1、Treatment Strategies for 3 cm HCC with US guided RF Ablation (Long term outcome from 302 cases)Chen Min Hua,Yang Wei,Yan KunPeking University,School of OncologylCandidates for surgery 3 cm HCC:244lWith the size increase,local recurrence higher tumor diameter 2.5 cm:11.6(18/155 cases)2.5 cm:20.5(17/8
2、3 cases)1、PurposePatients(1)2000 to 2010 yearl520 patients with HCC underwent percutaneous RFA lAmong them 3cm HCC 302 caseslMale 244,Female 58lAverage age lTumor size Patients(2)Treatment strategies1.Plan ablation protocol based on invasive range of tumor on Contrast Enhanced Ultrasound(CEUS)2.Perf
3、orm multiple overlapping ablations based on mathematical model3.Optimal ablation with 2-3 bipolar electrodes4.Color US guided ablation of feeding artery(or TACE)before RF ablation 1、Identify invasive range based on CEUSlObtain samples from border area which became bigger or more irregular on CEUS lC
4、ancer cell was found in 88 of these specimens and alternately grew with normal liverlCD34 immuhistochemistry staining showed strong positive staining in vessel endothelium cell of this area MVD was significantly higher than that in central area US:A 3.6 cm nodule with unclear borderCEUS:the tumor en
5、larged (5cm)Central necrosisM/54 10 ys of hepatitis BSurgery sample:tumor with poor borderHE stainingmalignant cell alternatively grows with normal liver cell without clear border between themCD34 staining:High density of micro-vessels in the margin area of the HCCl Set up mathematical model for lar
6、ge tumorsl Plan overlapping ablations protocol Least ablation number Proper ablation overlapping mode Optimal electrode placement design2.Multiple ablations based on mathematical modelM.H.Chen,W,Yang,et al.Radiology.2004;232:260-2713.New technique for RF ablationIt is good time for RFA treatment of
7、5-6cm liver tumor 2 bipolar electrodes 2 for 6.2x6x5 cm3(22 min x2)3 bipolar electrodes for 6.5x6x6 cm3 (40 Min)Male,77 years,6 cm HCC under diaphragm Percutaneous place tube under diaphragm and inj water to separate tumor and diaphragm()3 bipolar electrodes simultaneously 2 times(80mins)One month C
8、T:no enhancement 4.Individual protocol for rich supply and large tumor l Cool effect of flow during RF ablation would limit coagulation area and result in recurrence it is a challenge for RF ablation l Need effective treatment principle and new methodsl Control feeding artery for tumor with rich blo
9、od supplyChen MH,W,Yang,et al.JVIR 2006;17:671-683.Chen MH,W,Yang,et al.Abdominal Imaging 2007;17:567-595.lIt has been confirmed combination of TACERFA can decrease tumor supply and increase coagulation area improve efficiencylIn our center,we use 1.Yang W,Chen MH.Hepatology research 20092.Shen SQ,e
10、t al.Hepatogastroenterology.2005.3.Gasparini D,et al.Radiol Med.2002.Traditional strategyMale,64 years,hepatitis B and liver cirrhosis for more than 10 yearsHCC was in right lobe and after 2 times of TACECEUS Pre-RF:(left)CEUS:Lesion enhanced with size of 5.8x4.7cm,irregular close to right branch of
11、 PV(right)US:Heterogeneous lesion with unclear border PV(Left)T40 3 bipolar electrodes with 3 cm space (Middle)T40 2 bipolar electrodes with 2.1cm space (Right)post-RFA lesion present hyperechoic During RFA1 Mon post-RFA:(Left)US:lesion size about 6.0 x4.5cm (Middle)CT-AP:no enhancement (Right)CT-PP
12、:well defined margin Percutaneous ablation of feeding arteryChen MH,Yang W,et al.JVIR 2006;17:671-83.Chen MH,Yang W,et al.Abdominal Imaging 2007;17:587-95.Color US guided Percutaneous Ablationblocking feeding Artery(PAA)Additional 2-3 small ablations to ablate the entrance area of feeding artery to
13、enhance the coagulation effectCase.Wang XX,male,58 years.Hepatitis B for 10 years HCC was found 2 mons ago and size 5.5 x 4.8 cmTumor in right lobe and the size was 6x5 cmhad 2 big feeding arteriesfirst ablation the main feeding arteryPost-PAA contrast US(A phase):Main feeding A was blocked()Another
14、 feeding A still open()Parenchyma phaseRing-like enhanced “annular solar eclipse”signColor US guided PAA for the second feeding APost-second PAA Contrast US:The entire tumor perfusion defection“total solar eclipse”signPost-first PAA contrast USRim like enhancedPerform multiple ablations under tumor
15、ischemia condition24 h1 Mon5 MonFollow up CT:no viability in tuResult(2)Long-term outcomelFollow up 3122 months,average 29 monthslLocal recurrence 14.3(47/328 tu)lNew lesion incidence 38.4(116/302 tu)lLong-term survival 5cm HCC long-term survival lower than 3-5cm HCCSurvival curves after RFA for dif
16、ferent sizes of HCCComplication lCombine target chemotherapy and local physical therapy can interact actively and further improve efficiency lInternational multiple center randomized trail is going on lThermoDox IV drop 30mins prior RFA treat HCC 3cmlOur department was served as one of these centersGoldberg SN,et al.AJR 2002;179:93-101.Poon PT,et al.Expert Opin Pharmacother 2009;10:333-43.Thank you for your attention!(2009 KunMing China)2011,Dec 16 KunMing(Prof.CHEN chairman)13TH INTERNATIONAL CONFERRENCE ON ULTRASOUND CONTRAST IMAGING AND TUMOR ABLATION
