Radiofrequency ablation combined with percutaneous ethanol injection in patients with hepatocellular carcinoma.
Radiofrequency ablation combined with percutaneous ethanol injection in patients with hepatocellular carcinoma.
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DOI：
10.1016/j.ajg.2011.07.005
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发表时间：
2011-09-01
期刊：
影响因子：
--
通讯作者：
Atia, Faried
中科院分区：
文献类型：
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作者：
Azab, Mohamed;Zaki, Samy;Atia, Faried
背景和研究目的：肝细胞癌是全球卫生保健系统的主要负担。虽然射频消融术(RFA)目前被认为是治疗凝固性坏死的最佳技术，但同时使用射频消融术和经皮无水乙醇注射(PEI)的优越性还有待确定。这项研究旨在比较接受联合PEI-RFA和单独接受PEI-RFA治疗的肝细胞癌患者的疗效、安全性和存活率。随机分为PEI-RFA组(I组)、单纯RFA组(II组)或单纯PEI组(III组)。主要的终点是肿瘤的消融。次要终点是存活率和复发率。结果：第一次治疗后，联合组完全消融率(87.9%)明显高于射频消融组(54.54%)。第2次治疗后，联合组完全消融97.0%，RFA组84.8%完全消融。对于PEI组，75%的人在多次治疗后进行了完全消融，而25%的人进行了部分消融。1.5年后，I组存活率(86.7%)明显高于III组(63.3%)。总的严重不良事件发生率为零。结论：在肝细胞癌患者中，联合治疗在安全性和有效性方面优于单纯射频消融和单纯PEI。
BACKGROUND AND STUDY AIMS: Hepatocellular carcinoma (HCC) is a major burden on health-care systems worldwide. Although radiofrequency ablation (RFA) is currently considered the best technique for coagulative necrosis, the superiority of concomitant use of RFA and percutaneous ethanol injection (PEI) needs to be determined. The study was designed to compare efficacy, safety and rate of survival of patients with HCC assigned to receive combined PEI-RFA versus RFA alone and versus PEI alone.PATIENTS AND METHODS: This 3-year study enrolled 90 cirrhotic patients with HCC (Child's class A or B, but not class C). They were randomly assigned for either PEI-RFA (group I), RFA alone (group II) or PEI alone (group III). The primary end point was ablation of the tumour. The secondary end point was rate of survival and recurrence.RESULTS: After the first session, complete ablation was significantly higher in the combination group (87.9%) compared with the RFA group (54.54%). After the second session, complete ablation was achieved in 97.0% of the combination group and in 84.8% of the RFA group. Regarding the PEI group, 75% had complete ablation, whereas 25% had partial ablation after multiple sessions. The survival rate, 1.5 years later, was significantly higher in group I (86.7%) compared with group III (63.3%). The overall incidence of serious adverse events was nil.CONCLUSION: Combined treatment is superior to RFA alone and to PEI alone, in safety and efficacy in patients with HCC.