Percutaneous Radiofrequency Ablation For Huge Hepatocellular Carcinoma And Hepatocellular Carcinoma Adjacent To The Diaphragm

Part one:Percutaneous radiofrequency ablation for huge hepatocellular carcinomaObjective To investigate the therapeutic efficacy and safety of percutaneous CT-guided radiofrequency ablation in the treatment of huge hepatocellular carcinoma(HCC).Methods From January 2004 to January 2008,32 consecutive patients with tumor larger than 10cm in our institution were enrolled in this study.All tumors underwent one to four times percutaneous CT-guided radiofrequency ablation with cool-tip electrode and 20 lesions received ethanol injection simultaneity.1 to 10 times TACE treatment was carried out to combine together with RFA for 30 lesions.Follow-up with enhanced CT or MRI was performed to evaluate the treatment results.If no contrast enhancement was detected in the treated area on follow-up examinations,the treatment was considered successful.Complications local tumor progression,overall Survival were analyzed.Results 32 patients underwent 57 RFA treatments.No death and severity complications, which needed emergency surgery,were documented.Complete necrosis without recurrence was observed in 14 patients and majority necrosis with periphery enhancement was noted in the remaining 18 patients.One year survival rate was 81.3%with a medial of 25 months.Conclusion RFA can be effective and safe in treatment of huge hepatocellular carcinoma.Although our preliminary study showed compromise results,a further study with large sample and long term follow-up is warranted to clarify its several drawback of this study.Part two:Percutaneous radiofrequency ablation for hepatoeellular carcinoma adjacent to the diaphragmObjective To investigate the therapeutic efficacy and safety of percutaneous CT-guided radiofrequency ablation in the treatment of hepatocellular carcinoma adjacent to the diaphragm.Methods 37 patients with total 58 lesions adjacent to thediaphragm were treated by CT-guided RFA with cool-tip electrode.The diameter of lesions spaned from 0.5cm to 5.0cm with an average diameter of 2.8cm..The tumors were punctured using a fine needle at caudacephal direction by slant paracentesis first.Then the cool-tip electrode was penetrated into the lesion under the guide of the fine needle.RFA was performed after the cool-tip electrode arrived at the center of the tumors.CT or MRI examination was performed after RFA treatment to evaluate the necrotic degree of the tumor.Results The electrode was successfully positioned into all the 58 lesions and RFA was performed.During the operation and follow-up,no related complications were noted.On follow-up CT or MRI,52 tumors demonstrated completed necrosis and 6 lesions showed majority necrosis.Conclusion CT-guided RFA with the slant paracentesis is safe for the treatment of hepatocellular carcinoma adjacent to the diaphragm,which is worthy recommended in clinical work-up.