Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice

BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.

Efficacy of radiofrequency ablation combined with sorafenib for treating liver cancer complicated with portal hypertension and prognostic factors

BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.METHODS Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group(n=50)and a control group(n=50)according to the treatment regimen.The research group received radiofrequency ablation(RFA)in combination with sorafenib,and the control group only received RFA.The short-term efficacy of both the research and control groups was observed.Liver function and portal hypertension were compared before and after treatment.Alpha-fetoprotein(AFP),glypican-3(GPC-3),and AFP-L3 levels were compared between the two groups prior to and after treatment.The occurrence of adverse reactions in both groups was observed.The 3-year survival rate was compared between the two groups.Basic data were compared between the survival and non-surviving groups.To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension,multivariate logistic regression analysis was employed.RESULTS When comparing the two groups,the research group's total effective rate(82.00%)was significantly greater than that of the control group(56.00%;P<0.05).Following treatment,alanine aminotransferase and aspartate aminotransferase levels increased,and portal vein pressure decreased in both groups.The degree of improvement for every index was substantially greater in the research group than in the control group(P<0.05).Following treatment,the AFP,GPC-3,and AFP-L3 levels in both groups decreased,with the research group having significantly lower levels than the control group(P<0.05).The incidence of diarrhea,rash,nausea and vomiting,and fatigue in the research group was significantly greater than that in the control group(P<0.05).The 1-,2-,and 3-year survival rates of the research group(94.00%,84.00%,and 72.00%,respectively)were significantly greater than those of the control group(80.00%,64.00%,and 40.00%,respectively;P<0.05).Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade,history of hepatitis,number of tumors,tumor size,use of sorafenib,stage of liver cancer,histological differentiation,history of splenectomy and other basic data(P<0.05).Logistic regression analysis demonstrated that high Child-Pugh grade,tumor size(6–10 cm),history of hepatitis,no use of sorafenib,liver cancer stage IIIC,and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension(P<0.05).CONCLUSION Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates.The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade,tumor size(6-10 cm),history of hepatitis,lack of sorafenib use,liver cancer at stage IIIC,and prior splenectomy.

Severe hypoxemia after radiofrequency ablation for atrial fibrillation in palliatively repaired tetralogy of Fallot: A case report

BACKGROUND Patients with tetralogy of Fallot(TOF)often have arrhythmias,commonly being atrial fibrillation(AF).Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia,but the risk of complications may increase in patients with conditions such as TOF.CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt.The patient subsequently underwent atrial septal occlusion and eventually recovered.CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury;thus possible complications should be predicted in order to ensure successful treatment and patient safety.

Endoscopic ultrasound guided radiofrequency ablation for pancreatic tumors: A critical review focusing on safety, efficacy and controversies

The role of endoscopic ultrasound(EUS)in the last two decades has shifted from a diagnostic tool to an important therapeutic tool treating mainly pancreatobiliary disorders.In recent years,its applications for treating pancreatic diseases have broadened,including the implementation of radiofrequency ablation(RFA),which has been traditionally used for treating solid tumors.In this critical indepth review,we summarized all the papers throughout the literature regarding EUS-RFA for pancreatic neuroendocrine neoplasms,adenocarcinoma,and pancreatic cystic lesions.Overall,for pancreatic neuroendocrine neoplasms we identified 16 papers that reported 96 patients who underwent EUS-RFA,with acceptable adverse events that were rated mild to moderate and a high complete radiological resolution rate of 90%.For pancreatic adenocarcinoma,we identified 8 papers with 121 patients.Adverse events occurred in 13%of patients,mostly rated mild.However,no clear survival benefit was demonstrated.For pancreatic cystic lesions,we identified 4 papers with 38 patients.The adverse events were mostly mild and occurred in 9.1%of patients,and complete or partial radiological resolution of the cysts was reported in 36.8%.Notably,the procedure was technically feasible for most of the patients.Nevertheless,a long road remains before this technique finds its definite place in guidelines due to several controversies.EUS-RFA for pancreatic tumors seems to be safe and effective,especially for pancreatic neuroendocrine neoplasms,but multicenter prospective trials are needed to consider this treatment as a gold standard.

