对位置特殊的肝细胞癌进行射频消融：个体化治疗方法

Radiofrequency ablation of problematically located hepatocellular carcinoma: tailored approach.

作者信息

Chen Min-Hua, Yang Wei, Yan Kun, Hou Yi-Bin, Dai Ying, Gao Wen, Zhang Hui, Wu Wei

机构信息

Department of Ultrasound, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100036, China.

出版信息

Abdom Imaging. 2008 Jul-Aug;33(4):428-36. doi: 10.1007/s00261-007-9283-4.

DOI:10.1007/s00261-007-9283-4

PMID:17639375

Abstract

BACKGROUND

The challenge for radiofrequency ablation (RFA) of hepatocellular carcinomas (HCC) in problematic locations is that the outcome is limited due to insufficient ablation or injury of nearby structures. This study aimed to evaluate effective strategy and treatment results of RFA in these cases.

METHODS

Ultrasound guided percutaneous RFA was performed in 326 HCC patients. Among them, 249 tumors in 215 patients located at liver periphery, including 54 adjacent to GI tract, 110 close to the diaphragm, 49 close to the gallbladder, and 36 tumors close to liver surface. The sizes of the tumors ranged 1.2-7.0 cm (average 3.7 +/- 1.3 cm). Individualized treatment strategy was established for tumors in various locations, including "artificial ascites", "lift-expand" electrode placement, "draw-expand" electrode placement, "Supplementary ablation", and "accumulative multiple ablations" techniques. Treatment outcome was compared with another 64 central-located tumors (control group) in the same patients. One-month post-RFA contrast CT was used to evaluate early necrosis rate of the treated tumors.

RESULTS

Early tumor necrosis were obtained in 91.6% (228/249) of the problematically located HCC, including 90.7% (49/54) of the tumors adjacent to GI tract, 90.9% (100/110) near the diaphragm, 91.8% (45/49) by the gallbladder, and 94.4% (34/36) close to liver surface. The necrosis rate of control group was 98.4% (63/64), which was higher than the tumors close to diaphragm (P = 0.049). Local tumor recurrence was 8.4% (21/249), comparing with 3.1% (2/64) of the control group (P > 0.05). The 1-, 2- and 3-year survival rate of this group were 81.6%, 63.8%, and 53.6%, respectively. Major complications occurred in 3.2% (11/343) of the treatment sessions, including hemorrhage in two, nearby structure injury in five, and needle tract seeding in four patients.

CONCLUSIONS

Individualized treatment strategy for problematically located HCC is helpful in improving RFA outcome and expanding the application range of the therapy.

摘要

背景

对位于疑难位置的肝细胞癌（HCC）进行射频消融（RFA）面临的挑战是，由于消融不足或对附近结构的损伤，其治疗效果有限。本研究旨在评估在这些病例中RFA的有效策略和治疗结果。

方法

对326例HCC患者进行超声引导下经皮RFA。其中，215例患者的249个肿瘤位于肝周边，包括54个邻近胃肠道、110个靠近膈肌、49个靠近胆囊以及36个靠近肝表面。肿瘤大小为1.2 - 7.0 cm（平均3.7 +/- 1.3 cm）。针对不同位置的肿瘤制定了个体化治疗策略，包括“人工腹水”、“提拉-扩展”电极放置、“牵拉-扩展”电极放置、“补充消融”以及“累积多次消融”技术。将治疗结果与同一批患者中的另外64个位于肝中央的肿瘤（对照组）进行比较。RFA术后1个月的增强CT用于评估治疗后肿瘤的早期坏死率。

结果

位于疑难位置的HCC中，91.6%（228/249）的肿瘤获得了早期坏死，其中邻近胃肠道的肿瘤坏死率为90.7%（49/54），靠近膈肌的为90.9%（100/110），靠近胆囊的为91.8%（45/49），靠近肝表面的为94.4%（34/36）。对照组的坏死率为98.4%（63/64），高于靠近膈肌的肿瘤（P = 0.049）。局部肿瘤复发率为8.4%（21/249），而对照组为3.1%（2/64）（P > 0.05）。该组患者的1年、2年和3年生存率分别为81.6%、63.8%和53.6%。主要并发症发生率为3.2%（11/343），包括2例出血、5例附近结构损伤以及4例针道种植。