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,单击此处编辑母版标题样式,单击此处编辑母版文本样,*,单击此处编辑母版标题样式,单击此处编辑母版文本样,*,Treatment Strategies for 3 cm HCC,with US guided RF Ablation,( Long term outcome from 302 cases,),Chen Min Hua, Yang Wei, Yan Kun,Peking University, School of Oncology,-,Treatment Strategies for 3 cm,1,HCC incident account for 54,in the world,with mortality of 200, 000 cases every year,Advanced or large HCC common at first diagnosis,Associated with liver cirrhosis and,poor liver function,Candidates for surgery 3 cm HCC: 24,4,With the size increase, local recurrence higher,tumor diameter, 2.5 cm:11.6(18/155,cases), 2.5 cm: 20.5 (17/83 cases),1,、,Livraghi T. Radiology 2000;214:761-768.,2,、,Solbiati L. Radiology 1997;205:367-373.,3,、,Marco V. Annals of Surgery 2004;240,4,、,Lam VWT. J Am Coll Surg 2008;207:20-29.,-,The effect of tumor size on RF,3,Purpose,Investigate the treatment strategies and,outcome of ultrasound guided RF,ablation of 3cm HCC,-,Purpose Investigate the treatm,4,Patients (1),2000 to 2010 year,520 patients with HCC underwent percutaneous RFA,Among them 3cm HCC 302 cases,Male 244, Female 58,Average age,60.4 years(range, 24-87 years),Tumor size,3.1-7.0cm average,4.21.0cm,3.1-5.0cm 248,lesions,5.1-7.5cm 80,lesions,-,Patients (1) 2000 to 2010,5,Patients(2),Solitary tumor 212 cases,multiple 90,cases,(29.8),Liver function Child-A 196,cases, B 94,cases C 12 cases,58 cases,were recurrent after surgery,(19.2),-,Patients(2)Solitary tumor 212,6,Treatment strategies,Plan ablation protocol based on invasive range of tumor on Contrast Enhanced Ultrasound (CEUS),Perform multiple overlapping ablations based on mathematical model,Optimal ablation with 2-3 bipolar electrodes,Color US guided ablation of feeding artery (or TACE) before RF ablation,-,Treatment strategiesPlan ablat,7,1,、,Identify invasive range based on CEUS,Obtain samples from border area,which became,bigger or more irregular,on CEUS,Cancer cell was found in 88 of these specimens,and alternately grew with normal liver,CD34 immuhistochemistry staining showed,strong positive staining in vessel endothelium cell of this area,MVD was significantly higher than that in central area,-,1、Identify invasive range ba,8,US:,A,3.6 cm,nodule,with unclear border,CEUS:,the tumor enlarged,( 5cm),Central necrosis,M/54 10 ys of hepatitis B,Surgery sample:,tumor with poor border,-,US: A 3.6 cm nodule CEUS: the,9,HE staining,malignant cell alternatively grows,with normal liver cell without clear border,between them,CD34 staining:,High density of micro-vessels,in the margin area of the HCC,-,HE stainingCD34 staining: -,10,Set up mathematical model for large tumors,Plan overlapping ablations protocol,Least,ablation number,Proper,ablation overlapping mode,Optimal,electrode placement design,2. Multiple ablations based on mathematical model,M.H. Chen, W, Yang, et al. Radiology. 2004;232:260-271,-,Set up mathematical model fo,11,3. New technique for RF ablation,Recently, RF machine and equipment developed fast,Cool water circulation used in all kinds of machines,Umbrella or Cool-tip increased the coagulation area,by one ablation,(5-6cm),2-3 bipolar electrode simultaneously,achieve 6.5 cm,coagulation area (40,mins ),It is good time for RFA treatment of 5-6cm liver tumor,-,3. New technique for RF ablat,12,2 bipolar electrodes 2 for 6.2x6x5 cm,3,(22 min x2),1,2,1,2,-,2 bipolar electrodes 2 for 6,13,3,1,3 bipolar electrodes for 6.5x6x6,cm,3,(40 Min),2,-,313 bipolar electrodes for 6.5,14,Male, 77 years, 6 cm HCC under diaphragm,-,Male, 77 years, 6 cm HCC und,15,16,Percutaneous place tube under diaphragm and inj water to separate tumor and diaphragm (),-,16Percutaneous place tube unde,16,17,3 bipolar electrodes simultaneously 2 times (80mins),-,173 bipolar electrodes simulta,17,One month CT: no enhancement,-,One month CT: no enhancement-,18,4. Individual protocol for rich,supply and large tumor,Cool effect of flow during RF ablation would limit,coagulation area and result in recurrence,it is a challenge for RF ablation,Need effective treatment principle and new methods,Control feeding artery for tumor with rich blood supply,Chen MH, W, Yang, et al.,JVIR,2006;17: 671-683.,Chen MH,W, Yang,et al.,Abdominal Imaging,2007;17:567-595.,-,4. Individual protocol for ri,19,It has been confirmed combination of,TACE,RFA,can decrease tumor supply and increase coagulation area improve efficiency,In our center, we use,1-2 courses of TACE,followed by RFA for these cases,1. Yang W, Chen MH. Hepatology research 2009,2. Shen SQ, et al. Hepatogastroenterology. 