Radiofrequency ablation is an inferior option to liver resection for solitary hepatocellular carcinoma≤5 cm without cirrhosis:A population-based study with stratification by tumor size

Background:About 10%-20%of all individuals who develop hepatocellular carcinoma(HCC)do not have cirrhosis.Comparisons are rarely reported regarding the effectiveness of radiofrequency ablation(RFA)and liver resection(LR)in survival of HCC without cirrhosis and stratification by tumor size≤5 cm.Methods:We used the Surveillance,Epidemiology,and End Results(SEER)database and identified 1505 patients with a solitary HCC tumor≤5 cm who underwent RFA or LR during 2004-2015.Patients were classified into non-cirrhosis and cirrhosis groups and each group was categorized into three subgroups,according to tumor size(≤30 mm,31-40 mm,41-50 mm).Results:In patients without cirrhosis,LR showed better 5-year HCC cancer-specific survival than RFA in all tumor size subgroups(≤30 mm:82.51%vs.56.42%;31-40 mm:71.31%vs.46.83%;41-50 mm:74.7%vs.37.5%;all P<0.05).Compared with RFA,LR was an independent protective factor for HCC cancer-specific survival in multivariate Cox analysis[≤30 mm:hazard ratio(HR)=0.533,95%confidence interval(CI):0.313-0.908;31-40 mm:HR=0.439,95%CI:0.201-0.957;41-50 mm:HR=0.382;95%CI:0.159-0.916;all P<0.05].In patients with cirrhosis,for both tumor size≤30 mm and 31-40 mm groups,there were no significant survival differences between RFA and LR in multivariate analysis(all P>0.05).However,in those with tumor size 41-50 mm,LR showed significantly better 5-year HCC cancer-specific survival than RFA in both univariate(54.72%vs.23.06%;P<0.001)and multivariate analyses(HR=0.297;95%CI:0.136-0.648;P=0.002).Conclusions:RFA is an inferior treatment option to LR for patients without cirrhosis who have a solitary HCC tumor≤5 cm.

Radiofrequency ablation for renal tumours: A retrospective study from a tertiary centre

Objective:This study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation(RFA)for localised renal cell carcinoma(RCC)in a tertiary hospital patient who remained unfit for surgical intervention.Methods:We retrospectively analysed survival outcomes for patients with biopsy proven RCC treated by RFA at Royal Perth Hospital between September 2009 and May 2018.Complication data were gathered for all patients that underwent renal RFA along with 2-and 5-year recurrence-free survival(RFS)rate and compared the outcomes with data from previous studies.Results:A total of 69 patients(73 procedures)were eligible for the study,and those patients had biopsy-proven RCC with a minimum of 2-year follow-up.The complication rate was 8.2%(6/73)and local recurrence rate 9.6%(7/73).Two-year RFS is 95.7% and 5-year RFS is 78.8% on a median 3.82-year follow-up(interquartile range 1.90-5.75 years).Conclusion:RFA performed at our centre was found to be safe and effective with low complication rates and durable RFS in line with expectations from existing research.Our study demonstrated that RFA is an alternative modality of treatment for small renal tumours in patients unfit for surgical approach.

Hemocholecyst caused by accidental injury associated with radiofrequency ablation for hepatocellular carcinoma:A case report

BACKGROUND Radiofrequency ablation(RFA)is an effective and safe treatment for hepatocellular carcinoma that features a lower incidence of serious complications than surgical resection.Hemocholecyst caused by RFA is a rare complication of secondary damage to the intrahepatic bile duct that results in hemobilia.CASE SUMMARY Here we report on a case of a hemocholecyst caused by accidental injury during RFA that induced hematemesis and melena.Digital subtraction angiography revealed no gallbladder arterial injuries.After conservative treatment and transcatheter arterial chemoembolization,the patient’s condition stabilized,and she was discharged 1 wk later.CONCLUSION Therefore,when performing interventional procedures such as RFA,clinicians must be vigilant because even minor injuries can lead to serious complications such as hemocholecyst.

Endoscopic intraductal radiofrequency ablation for extrahepatic cholangiocarcinoma:An update(2023)

Recently,endoscopic intraductal radiofrequency ablation(ID-RFA)has attracted attention as a local treatment method for malignant biliary obstruction(MBO).IDRFA causes coagulative necrosis of the tumor tissue in the stricture and induces exfoliation.Its effects are expected to extend the patency period of biliary stents and prolong the survival period.Evidence for extrahepatic cholangiocarcinoma(eCCA)is gradually accumulating,and some reports show significant therapeutic effects in eCCA patients without distant metastasis.However,it is still far from an established treatment technique,and many unsolved problems remain.Therefore,when performing ID-RFA in clinical practice,it is necessary to understand and grasp the current evidence well and to operate appropriately for the true benefit of the patients.This paper reviews the current status,issues,and prospects of endoscopic ID-RFA for MBO,especially for eCCA.

