^(125)I粒子植入联合射频消融治疗中晚期非小细胞肺癌的近期疗效及安全性

目的探讨^(125)I粒子植入联合射频消融治疗中晚期非小细胞肺癌的近期疗效及安全性。方法选取中晚期非小细胞肺癌患者60例,依据治疗方法分为单独射频消融治疗组(单独治疗组)30例和^(125)I粒子植入联合射频消融治疗组(联合治疗组)30例。联合治疗组患者接受^(125)I粒子植入联合射频消融治疗,单独治疗组患者接受单独射频消融治疗。结果联合治疗组患者治疗的总有效率63.3%(19/30)显著高于单独治疗组46.7%(14/30),差异有显著性(P<0.05);两组患者的不良反应发生率差异无显著性(P>0.05);联合治疗组患者的1、2、3年生存率分别为76.7%(23/30)、66.7%(20/30)、13.3%(4/30),单独治疗组患者的1、2、3年生存率分别为60.0%(18/30)、46.7%(14/30)、3.3%(1/30),前者均显著高于后者,差异有显著性。结论 ^(125)I粒子植入联合射频消融治疗中晚期非小细胞肺癌的近期疗效较单独射频消融治疗高,不良反应发生率差异无显著性。

^(125)I粒子永久植入联合实时测温射频消融治疗肺癌效果分析

目的探讨^(125)I粒子永久植入联合实时测温射频消融治疗中晚期非小细胞肺癌(NSCLC)的临床效果。方法收集2012年10月至2015年1月在内蒙古呼和浩特市第一医院胸外科未接受外科手术治疗的中晚期NSCLC患者98例,根据患者意愿分为联合治疗组(n=45)和常规治疗组(n=53)。联合治疗组采用125I粒子永久植入联合实时测温射频消融治疗,并于术后3个月配合使用化疗方案(培美曲赛+卡铂);常规治疗组直接使用化疗方案(培美曲赛+卡铂)。术后1周和1、3、6、12个月复查增强CT明确临床疗效。采用欧洲癌症研究与治疗组织肺癌患者生命质量测定特异性模块(EORQLQ—LCl3中文版)、肺癌患者的总生存质量评价表和生存时间比较两组患者治疗前和治疗后的差异。结果联合治疗组患者治疗后均未出现严重并发症,术后复查增强CT,可见病灶部位于术后1个月开始强化逐渐减弱,3~6个月出现125I粒子位置缓慢聚集,病灶逐步固化坏死,形成空洞,去血管征象和凝固性坏死明显。随访7~24个月,联合治疗组生存率88.9%,常规治疗组生存率49.1%。治疗前,两组患者的EORQLQ—LCl3和总生存质量比较,差异均无统计学意义(P>0.05);治疗后,两组患者的EORQLQ—LCl3和总生存质量评分均较治疗前明显改善(P<0.05);且联合治疗组在EORQLQ—LCl3评分及总生存质量评分均明显优于常规治疗组(P<0.05)。联合治疗组患者的平均生存时间为(18.4±5.8)个月,显著优于常规治疗组的(10.9±4.2)个月(t=5.763,P<0.05)。结论125I粒子永久植入联合实时测温射频消融治疗肺癌是一种简单、安全、微创、有效的方法,同时125I粒子永久植入联合实时测温射频消融治疗与化疗有机结合,能很好地改善患者的生活质量并延长生存期。

