinelli, C,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, 21, 82-89(2008)
  22. Minami, Y, Kudo, M,Radiofrequency ablation of hepatocellular carcinoma: Current status, World J Radiol, 2, 22, 417-424(2010) https://doi.org/10.4329/wjr.v2.i11.417
  23. Livraghi, T, Meloni, F, Morabito, A, Vettori, C,Multimodal image-guided tailored therapy of early and intermediate hepatocellular carcinoma: long-term survival in the experience of a single radiologic referral center, Liver Transpl, 10, 23, S98-S106(2004) https://doi.org/10.1002/lt.20053
  24. 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, 226, 24, 441-451(2003) https://doi.org/10.1148/radiol.2262012198
  25. Kwon, JH,Is percutaneous ethanol injection therapy still effective for hepatocellular carcinoma in the era of radiofrequency ablation?, Gut Liver, 4, 25, S105-S112(2010) https://doi.org/10.5009/gnl.2010.4.S1.S105
  26. Sung, YM, Choi, D, Lim, HK, Lee, WJ, Kim, SH, Kim, MJ,Long-term results of percutaneous ethanol injection for the treatment of hepatocellular carcinoma in Korea, Korean J Radiol, 7, 26, 187-192(2006) https://doi.org/10.3348/kjr.2006.7.3.187
  27. Kim, SH, Lim, HK, Choi, D, Lee, WJ, Kim, SH, Kim, MJ,Changes in bile ducts after radiofrequency ablation of hepatocellular carcinoma: frequency and clinical significance, AJR Am J Roentgenol, 183, 27, 1611-1617(2004) https://doi.org/10.2214/ajr.183.6.01831611
  28. Koda, M, Okamoto, K, Miyoshi, Y, Kawasaki, H,Hepatic vascular and bile duct injury after ethanol injection therapy for hepatocellular carcinoma, Gastrointest Radiol, 17, 28, 167-169(1992) https://doi.org/10.1007/BF01888537
  29. Ogawa, T, Kawamoto, H, Kobayashi, Y, Nakamura, S, Miyatake, H, Harada, R,Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma-Cooling effect by endoscopic nasobiliary drainage tube, Eur J Radiol, 73, 29, 385-390(2010) https://doi.org/10.1016/j.ejrad.2008.10.021
  30. Lam, VW, Ng, KK, Chok, KS, Cheung, TT, Wat, J, Fan, ST,Safety and efficacy of radiofrequency ablation for periductal hepatocellular carcinoma with intraductal cooling of the central bile duct, J Am Coll Surg, 207, 30, e1-e5(2008)

피인용 문헌

  1. Recent advance of local ablation for hepatocellular carcinoma vol.56, pp.11, 2013, https://doi.org/10.5124/jkma.2013.56.11.964
  2. Perivascular versus Nonperivascular Small HCC Treated with Percutaneous RF Ablation: Retrospective Comparison of Long-term Therapeutic Outcomes vol.270, pp.3, 2013, https://doi.org/10.1148/radiol.13130753
  3. Ablation of hepatocellular carcinoma vol.28, pp.5, 2014, https://doi.org/10.1016/j.bpg.2014.08.011
  4. Response to Lo vol.110, pp.1, 2015, https://doi.org/10.1038/ajg.2014.365
  5. Propensity Score Matching: A Conceptual Review for Radiology Researchers vol.16, pp.2, 2013, https://doi.org/10.3348/kjr.2015.16.2.286
  6. Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Tumors: How We Do It Safely and Completely vol.16, pp.6, 2013, https://doi.org/10.3348/kjr.2015.16.6.1226
  7. 2014 KLCSG-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma vol.9, pp.3, 2013, https://doi.org/10.5009/gnl14460
  8. 2014 Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guideline for the Management of Hepatocellular Carcinoma vol.16, pp.3, 2015, https://doi.org/10.3348/kjr.2015.16.3.465
  9. 3D CACT-assisted Radiofrequency Ablation Following Transarterial Chemoembolization for Hepatocellular Carcinoma: Early Experience vol.16, pp.17, 2013, https://doi.org/10.7314/apjcp.2015.16.17.7897
  10. Development and novel therapeutics in hepatocellular carcinoma: a review vol.12, pp.None, 2013, https://doi.org/10.2147/tcrm.s92377
  11. Innovative Techniques for Image-Guided Ablation of Benign Thyroid Nodules: Combined Ethanol and Radiofrequency Ablation vol.18, pp.3, 2013, https://doi.org/10.3348/kjr.2017.18.3.461
  12. Radiofrequency ablation combined with percutaneous ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis vol.33, pp.3, 2013, https://doi.org/10.1080/02656736.2016.1237681
  13. Liver resection versus radiofrequency ablation for hepatitis B virus-related small hepatocellular carcinoma vol.5, pp.None, 2013, https://doi.org/10.2147/jhc.s152202
  14. 2018 Korean Liver Cancer Association–National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma vol.13, pp.3, 2013, https://doi.org/10.5009/gnl19024
  15. Predictive factors of treatment outcomes after percutaneous ablation of hepatocellular carcinoma in the caudate lobe: a retrospective study vol.19, pp.1, 2019, https://doi.org/10.1186/s12885-019-5881-0
  16. Comparison of procedure-related complications between percutaneous cryoablation and radiofrequency ablation for treating periductal hepatocellular carcinoma vol.37, pp.1, 2013, https://doi.org/10.1080/02656736.2020.1849824
  17. The Islanding effect - a special method of percutaneous peritumor ethanol injection for hepatocellular carcinoma : 15-year follow-up outcome vol.100, pp.3, 2021, https://doi.org/10.1097/md.0000000000024365
  18. The development of a predictive risk model on post-ablation hemobilia: a multicenter matched case-control study vol.94, pp.1118, 2021, https://doi.org/10.1259/bjr.20200163
  19. Improving Ablation Safety for Hepatocellular Carcinoma Proximal to the Hilar Bile Ducts by Ultrasound-MR Fusion Imaging: A Preliminary Comparative Study vol.11, pp.None, 2021, https://doi.org/10.3389/fonc.2021.570312