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Type:
Educational Exhibit
Keywords:
Multidisciplinary cancer care, Cirrhosis, Cancer, Treatment effects, Education, Ablation procedures, Ultrasound, Percutaneous, CT, Management, Liver, Abdomen
Authors:
S. W. Jeon, J. H. Kwon, M. J. Kim; Daegu/KR
DOI:
10.1594/ecr2014/C-0747
Findings and procedure details
3.
Principle,
technique,
advantage and disadvantage of each combination therapy
3.1.
TACE plus PEI
- Principle and technique: TACE performed followed by PEI.
PEI performed at 7 to 10 days after TACE because recovery of side effects of TACE without recanalization of tumor vessels when PEI will be performed.
The Principle of TACE plus PEI is increasement of ethanol diffusion secondary to tumor necrosis and disruption of intratumoral septa produced by TACE before the PEI.
In addition,
embolization may reduce ethanol wash-out.
- Advantage: (Fig.
2) Significantly improve the survival rate in patients with HCC (3–8cm),
compared to PEI alone.
Also has benefit to HCCs(larger than 3 cm) at risky or difficult to ablate by RFA ,
especially in HCCs larger than 5 cm.
- Disadvantage: No advantage in small HCC (less than 3cm) compared to PEI alone.
3.2.
TACE plus RFA
- Principle and technique: TACE performed followed by RFA. RFA performed at 7 to 10 days after TACE because recovery of side effects of TACE without recanalization of tumor vessels when RFA will be performed.
The principle of TACE plus RFA is diminishment of blood flow and heat sink effect facilitating a larger zone of ablation during RFA.
In addition,
thermal therapy may also potentiate the effects of chemotherapy.
3.3.
PEI plus RFA
- Principle and technique: PEI performed followed by simultaneous application of RFA.
In high risk location to RFA,
PEI needle is located on the tumor closest to the blood vessel or vital structure.
On the other hand,
RFA electrode is located on the tumor at least 10mm away from vital structures. The principles of PEI plus RFA is diffusion of ethanol into areas not reached by RFA.
In addition, destruction of small vessels and tissue desiccation by PEI can produce less tissue cooling effect and more increased ablation zone during RFA.
4.
Choice among various treatment modalities
Consider advantage and disadvantage of each therapy,
tumor and patient characteristics such as tumor size,
number,
location,
margin,
whether conspicuous at US or CT or not or patient’s hepatic function (Fig.
5).
- The number of HCC > 3 or the size of HCC ≥ 5cm: First treatment of choice is TACE.
But in cases of compromised liver function or the tumor had no therapeutic effect by TACE, PEI plus RFA should be considered first.
- The size of HCC ≥ 3cm: If tumor size is 3-5cm,
TACE plus RFA or PEI plus RFA are firstly considered.
If tumor size is 5-8cm,
TACE plus PEI is first treatment choice.
If tumor had risk to be ablated with RFA,
TACE plus PEI or PEI plus RFA should be considered.
And if tumor had no therapeutic effect by TACE,
PEI plus RFA can be performed.