Rapid progression of hepatocellular carcinoma after Radiofrequency Ablation

AIM:To report the results of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in cirrhotic patients and to describe the treatment related complications (mainly the rapid intrahepatic neoplastic progression). METHODS:Eighty-seven consecutive cirrhotic patients with 104 HCC (mean diameter 3.9 cm,1.3 SD) were submitted to RFA between January 1998 and June 2003.In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable electrode needles. Treatment efficacy (necrosis and recurrence) was estimated with dual phase computed tomography (CT) and alpha- fetoprotein (AFP)level. RESULTS:Complete necrosis rate after single or multiple treatment was 100%,87.7% and 57.1% in HCC smaller than 3 cm,between 3 and 5 cm and larger than 5 cm respectively (P=0.02).Seventeen lesions of 88(19.3%) developed local recurrence after complete necrosis during a mean follow up of 19.2 mo.There were no treatment-related deaths in 130 procedures and major complications occurred in 8 patients (6.1%).In 4 patients,although complete local necrosis was achieved,we observed rapid intrahepatic neoplastic progression after treatment.Risk factors for rapid neoplastic progression were high preoperative AFP values and location of the tumor near segmental portal branches. CONCLUSION:RFA is an effective treatment for hepatocellular carcinoma smaller than 5 cm with complete necrosis in more than 80% of lesions.Patients with elevated AFP levels and tumors located near the main portal branch are at risk for rapid neoplastic progression after RFA.Further studies are necessary to evaluate the incidence and pathogenesis of this underestimated complication.

Treatment efficacy of radiof requency ablation of 338 patients with hepatic malignant tumor and the relevant complications

AIM： To investigate the treatment efficacy of radiofrequency ablation （RFA） of hepatic malignant tumor and the relevant complications. METHODS： A total of 338 patients with 763 hepatic tumors underwent ultrasound-guided RFA （565 procedures）. There were 204 cases of hepatic cellular carcinoma （HCC） with 430 tumors, the mean largest diameter was 4.0 cm. Of them, 48 patients （23.5%） were in stages Ⅰ-Ⅱ （UICC Systems） and 156 （76.5%） in stages Ⅲ-Ⅳ There were 134 cases of metastatic liver carcinoma （MLC）, with 333 metastases in the liver, the mean diameter was 4.1 cm, the liver metastases of 96 patients （71.6%） came from gastrointestinal tract. Ninety-three percent of the 338 patients were treated using the relatively standard protocol. Crucial attention must be paid to monitor the abnormal changes in ultrasound images as well as the vital signs of the patients to find the possible hemorrhage and peripheral structures injury in time. The tumors were considered as ablated completely, if no viability was found on enhanced CT within 24 h or at 1 mo after RFA. These patients were followed up for 3-57 too. RESULTS： The ablation success rate was 93.3% （401/430 tumors） for HCC and was 96.7% （322/333 tumors） for MLC. The local recurrence rate for HCC and MLC was 7.9% （34/430 tumors） and 10.5% （351333 tumors）, respectively. A total of 137 patients （40.5%） underwent 2-11 times of repeated ablations because of tumor recurrence or metastasis. The 1st, 2nd, and 3rd year survival rate was 84.6%, 66.6%, and 63.1%, respectively; the survival rate from 48 patients of I-II stage HCC was 93.7%, 80.4%, and 80.4%, respectively. The major complication rate in this study was 2.5% （14 of 565 procedures）, which consisted of 5 hemorrhages, i colon perforation, 5 injuries of adjacent structures, 2 bile leakages, and 1 skin burn. CONCLUSION： RFA, as a minimally invasive local treatment, has become an effective and relatively safe alternativefor the patients of hepatic malignant tumor, even of advanced liver tumor, tumor recurrence, and liver metastases. Knowledge about possible complications and their control may increase the treatment efficacy and help to promote the use of RFA technique.

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

AIM:To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation(RFA) of the feeding artery of hepatocellular carcinoma(HCC) in reducing the blood-flow-induced heat-sink effect of RFA.METHODS:A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups.Seventy-one patients with 75 HCCs(average tumor size,4.3 ± 1.1 cm) were included in group A,in which the feeding artery of HCC was identified by color Doppler flow imaging,and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery(PAA)] before routine RFA treatment of the tumor.Eighty-three patients with 102 HCC(average tumor size,4.1 ± 1.0 cm) were included in group B,in which the tumors were treated routinely with RFA.Contrast-enhanced computed tomography was used as post-RFA imaging,when patients were followed-up for 1,3 and 6 mo.RESULTS:In group A,feeding arteries were blocked in 66(88%) HCC lesions,and the size of arteries decreased in nine(12%).The average number of punctures per HCC was 2.76 ± 1.12 in group A,and 3.36 ± 1.60 in group B(P = 0.01).The tumor necrosis rate at 1 mo post-RFA was 90.67%(68/75 lesions) in group A and 90.20%(92/102 lesions) in group B.HCC recur-rence rate at 6 mo post-RFA was 17.33%(13/75) in group A and 31.37%(32/102) in group B(P = 0.04).CONCLUSION:PAA blocked effectively the feeding artery of HCC.Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.

