Yao Xue-Song, Yan Dong, Jiang Xian-Xian, Li Xiao, Zeng Hui-Ying, Li Huai
Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Australian Research Council Training Centre for Innovation in Biomedical Imaging Technology, University of Queensland, Brisbane 4000, Australia.
World J Clin Cases. 2021 Mar 6;9(7):1580-1591. doi: 10.12998/wjcc.v9.i7.1580.
Percutaneous radiofrequency ablation (RFA) is an effective treatment for unresectable hepatocellular carcinoma (HCC) and a minimally invasive alternative to hepatectomy for treating tumour recurrence. RFA is often performed using contrast-enhanced computed tomography (CECT) and/or ultrasonography. In recent years, angiographic systems with flat panel image detectors and advanced image reconstruction algorithms have broadened the clinical applications of cone-beam computed tomography (CBCT), including RFA. Several studies have shown the effectiveness of using CBCT for immediate treatment assessments and follow-ups.
To assess the treatment response to RFA for HCC using CBCT.
Forty-eight patients (44 men; aged 37-89 years) with solitary HCC [median size: 3.2 (1.2-6.6) cm] underwent RFA and were followed for 25.6 (median; 13.5-35.2) mo. Image fusion of CBCT and pre-operative CECT or magnetic resonance imaging (MRI) was used for tumour segmentation and needle path and ablation zone planning. Real-time image guidance was provided by overlaying the three-dimensional image of the tumour and needle path on the fluoroscopy image. Treatment response was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Disease progression, death, time to progression (TTP), and overall survival (OS) were recorded. Kaplan-Meier and Cox regression analyses were performed.
Initial post-RFA CECT/MRI showed 38 cases of CR (79.2%), 10 of PR (20.8%), 0 of SD, and 0 of PD, which strongly correlated with the planning estimation (42 CR, 87.5%; 6 PR, 12.5%; 0 SD; and 0 PD; accuracy: 91.7%, < 0.01). Ten (20.8%) patients died, and disease progression occurred in 31 (35.4%, median TTP: 12.8 mo) patients, resulting in 12-, 24-, and 35-mo OS rates of 100%, 81.2%, and 72.2%, respectively, and progression-free survival (PFS) rates of 54.2%, 37.1%, and 37.1%, respectively. The median dose-area product of the procedures was 79.05 Gycm (range 40.95-146.24 Gycm), and the median effective dose was 10.27 mSv (range 5.32-19.01 mSv). Tumour size < 2 cm ( = 0.008) was a significant factor for OS, while age ( = 0.001), tumour size < 2 cm ( < 0.001), tumour stage ( = 0.010), and initial treatment response ( = 0.003) were significant factors for PFS.
Reliable RFA treatment planning and satisfactory outcomes can be achieved with CBCT.
经皮射频消融术（RFA）是治疗不可切除肝细胞癌（HCC）的有效方法，也是治疗肿瘤复发的肝切除术的微创替代方法。RFA通常使用对比增强计算机断层扫描（CECT）和/或超声检查进行。近年来，具有平板图像探测器和先进图像重建算法的血管造影系统拓宽了锥束计算机断层扫描（CBCT）的临床应用，包括RFA。多项研究表明使用CBCT进行即时治疗评估和随访的有效性。
使用CBCT评估RFA治疗HCC的疗效。
48例（44例男性；年龄37 - 89岁）单发HCC患者[中位大小：3.2（1.2 - 6.6）cm]接受了RFA治疗，并随访25.6（中位；13.5 - 35.2）个月。CBCT与术前CECT或磁共振成像（MRI）的图像融合用于肿瘤分割以及针道和消融区规划。通过将肿瘤和针道的三维图像叠加在荧光透视图像上提供实时图像引导。治疗反应分为完全缓解（CR）、部分缓解（PR）、疾病稳定（SD）或疾病进展（PD）。记录疾病进展、死亡、进展时间（TTP）和总生存期（OS）。进行了Kaplan-Meier和Cox回归分析。
RFA术后初始CECT/MRI显示38例CR（79.2%），10例PR（20.8%），0例SD，0例PD，这与规划估计高度相关（42例CR，87.5%；6例PR，12.5%；0例SD；0例PD；准确率：91.7%，<0.01）。10例（20.8%）患者死亡，31例（35.4%，中位TTP：12.8个月）患者出现疾病进展，12个月、24个月和35个月的OS率分别为100%、81.2%和72.2%，无进展生存期（PFS）率分别为54.2%、37.1%和37.1%。手术的中位剂量面积乘积为79.05 Gycm（范围40.95 - 146.24 Gycm），中位有效剂量为10.27 mSv（范围5.32 - 19.01 mSv）。肿瘤大小<2 cm（=0.008）是OS的显著因素，而年龄（=0.001）、肿瘤大小<2 cm（<0.001）、肿瘤分期（=0.010）和初始治疗反应（=0.003）是PFS的显著因素。
CBCT可实现可靠的RFA治疗规划并取得满意的结果。
