CT-Guided Radio-frequency Ablation Of Liver Cancer

Objective : To investigate the clinical efficacy of CT-guided percutaneous radio-frequency ablation(PRFA)of liver cancer.Methods:1.145 liver malignant tumor patients underwent CT-guided percutan- eous radio-frequency ablation from Nov. 2005 to Jan.2009 were reviewed retrospectively(aged 57.7±14.5year old) , including 96 males and 49 females.The hepatic tumors consisted of primary hepatic carcinoma (PHC) (n=103) (final diagnosis A/W:①hepatic cirrhosis case history;AFP >300IU/L; contrast enhanced CT and/or MR demonstrated lesion typical enhanced②patients without those clinical trials, underwent liver biopsy.). For those metastatic carcinoma (n=42)(final diagnosis A/W: Primary lesion has be resected with malifnant pathologic diagnosis . contrast enhanced CT and/or MR showed liver metastasis). Standards: Child-pugh A grade (n=121)and Child-pugh B grade(n=44),; Numbers of tumor in liver is less than 3, and diameter of maximum tumor is less than 7cm;No metastasis outside liver; no portal malignant embolism.195 lesions were treated, including primary hepatic carcinoma (n=134)and hepatic metastasis(n=61). 85 lesions is less than 3cm in diameter(A group); 65 lesions is 3-5cm in diameter (B group); 45 lesions is larger than 5cm in diameter (C group). 49 lesions were nearby surface of liver(Ⅰgroup),43 lesions were nearby great vessels (Ⅱgroup);103 lesions were far from surface of liver and great vessels (Ⅲgroup).2. therapeutics: radio frequency ablation electrode: welfare radio frequency ablation electrode(Beijing Welfare Eleectronics Co.),its maximum output power is 100w.This electrode is a kind of multipolar electrode with 11 expanding branch electrodes on its top,and maximal diameter of expanded branch electrode is 4cm. This kind of electrode has to be use with WE7568 system only. Image equipment: GE lightspeed Ultra 4slice CT scanning(GE,Co.).Guiding needle: 22G Chiba needle. Anesthesia and analgesia: Pet- hidine 50mg,Promethazine 25mg and NS 250ml is transfused by intravenous slowly. Theraputic procedure: according to the CT scanning results, describing the exact slice. Puncture Chiba needle into the lesion, then push the radio frequency ablation electrode into the lesion along Chiba needle expanding the branch electrode. When the theraputic temperature reached 900C, taking 10minutes abation.When the lesion need more ablation,repeat the above procedures. Multi-points electric coagulation need to perform after each ablation.3.Evaluation of ablation and follow-up: Contrasted CT and/or MR scanning and tumor marker examination was carried out in 1,3,6,12,18,24monthes follow-up. Another ablation should be performed again when suspect of residual tumor was discovered.4.statistics: Data analysis were performed using SPPS 10.0 software, (∝=0.05).Results:1.Status of ablation: Local Complete Ablation (CA) rate of A group,B group and C group was 95.3%(81/85),89.2% (58/65) and 66.7% (30/45), difference among groups possess statistical significance (chi square test, P<0.05).Local CA rate ofⅠgroup,Ⅱgroup andⅢgroup was 81.6%(40/49),76.7% (33/43) and 93.2%(96/103), difference betweenⅢgroup andⅡgroup orⅠgroup possess statistical significance (chi square test, P<0.05).Local CA rate of primary hepatic carcinoma, hepatic metastatic carcinoma was 90.3%(121/134) and 78.7% (48/61), and difference between two groups possess statistical significance (chi square test, P<0.05).2. local recurrence condition: Local recurrence rate of A group,B group and C group was 12.3%(10/81),24.1% (14/58) and 56.7% (17/30), and difference among groups possess statistical significance (chi square test, P<0.05).Local recurrence rate ofⅠgroup,Ⅱgroup andⅢgroup was 35.0% (14/40),39.4% (13/33) and 114.6%(14/96), and difference betweenⅢgroup andⅠgroup orⅡgroup possess statistical significance (chi square test, P<0.05).Local recurrence rate of primary hepatic carcinoma and hepatic metastatic carcinoma was 17.4%(21/121) and 41.7% (20/48), and difference difference between two groups possess statistical significance (chi square test, P<0.01).3.Complication: Seven patients(7/145,4.83%) developed complications, including hemorrhage under liver capsule(n=1,0.69%),burn injury of skin (n=2,1.38%), Hemopneumothorax (n=1,0.69%),portal vein thrombosis (n=1,0.69%), hepatic arteriovenous fistula (n=2,1.38%), no hepatapostema, bile peritonitis, abdominal cavity organ damage, needle track implatation,liver function failure and death.Conclusion: The CT-guided RFA is most effective in the treatment of liver tumors especially for the micro-liver cancer which were far from vessels or the surface of liver.