Radiofrequency ablation or percutaneous ethanol injection for the treatment of liver tumors

The liver is a common location of both primary and secondary malignancies. For unresectable liver cancer, many local ablative therapies have been developed. These include e.g., percutaneous ethanol injection (PEI), percutaneous acetic acid injection, radiofrequency ablation (RFA), cryoablation, microwave ablation, laserinduced thermotherapy, and high-intensity focused ultrasound. RFA has recently gained interest and is the most widely applied thermoablative technique. RFA allows more effective tumor control in fewer treatment sessions compared with PEI, but with a higher rate of complications. However, there are certain circumstances where PEI therapy represents a better strategy to control liver tumors than RFA, especially in situations where RFA is difficult, for example when large vessels surround the tumor. In the context of hepatocellular carcinoma (HCC), both RFA and PEI are feasible and of benefit in non-operable patients. RFA seems superior to PEI in HCC > 2 cm, and the combination of interventions may be of benefit in selected patients. Liver resection is superior to RFA for patients with HCC meeting the Milan criteria, but RFA can be employed in tumors ≤ 3 cm and where there is an increased expected operative mortality. In addition, some lines of evidence indicate that RFA and PEI can be employed as a bridge to liver transplantation. The use of RFA in colorectal liver metastases is currently limited to unresectable disease and for patients unfit for surgery. The aim of this article is to summarize the current status of RFA in the management of liver tumors and compare it to the cheap and readily available technique of PEI.

Radiofrequence ablation of liver cancers

Primary and secondary malignant liver cancer are some of most common malignant tumors in the world. Chemotherapy and radiotherapy are not very effective against them. Surgical resection has been considered the only potentially curtive option, but the majority of patients are not candidates for resection because of tumor size, location near major intrahepatic blood vessels and bile ducts, precluding a margin-negative resection, cirrhotic, hepatitis virus infection or multifocial. Radiofrequence ablation (RFA), which is a new evolving effective and minimally invasive technique, can produce coagulative necrosis of malignant tumors. RFA should be used percutaneously, laparascopically, or during the open laparotomy under the guidance of ultrasound, CT scan and MRI. RFA has lots of advantages superior to other local therapies including lower complications, reduced costs and hospital stays, and the possibility of repeated treatment. In general, RFA is a safe, effective treatment for unresectable malignant liver tumors less than 7.0 cm in diameter. We review the principle, mechanism, procedures and experience with RFA for treating malignant liver tumors.

Comparison between combination therapy of percutaneous ethanol injection and radiofrequency ablation and radiofrequency ablation alone for patients with hepatocellular carcinoma

AIM: In the present study, the characteristics of PEI-RFA treatment were further elucidated by analyzing the relationship between the volume of coagulated necrosis and the energy requirement for ablation or the amount of ethanol injected into HCC.METHODS: The volume of coagulated necrosis, total energy requirement and energy requirement for coagulation of per unit volume were examined in the groups of PEI-RFA and RFA alone using the Cool-tip RF system.RESULTS: The results showed that the volume of coagulated necrosis induced was significantly larger in PEI-RFA group than in routine RFA group, when the total energy administered was comparable in both groups.In PEI-RFA, enlargement of coagulated necrosis was admitted in 3 dimensions and the amount of energy requirement per unit volume of coagulated necrosis was negatively correlated with the amount of ethanol injected into HCC.CONCLUSION: These results suggest that, compared to RFA alone, PEI-RFA enables to induce comparable coagulated necrosis with smaller energy requirement, and that PEI-RFA is likely to be less invasive than RFA alone irrespective of inducing enhanced coagulated necrosis.Thus, simple prior injection of ethanol may make RFA treatment more effective and less invasive for the treatment of patients with HCC.

