Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

AIM To assess the usefulness of intra-arterial contrastenhanced ultrasonography(IAUS) during transarterial chemoembolization(TACE) with drug-eluting beads(DEB) for hepatocellular carcinoma(HCC).METHODS Thirty two patients with 39 HCC underwent DEB-TACE guided with IAUS, and examined by contrast-enhanced ultrasonography(CEUS) or dynamic CT after DEB-TACE were enrolled in this study. CEUS findings before DEBTACE and IAUS findings were compared. Treatments judged to be complete and incomplete for lesions were appropriate and insufficient, respectively. Findings on CEUS and/or dynamic CT performed 1, 3 and 6 mo after DEB-TACE were evaluated using m RECIST(CR/PR/SD/PD).RESULTS The treatments were complete and incomplete in 26 and 13 lesions, respectively. On imaging evaluation using CEUS and/or dynamic CT one month after treatment, 25 and 1 lesions were judged to be CR and PR, respectively, and at 6 mo after treatment, the results were CR, PR, SD and PD for 24, 1, 0 and 1 of these lesions, respectively, in the 26 completely treated lesions. Of the 13 lesions in which treatment was incomplete, the results on imaging at one month after treatment were CR, PR, SD and PD for 0, 6, 4 and 3 lesions, respectively. The overall CR rate at 6 mo after treatment was 61.5%(24/39).CONCLUSION A combination of DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC.

Comparison of percutaneous radiofrequency ablation and CyberKnife®for initial solitary hepatocellular carcinoma:A pilot study

AIM To compare therapeutic outcomes and adverseevents in initial solitary hepatocellular carcinoma（HCC） treated with radiofrequency ablation （RFA） andCyberKnife？.METHODS： Seventy three consecutive patients withinitial solitary HCC treated with RFA （38 patients;RFA group） and CyberKnife （35 patients; CK group）were enrolled in this study. Background factorswere compared between the two groups. Local andintrahepatic distant recurrence control, and cumulativesurvival rates were compared between the two groups.These were determined using the Kaplan-Meier method,and the significance of differences was analyzed by log-rank test. The presence of more grade 3 on CTCAE ver.4.0 early and late adverse events was investigated.RESULTS： In background factors, age was significantlyhigher （P = 0.005） and the tumor diameter wassignificantly larger （P = 0.001） in the CK group. The1-year local recurrence control rates were 97.4%and 97.1% in the RFA and CK groups, respectively （P= 0.71）; the 1-year intrahepatic distant recurrencecontrol rates were 85.6% and 86.1%, respectively （P= 0.91）; and the 1-year cumulative survival rates were100% and 95.2%, respectively （P = 0.075）, showingno significant difference in any rate between the twogroups. There were no late adverse event in the RFAgroup, but 11.4% in the CK group had late adverseevents. In the CK group, the Child-Pugh score at 12 moafter treatment was significantly higher than that in theRFA group （P = 0.003） and significantly higher than thescore before treatment （P = 0.034）.CONCLUSION： The occurrence of adverse events is aconcern, but CyberKnife treatment is likely to becomean important option for local treatment of early HCC.