Radiofrequency ablation in the treatment of small hepatocellular carcinoma:A meta analysis

AIM:To evaluate survival and recurrence after radiofrequency ablation(RFA) for the treatment of small hepatocellular carcinoma(HCC) using a meta-analysis.METHODS:Literature on RFA vs surgical resection for the treatment of small HCC published between January 1990 and December 2008 was retrieved.A metaanalysis was conducted to estimate pooled survival and recurrence ratios.A fixed or random effect model was established to collect the data.RESULTS:The differences in overall survival at 1-year,3-years and at end of follow-up were not statistically significant between the RFA and surgery groups(P > 0.05).There were no differences in 1-year and 3-year recurrences between the RFA and surgery groups(P > 0.05).However,recurrence in the RFA group was lower than that in the surgery group up to the end of follow-up(P = 0.03).Survival was not significantly different.There was a significant difference in recurrences at the end of follow-up after RFA compared with surgical resection.CONCLUSION:RFA did not decrease the number of overall recurrences,and had no effect on survival when compared with surgical resection in a selected group of patients.

Combination of percutaneous radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: observation of clinical effects

Objective： To observe the clinical effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） for advanced hepatocellnlar carcinoma （HCC）. Methods： A total of 92 eases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups： 43 patients treated with TACE （TACE group） and 45 patients that received TACE combined with RFA treatment （TACE ＋ RFA group）. After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. Results： Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment （CR ＋ PR） were 67.4% （29/43） and 91.1% （41/45） for the TACE and combined treatment groups, respectively, and the difference was statistically significant （P〈0.05）. The quality of life was significantly improved for patients undergoing TACE ~ RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE ~ RFA compared with the control group. Conclusions： In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.

Endobiliary radiofrequency ablation for malignant biliary obstruction

BACKGROUND: The cornerstone of palliative treatment for inoperable extrahepatic cholangiocarcinoma is the relief of malignant biliary obstruction. The most commonly applied method is endoscopic stenting. However, the procedure can be complicated with stent obstruction. In this respect, endobiliary radiofrequency ablation may serve as an adjunctive tool for prolonging the stent patency. METHODS: Patients who underwent endoscopic retrograde cholangiopancreatography for differential diagnosis and/ or palliative treatment after the diagnosis of inoperable extrahepatic cholangiocarcinoma between March 2011 and January 2012 were analyzed. Those in whom endobiliary radiofrequency ablation and endoscopic stenting was successfully performed were included in the study. Technical details of the procedure, duration of stent patency, length of hospital stay, short-term morbidity and mortality rate were documented. RESULTS: Seventeen patients were analyzed, and 10 patients were included in the study. The morbidity and mortality rate within the first 30 days after the procedure was 20% and 0%, respectively. In 2 patients, mild pancreatitis occurred because of the endobiliary procedure. In 1 patient, endobiliary decompression could not be achieved, and therefore, percutaneous transhepatic biliary drainage was carried out. The median duration of stent patency in 9 patients with successful biliary decompression was 9 months (range 6-15). CONCLUSION: Endobiliary radiofrequency ablation seems to be safe and feasible as a palliative measure and may prolong the stent patency and overall survival in patients with malignant biliary obstruction due to inoperable extrahepatic cholangio-carcinoma.

Combined resection and radiofrequency ablation for multifocal hepatocellular carcinoma: Prognosis and outcomes

AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.METHODS: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fiftyfour patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and diseasefree survival were compared.RESULTS: In the combination group, the medianage was 65 years (range, 3477 years), the median tumor number was 3 (range, 29), and the median tumor size was 6 cm (range, 1.214 cm). In the resection group, the median age was 51.5 years (range, 2780 years, P = 0.003), the median tumor number was 3 (range, 29, P = 0.574), and the median tumor size was 6 cm (range, 114 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had ChildPugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had fewer major resections (32% vs 65%, P = 0.012), less blood loss (400 vs 657 mL, P = 0.007), shorter operation time (270 vs 400 min, P = 0.001), and shorter hospital stay (7 vs 8.5 d, P = 0.042). The two groups displayed no major differences in surgical complications (15.8% vs 31.5%, P = 0.24), disease recurrence (63.2% vs 50%, P = 0.673), hospital mortality (5.3% vs 5.6%, P = 1), and overall survival (53 vs 44.5 mo, P = 0.496).CONCLUSION: Safe and effective for selected patients with multifocal hepatocellular carcinoma, the combination of resection and intraoperative RFA widens the applicability of surgical intervention for the disease.