Cholangiocarcinoma:A compact review of the literature

Cholangiocarcinoma(CC) is a devastating cancer aris-ing from biliary epithelia.Unfortunately,the incidence of this disease is increasing in Western countries.These tumors progress insidiously,and liver failure,biliary sepsis,malnutrition and cancer cachexia are general modes of death associated with this disease.To date,no established therapy for advanced dis-ease has been established or validated.However,our knowledge in tumor biology is increasing dramatically and new drugs are under investigation for treatment of this notorious tumor.In clinical practice,there are better diagnostic tools in use to facilitate an earlier diagnosis of CC,at least in those patients with known risk factors.CC is resectable for cure in only a small percentage of patients.Preoperative staging for vas-cular and biliary extension of CC is very important in this tumor.Laparoscopy and recently endosonography seem to protect against unnecessary laparotomies in these patients.During the last 15 years,aggressive surgical approaches,including combined liver resec-tions and vascular reconstructive surgical expertise,have improved survival in patients with CC.Surgery is contraindicated in CC cases having primary sclerosing cholangitis(PSC).Although CC was previously consid-ered a contraindication to liver transplantation,new cautious protocols,including neo-adjuvant chemora-diation therapies and staging procedures before the transplantation,have made it possible to achieve long-term survival after liver transplantation in this disease.New ablative therapies with photodynamic therapy,intraductal high-intensity ultrasonography and chemo-therapy-impregnated plastic biliary endoprosthesis are important steps in the palliative management of extra-hepatic CCs.Radiofrequency and chemo-embolization methods are also applicable for intra-hepatic CCs as palliative modes of treatment.We need more prospec-tive randomized controlled trials to evaluate the role of the new emerging therapies for CC patients.

Review of dynamic contrast-enhanced ultrasound guidance in ablation therapy for hepatocellular carcinoma

Local ablative techniques-percutaneous ethanol injection, microwave coagulation therapy and radiofrequency ablation (RFA)-have been developed to treat unresectable hepatocellular carcinoma (HCC). The success rate of percutaneous ablation therapy for HCC depends on correct targeting of the tumor via an imaging technique. However, probe insertion often is not completely accurate for small HCC nodules, which are poorly def ined on conventional B-mode ultrasound (US) alone. Thus, multiple sessions of ablation therapy are frequently required in diffi cult cases. By means of two breakthroughs in US technology, harmonic imaging and the development of second-generation contrast agents, dynamic contrast-enhanced harmonic US imaging with an intravenous contrast agent can depict tumor vascularity sensitively and accurately, and is able to evaluate small hypervascular HCCs even when B-mode US cannot adequately characterize the tumors. Therefore, dynamic contrast-enhanced US can facilitate RFA electrode placement in hypervascular HCC, which is poorly depicted by B-mode US. The use of dynamic contrast-enhanced US guidance in ablation therapy for liver cancer is an effi cient approach. Here, we present an overview of the current status of dynamic contrast-enhanced US-guided ablation therapy, and summarize the current indications and outcomes of reported clinical use in comparison with that of other modalities.

Surgical vs percutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations

AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous locations.METHODS:One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study.The patients were divided into percutaneous RFA group and surgical RFA group.After the patients were regularly followed up for a long time,their curative rate,hospital stay time,postoperative complications and 5-year local tumor progression were compared and analyzed.RESULTS:No significant difference was observed in curative rate between the two groups(91.3% vs 96.8%,P = 0.841).The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group(P < 0.05).The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group(P = 0.05).The relative risk of local tumor progression was 14.315 in percutaneous RFA group.CONCLUSION:The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.

Acoustic radiation force impulse elastography for hepatocellular carcinoma-associated radiofrequency ablation

AIM:To evaluate the potential usefulness of acoustic radiation force impulse (ARFI) images for evaluation of hepatocellular carcinomas (HCC)-associated radiofrequency ablation. METHODS:From January 2010 to June 2010,a total of 38 patients with HCC including recurred HCCs after RFA underwent ARFI elastography. The brightness of tumor was checked and the shear wave velocity was measure-d for the-quantification of stiffne-ss. According to theb-rightne-ss,the-tumors we-re-classifie-d as b-righte-r,samecolor and darker compared with adjacent parenchyma. Using the same methods,8 patients with recurred HCCs after RFA state were evaluated about the brightness compared with adjacent RFA ablation area. RESULTS:In the 38 patients with HCCs,20 (52.6%)were brighter than surrounding cirrhotic parenchyma. Another 13 (34.2%) were darker. The others (5 cases,13.2%) were seen as the same color as the adjacent liver parenchyma. Post-RFA lesions were darker than previous tumor and surrounding parenchyma in all 38 cases. However,recurred HCCs were brighter than the treated site in all 8 cases. CONCLUSION:Using ARFI technique is helpful for differential diagnosis in order to detect recurred HCCs more easily in patients with confusing status.