2005.,3. Gasparini D, et al. Radiol Med. 2002.,Traditional strategy,-,It has been confirmed combinat,20,Male,64 years, hepatitis B and liver cirrhosis,for more than 10 years,HCC was in right lobe and after 2 times of TACE,-,Male,64 years, hepatitis B and,21,CEUS Pre-RF: (left)CEUS:Lesion enhanced with size of,5.8x4.7cm,irregular close to right branch of PV,(right)US:Heterogeneous lesion with unclear border,PV,-,CEUS Pre-RF: (left)CEUS:Lesio,22,(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 RFA,-,(Left) T40 3 bipolar electrod,23,1 Mon post-RFA,:(Left)US: lesion size about 6.0x4.5cm,(Middle),CT-AP: no enhancement,(Right)CT-PP: well defined margin,-,1 Mon post-RFA :(Left)US: lesi,24,Percutaneous ablation of feeding artery,Large HCC,not suitable for TACE or,still have viability after TACE,Percutaneous Artery Ablation,( PAA),-,Percutaneous ablation of feedi,25,Chen 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 enhance the coagulation effect,-,Chen MH, Yang W, et al. JVIR 2,26,Case. Wang XX, male, 58 years. Hepatitis B for 10 years HCC was found 2 mons ago and size 5.5 x 4.8 cm,-,Case. Wang XX, male, 58 years.,27,Tumor in right lobe and the size was 6x5 cmhad 2 big feeding arteriesfirst ablation the main feeding artery,-,Tumor in right lobe and the si,28,Post-PAA contrast US ( A phase ) :,Main feeding A was blocked ( ),Another feeding A still open (,),Parenchyma phase,Ring-like enhanced,“,annular solar eclipse,”,sign,-,Post-PAA contrast US ( A phase,29,Color US guided PAA for the second feeding A,-,Color US guided PAA for the se,30,Post-second PAA Contrast US:,The entire tumor perfusion defection,“total solar eclipse,”,sign,Post-first PAA contrast US,Rim like enhanced,-,Post-second PAA Contrast US:P,31,Perform multiple ablations,under tumor ischemia condition,-,Perform multiple ablations -,32,24 h,1 Mon,5 Mon,Follow up CT:,no viability in tu,-,24 h1 Mon5 MonFollow up CT: -,33,Result,(1),Early necrosis rate,92.4 (303/328 tu),3.15.0cm tumor,94.0(233/248 tu),5.17.0cm tumor,87.5(70/80 tu),(P0.059),-,Result (1)Early necrosis rate,34,Result(2) Long-term outcome,Follow up 3122 months,average 29,months,Local recurrence 14.3 (47/328 tu),New lesion incidence 38.4(116/302 tu),Long-term survival,1 Y,3 Y,5 Y,7 Y,P Value,3-5 cm,83.9,55.6,42.6,32.5,0.174,5-7 cm,83.3,47.0,25.4,18.2,Total,83.7,53.1,38.6,27.0,-,Result(2) Long-term outcomeFo,35,5cm HCC long-term survival lower than 3-5cm HCC,Survival curves after RFA for different sizes of HCC,-,5cm HCC long-term survival lo,36,Complication,Incidence of major complications 3.9 ,(12/302 cases),including liver function failure (n1),Bowel perforation (n3),Intraperitoneal hemorrhage (n 3),Hemothorax (n2),Needle tract seeding (n 3),-,ComplicationIncidence of major,37,Conclusion:,The strategies for tumor 3 cm can achieve a high success rate with a low complication rate,and then benefit for survival.,But the patients with 5 cm HCC tended have lower survival than 3.1-5.0 HCC patients, thus optimized multi-modalities treatment should be investigated for these tumors in the future.,-,Conclusion: The strategies for,38,Combine,target chemotherapy and local physical therapy,can interact actively and further improve efficiency,International multiple center randomized trail is going on,ThermoDox IV drop 30mins prior RFA,treat HCC 3cm,Our department was served as one of these centers,Prospective ,Combination with RFA,and target chemotherapy,Goldberg SN, et al. AJR 2002;179:93-101.,Poon PT, et al. Expert Opin Pharmacother 2009;10:333-43.,-,Prospective Goldberg SN,39,Thank you for your attention!,-,Thank you for your attention!-,40,( 2009 KunMing China),2011, Dec 16 KunMing (Prof. CHEN chairman),13TH INTERNATIONAL CONFERRENCE ON ULTRASOUND CONTRAST IMAGING AND TUMOR ABLATION,-,( 2009 KunMing China)2011, De,41,
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