Role of contrast-enhanced ultrasonography in percutaneous radiofrequency ablation of liver metastases and efficacy evaluation

Objective： To retrospectively investigate the role of contrast-enhanced ultrasonography （CEUS） in percutaneous radiofrequency ablation （RFA） in patients with liver metastases and evaluate the therapeutic efficacy of RFA assisted by CEUS. Methods： From May 2004 to September 2010, 136 patients with 219 liver metastatic lesions received CEUS examination 1 h before RFA （CEUS group）, and other 126 patients with 216 lesions without CEUS examination in the earlier period were served as a historical control group. The mean tumor size was 3.2 cm and the mean tumor number was 1.6 in the CEUS group, while 3.4 cm and 1.7 in the control group, respectively （P〉0.05）. The clinical characteristics, recurrence results and survival outcomes were compared between two groups. Results： In the CEUS group, two isoechoic tumors were not demonstrated on unenhanced ultrasonography （US）, and 63 （47%） of 134 tumors examined with CEUS were 0.3 cm larger than with unenhanced US. Furthermore, in 18.4% of 136 patients, additional 1-3 tumors were detected on CEUS. The CEUS group showed higher early tumor necrosis and lower intrahepatic recurrence than the control group. The 3-year overall survival （OS） rate and the 3-year local recurrence-free survival （LRFS） rate in the CEUS group were 50.1% and 38.3%, in contrast to 25.3% and 19.3% in the control group, respectively （P=0.002 and P〈0.001）. Conclusions： CEUS provides important information for RFA treatment in patients with liver metastases and better therapeutic effect could be attained.

Radiofrequency ablation or microwave ablation combined with transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma by comparing with radiofrequency ablation alone

Objective：To compare radiofrequency ablation （RFA） or microwave ablation （MWA） and transcatheter arterial chemoembolization （TACE） with RFA or MWA monotherapy in hepatocellular carcinoma （HCC）.Methods：A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA （combined treatment group） and the RFA-alone or MWA-alone groups （control group）.The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results：Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months （range,29 to 62 months）.The 1-,3-and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6％,68.1％ and 61.7％,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months （range,28 to 62 months）.The 1-,3-and 5-year overall survival for the RFA or MWA group was 85.1％,59.6％ and 44.7％,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio （HR）,0.526; 95％ confidence interval （95％ CO,0.334-0.823; P=0.002],and showed better recurrence-free survival than the RFA or MWA group （HR,0.582; 95％ CI,0.368-0.895; P=0.008）.Conclusions：RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA.

Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option

We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient's underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation(RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.

Intraoperative radiofrequency ablation combined with ^(125)iodine seed implantation for unresectable pancreatic cancer

AIM: To evaluate the feasibility, efficacy and safety of intraoperative radiofrequency ablation (RFA) combined with 125 iodine seed implantation for unresectable pancreatic cancer. METHODS: Thirty-two patients (21 males and 11 females) at the age of 68 years (range 48-90 years) with unresectable locally advanced pancreatic cancer admitted to our hospital from January 2006 to May 2008 were enrolled in this study. The tumor, 4-12 cm in diameter, located in pancreatic head of 23 patients and in pancreatic body and tail of 9 patients, was found to be unresectable during operation. Diagnosis of pancreatic cancer was made through intraoperative biopsy. Patients were treated with FRA combined with 125 iodine seed implantation. In brief, a RFA needle was placed, which was confirmed by intraoperative ultrasound to decrease the potential injury of surrounding vital structures, a 125 iodine seed was implanted near the blood vessels and around the tumor border followed by bypass palliative procedure (cholangio-jejunostomy and/or gastrojejunostomy) in 29 patients.RESULTS: The serum CA 19-9 level was decreased from 512 ± 86 U/mL before operation to 176 ± 64 U/mL, 108 ± 42 U/mL and 114 ± 48 U/mL, respectively, 1, 3 and 6 mo after operation (P < 0.05). The pain score on day 7 after operation, 1 and 3 mo after combined therapy was decreased from 5.86 ± 1.92 before operation to 2.65 ± 1.04, 1.65 ± 0.88 and 2.03 ± 1.16, respectively, after operation (P < 0.05). The rate of complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD) in 32 patients was 21.8% (7/32), 56.3% (18/32), 15.6% (5/32) and 6.3% (2/32), respectively, 6 mo after operation, with a median overall survival time of 17. 5 mo. The median survival time of patients at stage Ⅲ was longer than that of those at stage Ⅳ (19 mo vs 10 mo, P = 0.0026). The median survival time of patients who received and did not receive chemotherapy after operation was 20 mo and 16 mo, respectively (P = 0.0176). Of the 32 patients, 3 (10.6%) experienced postoperative complications including transient biliary leaks in 2 patients and acute pancreatitis in 1 patient. All the patients recovered well after conservative support treatment. CONCLUSION: Intraoperative RFA combined with 125 iodine seed implantation is a feasible and safe procedure for unresectable pancreatic cancer with acceptable minor complications, and can prolong the survival time of patients, especially those at stage Ⅲ.