Contrast-enhanced 3D ultrasound in the radiofrequency ablation of liver tumors

Liver metastases and hepatocellular carcinomas are two of the most common causes of cancer deaths in the world.Radiofrequency ablation(RFA) is a well recognized,effective and minimally invasive means of treating malignant hepatic tumors.This article describes the use of contrast-enhanced 3D ultrasound(CE-3DUS) in the staging,targeting and follow-up of patients with liver tumors undergoing RFA.In particular,its value in the management of large hepatic lesions will be illustrated.Current limitations of CE-3DUS and future developments in the technique will also be discussed.In summary,CE-3DUS is useful in the RFA of liver tumors with improved detection and display of occult lesions and recurrence,in the assessment of lesional geometry and orientation for a more accurate planning and guidance of multiple RFA needle electrodes in large tumors and in the evaluation of residual or recurrent disease within the immediate and/or subsequent follow-up periods.

Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy

AIM: To evaluate the factors affecting the early tumor recurrence within one year in cirrhotic patients having a single small hepatocellular carcinoma (HCC) after complete tumor necrosis by radiofrequency ablation (RFA)therapy.METHODS: Thirty patients with a single small HCC received RFA therapy by a RFA 2000 generator with LeVeen needle. Tri-phase computerized tomogram was followed every 2 to3 mo after RFA. The clinical effects and tumor recurrence were recorded.RESULTS: The initial complete tumor necrosis rate was 86.7%. Twenty-two patients were followed for more than one year. The local and overall recurrence rates were 13.6% and 36.4%, 33.3% and 56.2%, 46.6% and 56.2%at 12, 24 and 30 mo, respectively. No major complication or procedure-related mortality was found. The risk factors for early local tumor recurrence within one year were larger tumor size, poor pathologic differentiation of tumor cells and advanced tumor staging. The age of patients with new tumor formation within one year was relatively younger (55.1±8.3 vs 66.7±10.8, P = 0.029).CONCLUSION: Large tumor size, poor pathologic differentiation of tumor cells and advanced tumor staging are the risk factors for early local tumor recurrence within one year, and young age is the positive predictor for new tumor formation within one year.

Therapeutic effectiveness of echo-guided percutaneous radiofrequency ablation therapy with a LeVeen needle electrode in hepatocellular carcinoma

AIM： To investigate the results of radiofrequency ablation （RFA） in obtaining the necrosis of hepatocellular carcinoma （HCC） in cirrhotic patients and to assess the results of RFA in relation to recurrence of HCC and survival of the treated patients.METHODS： Fifty-six consecutive cirrhotic patients with 63 HCCs were treated with RFA between May 2000 and May 2004. The diameter of the HCCs ranged from 1 cm to 5 cm （mean 2.8 cm）. In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable needle electrode （LeVeen needle）. Treatment efficacy and recurrence were evaluated with dual-phase spiral computed tomography （CT）.RESULTS： Complete necrosis after single or multiple treatment was achieved in 96.8% （61/63） tumors. We observed recurrence after complete necrosis in 23 patients （41%） during a mean follow-up of 32.3 months. The recurrences were local in 2 patients （8.6%） and in different segments in 21 （91.4%）. Major complications occurred in 3 patients （4%）. During follow-up period, 32 （57.1%） patients died; 15 due to progression of HCC, 11 from liver failure, 3 from esophageal varices bleeding and 3 from the causes not related to liver disease.CONCLUSION： RFA with LeVeen needle is an effective and safe treatment for HCC 〈 5cm in cirrhotic patients. It has yet to be established how far this treatment influences the survival rate of patients. It becomes important to establish treatments to prevent recurrences in different segments, such as interferon therapy.

Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation

AIM： To evaluate the outcome of transarterial chemoembolization （TACE）in patients with unresectable hepatocellular cardnoma （HCC） 〈5 cm in diameter eligible for radiofrequency ablation （RFA）. METHODS： The treatment-related mortality, morbidity, long-term survival, and prognostic factors of HCC patients who had TACE and fulfilled the present inclusion criteria for RFA were evaluated. RESULTS： Of the 748 patients treated with TACE between January 1990 and December 2002, 114 patients were also eligible for RFA. The treatment-related mortality and morbidity were 1% and 19%, respectively. Survival at 1, 3, and 5 years was 80%, 43%, and 23%, respectively. Older age and a high albumin level were associated with a better survival, whereas a high α-fetoprotein level （AFP） and the size of the largest tumor 〉3 cm in diameter were adverse prognostic factors in multivariate analysis. CONCLUSION： The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs.

Radiofrequency ablation vs hepatic resection for solitary colorectal liver metastasis:A meta-analysis

AIM:To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection (HR) for solitary colorectal liver metastases (CLM).METHODS:A literature search was performed to identify comparative studies reporting outcomes for both RFA and HR for solitary CLM.Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model.RESULTS:Seven nonrandomized controlled trials studies were included in this analysis.These studies included a total of 847 patients:273 treated with RFA and 574 treated with HR.The 5 years overall survival rates in the HR group were significantly better than those in the RFA group (OR:0.41,95% CI:0.22-0.90,P=0.008).RFA had a higher rate of local intrahe-patic recurrence compared to HR (OR:4.89,95% CI:1.73-13.87,P=0.003).No differences were found between the two groups with respect to postoperative morbidity and mortality.CONCLUSION:HR was superior to RFA in the treatment of patients with solitary CLM.However,the findings have to be carefully interpreted due to the lower level of evidence.

A case of splenic abscess after radiofrequency ablation

Radiofrequency ablation （RFA） is an innovative technique used primarily for the palliative treatment of unresectable liver tumors. Its therapeutic indications however, have been expanded and now include various other organs and diseases. There is a paucity of data regarding technical details and complications of the use of RFA in the spleen. We report a case of partial splenectomy using radiofrequency ablation for splenic hydatid disease, complicated by an abscess formation.

Radiofrequency ablation for incidentally identified primary intrahepatic cholangiocarcinoma

Cholangiocarcinoma is the second most common primary hepato-biliary malignancy. The majority of patients with primary hepatic tumors are not suitable candidates for resection, due to advanced stage of the disease at presentation, anatomic limitations and medical comorbidities. At present, radiofrequency ablation (RFA) may offer an alternative, feasible and safe therapy for selected patients with hepatic tumors, who are not otherwise candidates for hepatic resection. Herein, we present the case of successful RFA in a patient with a solitary, primary intrahepatic cholangiocarcinoma. The patient remained free of disease 24 mo after the procedure, and is still followed up. This is the first report of RFA application inthe treatment of primary intrahepatic cholangiocarcinoma.

Lamivudine treatment enabling right hepatectomy for hepatocellular carcinoma in decompensated cirrhosis

A 69-year-old man was admitted to our hospital in October 2003,for further examination of two liver tumors.He was diagnosed with hepatocellular carcinoma(HCC) arising from decompensated hepatitis B virus(HBV)-related cirrhosis.Long-term lamivudine administration improved liver function dramatically despite repeated treatment for HCC.His Child-Pugh score was 9 points at start of lamivudine treatment,improving to 5 points after 1 year.His indocyanine green at 15 min after injection test score was 48%before lamivudine treat-ment,improving to 22%after 2 years and to 5%after 4 years.Radiofrequency ablation controlled the HCC foci and maintained his liver function.In April 2009,abdominal computed tomography revealed a tumor thrombus in the right portal vein.Since his indocyanine green test results had improved to less than 10%,we performed a right hepatectomy,which was successful.To our knowledge,there have been no documented reports of patients undergoing successful right hepatectomy for HCC arising from decompensated cirrhosis.The findings observed in our patient indicate the importance of nucleoside analogs for treating HBV-related HCC.