Clinical Application Of High Intensity Focused Ultrasound Therapy For Primary Liver Cancer With Vascular Invasion

Background Primary liver cancer is due to intrahepatic bile ductepithelial cells or malignant tumour of the liver cells. At present, thismultidisciplinary, multimode and sequential treatment comes more effectiveto control the disease progression and improved the prognosis of patients.Primary liver cancer, however, often invasive growth that may invade theblood vessels such as portal vein, hepatic vein, inferior vena cava. Vascularinvasion, can not only cause tumor metastasis but also lead to portalhypertension, upper gastrointestinal hemorrhage, liver failure and the shedof Cancer Embolus that may lead to complications such as pulmonaryembolism and so on, and even endanger the patient lives. High intensityfocused ultrasound is a non-invasive status and has used for treatment ofmany tumors such as primary liver cancer.The preliminary results of thestudy for portal vein invasion aspects of HIFU treatment of primary livercancer show that HIFU treatment could lead to the cancer embolus somenarrow, the liver function of some patients could be improved, and theascites could be decreased. But now mostly clinical studies for HIFU treatment of hepatocellular carcinoma with portal vein invasion werepreliminar.And there is lack of more in-depth analysis of controlledclinical studies.Objective To research the safety and efficacy of HIFU treatmentfor treating the primary liver cancer with vascular invasion.To do theclinical analysis of main factors that may affect HIFU treatment for fortreating the primary liver cancer with vascular invasion, look for the factorsmay affect the prognosis and predict prognosis and improve clinicaltreatment programs.Metheods77cases of primary liver cancer patients with vascularinvasion enrolled in the study. These patients were randomly divided intotwo groups:HIFU was performed in group HIFU(n=37),and without HIFUwas performed in group without HIFU (n=40). Compare the enhanced CTor MRI before and after HIFU, evaluate the ablation of tumors after HIFU.Observed the change of albumin, total bilirubin, direct bilirubin, alanineaminotransferase, aspartate aminotransferase, international normalizedratio(INR) and other key indicators of liver function before and after HIFUtreatment. Adverse reactions were observed and recorded after HIFUtreatment. Using the Kaplan-Mier method to conduct the survival analysisof the two groups of patients, to assess overall survival and median survivalof the two groups of patients and to and compare the differences ofsurvivals between the two groups of patients. Results1. During the follow-up period, there are18deaths(48.6%) and themedian survival is13.3months in HIFU group.The1-,2-and3-year overallsurvival rates were2.6%、16.3%and8.2%.In non-HIFU group,there are21deaths(52.5%)and1-year overall survival rates was22.2%.There wassignificant difference between the two groups in survival(Log rank,P=0.005）.2. The enhanced CT or MRI of the37cases of patients four weeksafter HIFU treatment showed that average ablation rates of tumor is67.5±19.8%(33.0%-98%).There is29cases (79.4%) whose ablation rates isover50%of (CR+PR).3. In HIFU group,the AFP average is611.1±563.9ug/L and aftertreatment AFP average is436.4±457.3ug/L.AFP decreased significantlyafter treatment(P=0.03).4. In HIFU group,there were no obvious differences about thealbumin, total bilirubin, direct bilirubin, alanine aminotransferase, aspartateaminotransferase, aspartate aminotransferase, and coagulation internationalnormalized ratio between before and after HIFU one week (P=0.248,0.300,0.348,0.064,0.271,0.334, respectively).5.There was37patients treated with HIFU.13of them feelingdiscomfort in liver area of the37patients treated with HIFU and relaxedwithout special treatment in a week.3of them had fever,and the body temperature up to38.5℃.And the body temperature returned to normalwithin three days, without special treatment.3of them had skin damagewith orange peel-like change.Keep the skin clean and dry and relieve themwere recovered and edema relieved after1week.6. The analysis of doing TAE or TACE before HIFU on the survival ofpatients in HIFU group showed that doing TAE or TACE before HIFU hadno significant effect on the survival of patients (Log rank, P=0.819). TAE orTACE treatment had no significant effect on the survival of patients (Logrank, P=0.175).7. The analysis of portal vein invasion degree on survival showed thatsurvival of the patients was VP2＞VP3＞VP4(the classification methodof liver cancer study of Japan),in HIFU group.There was significantdifference between the three groups in survival(Log rank, P=0.002）.And itis the same in non-HIFU group survival of the patients was VP2＞VP3＞VP4. There was significant difference between the three groups insurvival,too(Log rank, P=0.036）.8. The analysis of portal vein invasion location on survival showed thatthere was no significant difference in survival,in HIFU group andnon-HIFU group(Log rank, P=0.140,P=0.059, Respectively)Conclusion1.HIFU can treat the primary liver cancer with vascular invasion safelyand effectively. It offers a chance of cure of liver cancer with vascular invasion.2. Do TAE or TACE before HIFU cannot improve the prognosis ofpatients.3. The location of portal vein invasion had no significant difference insurvival and the degree f portal vein invasion had significant difference insurvival.That means the degree f portal vein invasion may be the majorprognostic factors of portal vein invasion treated with HIFU.