Treatment of hepatic cysts by B-ultrasound-guided radiofrequency ablation

BACKGROUND: The traditional therapy for hepatic cysts has limited success because of recrudescence. Radiofrequency ablation (RFA) has become popular because of its advantages including little damage, therapeutic effect and reduced suffering. This report describes the effects and reliability of RFA in the treatment of 29 patients with hepatic cysts. METHODS: B-ultrasound-guided REA was used to treat hepatic mono-cyst or multi-cysts of 29 patients (63 tumors). Ablative efficiency and complications were assessed by imaging and clinical symptoms. RESULTS: The tumors were abated completely in 34 cysts with a diameter <5 cm and no recurrence was seen after 3 months. In 21 cysts with a diameter of 5-10 cm, tumor volume was decreased by over 70%, then reduction and fiberosis were found. In 8 cysts with a diameter greater than 10 cm, tumor volume was decreased by more than 60%, and in 2 cysts it was increased more slightly than that at I month after REA. In subsequent follow-up (6 and 12 months after REA), tumors <10 cm in diameter were fully ablated. No significant discomfort and complications were found in any patient. CONCLUSION: RFA for the treatment of hepatic cysts is safe, and free from complications.

Effects of Radiofrequency Ablation on Lymphocyte Subsets and Type 1/Type 2 T Cell Subpopulations in Patients with Hepatocellular Carcinoma

Objective： To evaluate whether radiofrequency ablation （RFA） might have an influence on immune status in hepatocellular carcinoma （HCC） patients. Methods： We measured the T lymphocytes, B lymphocyte and NK cells, and determined the population of Thl, Th2, Tcl and Tc2 of peripheral blood samples taken from 26 HCC patients before and after RFA. Results： The proportion of Typel cells （Thl and Tcl） and NK cells were significantly increased after RFA, especially in patients of the following subgroups： male, age〉55 years, pathological grade Ⅰ-Ⅱ tumor, clinical stage Ⅰ-Ⅱ or Child-Pugh A and B. Conclusion： TypeⅠ cells and NK cells in HCC patients were increased in a short period after RFA.

Radiofrequency ablation,heat shock protein 70 and potential anti-tumor immunity in hepatic and pancreatic cancers:a minireview

BACKGROUND: Radiofrequency ablation (RFA) is a minimally invasive surgical procedure which has widespread popularity in the treatment of hepatic and pancreatic cancers. Increased evidence indicates that RFA stimulates anti-tumor immunity, possibly through the induction heat shock protein 70 (HSP70) expression. HSP70 has the capacity to affect the immunogenicity of tumor cells, to chaperone antigenic peptides and deliver these into antigen presentation pathways within antigen-presenting cells, and to activate and regulate innate and adaptive immunity, which makes it useful in immunotherapeutic strategies for the treatment of cancers. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1991-2010) on anti-tumor immunity, heat shock protein 70, radiofrequency ablation, hepatic cancer, pancreatic cancer, and other related subjects. RESULTS: RFA has an increasing application in the surgical treatment of hepatic and pancreatic cancers. Increased evidence indicates that RFA can induce the expression of HSP70 which possesses properties that enable it to influence a variety of immunological processes. Tumor-derived HSP70 is regarded as a potent adjuvant facilitating presentation of tumor antigens and induction of anti-tumor immunity. CONCLUSIONS: This review addresses the potential association of RFA, HSP70, and anti-tumor immunity in treatment of hepatic and pancreatic cancers. To establish direct evidence of a potential association of RFA, HSP70, and anti-tumor immunity in hepatic and pancreatic cancers, further investigations should be conducted.

Radiofrequency ablation of locally advanced pancreatic adenocarcinoma:An overview

Radiofrequency ablation(RFA)of pancreatic neoplasms is restricted to locally advanced,non-resectable but nonmetastatic tumors.RFA of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparotomy in open surgery.Intraoperative ultrasound covers the mandatory role of staging,evaluation of feasibility,guidance and monitoring of the procedure.Different types of needle can be used.The first aim in the evaluation of RFA as a treatment for locally advanced pancreatic ductal adenocarcinoma,in order of evaluation but not of importance,is to determine the feasibility of the procedure.The second aim is to establish the effect of RFA on tumoral mass in terms of necrosis andcytoreduction.The most important aim,third in order of evaluation,is the potential improvement of quality of life and survival rate.Nowadays,only a few studies assess the feasibility of the procedure.The present paper is an overview of RFA for pancreatic adenocarcinoma.