Radiofrequency Ablation Combined with Chemoembolization for the Treatment of Hepatocellular Carcinomas Larger than 5 cm
Radiofrequency Ablation Combined with Chemoembolization for the Treatment of Hepatocellular Carcinomas Larger than 5 cm
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DOI：
10.1016/j.jvir.2008.10.019
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发表时间：
2009-02-01
影响因子：
2.9
通讯作者：
Takeda, Kan
中科院分区：
文献类型：
--
作者：
Takaki, Haruyuki;Yamakado, Koichiro;Takeda, Kan
目的：评价射频消融联合化疗栓塞治疗大于5 cm肝细胞癌（hcc）患者的生存、自由生存、技术成功、技术有效性和安全性。材料和方法：纳入Child-Pugh A级或B级肝硬化和3个或更少的hcc患者，最大肿瘤直径为10 cm。纳入了20例32型hcc患者。男性1.6例，女性4例，年龄69岁±7.4例（范围46-79岁）。最大平均肿瘤直径为6.2 cm（范围5.1 ~ 9.5 cm）。化疗栓塞后1-2周在计算机断层扫描（CT）透视引导下进行射频消融。这项研究的主要终点是生存。结果：射频电极放置在计划的位置，并按照计划的方案完成射频消融（技术成功率100%）。32次射频治疗后，所有患者的强化症状均消失。一级和二级技术的有效性分别为40%和100%。32例射频手术（6%）有两大并发症——肝穿孔和膈穿孔。20例患者中有5例（25%）在30个月内出现局部肿瘤进展。总生存率和无复发生存率分别为100%和1年，3年为62%和28%，5年为41%和14%。在单因素分析中，血清胆红素水平低于1.0 mg/dL （17.1 μ mol/L）是一个明显更好的预后因素。结论：该联合治疗可提高hcc大于5 cm患者的生存率。
PURPOSE: To evaluate survival, free survival, technical success, technique effectiveness, and safety of radiofrequency (RF) ablation combined with chemoembolization in patients with hepatocellular carcinomas (HCCs) larger than 5 cm.MATERIALS AND METHODS: Patients with Child-Pugh class A or B cirrhosis and three or fewer HCCs with a maximum tumor diameter of 10 cm were included. Twenty patients with 32 HCCs were included. There were 1.6 men and four women with age of 69 years +/- 7.4 (range, 46-79 years). The maximum mean tumor diameter was 6.2 cm (range, 5.1-9.5 cm). RF ablation was performed under computed tomographic (CT) fluoroscopic guidance 1-2 weeks after chemoembolization. The primary endpoint of this study was survival.RESULTS: RF electrodes were placed in the planned sites, and RF ablation was completed witha planned protocol (technical success rate, 100%). enhancement was eradicated in all patients after 32 RF sessions. The primary and secondary technique effectiveness were 40% and 100%, respectively. There were two major complications in the 32 RF sessions (6%)-hepatic and diaphragm perforation. Local tumor progression developed in five of the 20 patients (25%) during tie of 30 months. The overall and recurrence-free survival rates were, respectively, 100% and at year, 62% and 28% at 3 years, and 41% and 14% at 5 years. The serum bilirubin level of 1.0 mg/dL (17.1 mu mol/L) less was a significantly better prognostic factor in the univariate analysis.CONCLUSIONS: This combination therapy may enhance survival in patients with HCCs larger than 5 cm.