Magnetic resonance image-guided versus ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer

Image-guided high-intensity focused ultrasound (HIFU) has been used for more than ten years, primarily in the treatment of liver and prostate cancers. HIFU has the advantages of precise cancer ablation and excellent protection of healthy tissue. Breast cancer is a common cancer in women. HIFU therapy, in combination with other therapies, has the potential to improve both oncologic and cosmetic outcomes for breast cancer patients by providing a curative therapy that conserves mammary shape. Currently, HIFU therapy is not commonly used in breast cancer treatment, and efforts to promote the application of HIFU is expected. In this article, we compare different image-guided models for HIFU and reviewed the status, drawbacks, and potential of HIFU therapy for breast cancer.

Transcatheter arterial chemoembolization combined with CT-guided percutaneous thermal ablation versus hepatectomy in the treatment of hepatocellular carcinoma

Introduction:Transcatheter arterial chemoembolization(TACE)plus thermal ablation has been widely used recently in the treatment of hepatocellular carcinoma(HCC).In this study,we aimed to compare results of the combination of TACE and percutaneous thermal ablation with those of hepatectomy in patients with HCC.Methods:The clinical data of 137 HCC patients who sequentially received TACE and computed tomography(CT)-guided percutaneous thermal ablation as an initial curative treatment(combination group)and 148 matched HCC patients who received hepatectomy(surgery group)between 2004 and 2011 were collected and analyzed.After TACE,multiphase contrast-enhanced CT was performed to identify the total number of tumors as well as lipiodol deposition in the liver.Survival was calculated by using the Kaplan-Meier method and compared by using the log-rank test.The prognostic factors were assessed with multivariate Cox proportional hazards regression analysis.Results:Of all 285 patients,225(79.0%)had cancerous lesions≤5 cm in diameter.In preoperative contrast-enhanced CT or magnetic resonance imaging,the number of tumors was 1–4 for each patient.The 1-,3-,and 5-year overall survival rates were 95,74%,and 67%in the combination group and 88,66,and 47%in the surgery group,respectively(P=0.004);the corresponding recurrence-free survival rates for the two groups were 92,69,and 61%and 75,58,and44%,respectively(P=0.001).In the multivariate analysis,treatment allocation was an independent prognostic factor for survival.Only 60 patients in the combination group had sufficient imaging data,and 135 new lesions with lipiodol deposition were diagnosed as malignancies in 22 of 60 patients,whereas 20 new lesions were found in 11 of 148patients in the surgery group.Conclusion:The combination of TACE and CT-guided percutaneous thermal ablation for HCC improves survival of HCC patients compared with hepatectomy.

Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer

The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography(CT)-guided radiofrequency ablation(RFA) and systemic chemotherapy plus hepatic artery infusion of floxuridine(HAIFUDR). Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR(ablation group, n = 39) or systemic chemotherapy plus HAI-FUDR(FUDR group, n = 22). Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. All patients in the ablation group underwent RFA and chemotherapy. Median follow-up was 56.8 months. The 1-, 3-, and 5-year overall survival(OS) rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26% for the ablation group, and 72%, 24%, and 24% for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment allocation was a favorable independent prognostic factor for OS(P = 0.001) and survival after metastasis(P = 0.009). These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.

CIK细胞回输降低肝癌微创介入术后复发中AFP定量检测的临床意义(英文)

Background and Objective:In patients with hepatocellular carcinoma(HCC) receiving potentially curative minimally invasive therapy,autologous cytokine-induced killer(CIK) cells were used to reduce recurrence.In this study we observed the changes in serum alpha-fetoprotein(AFP) after the treatment with CIK cells to explore if AFP could serve as a marker for predicting immunotherapeutic clinical outcome.Methods:A total of 122 patients with HCC and elevated AFP(> 25 ng/mL) received a curative treatment of transcatheter arterial chemoembolization(TACE) plus radiofrequency ablation(RFA) at the Sun Yat-sen University Cancer Center.Of these patients,83 patients without residual tumor or extrahepatic metastasis and with AFP level less than 1.5 times the normal range(AFP < 37.5 ng/mL) were randomly assigned to the study group(n = 42) and the control group(n = 41).In the study group,CIK cells were transfused intravenously or via common hepatic arteries every week for at least 4 times,and the T-lymphocyte subset data before and after CIK cell infusions was examined by flow cytometry.All the two groups of patients were screened by tomography every 2 months to observe tumor recurrence.Serum AFP was collected at baseline and at different time points after treatment in parallel with radiologic response and clinical outcome.Results:Two patients in the control group were lost to follow-up after treatment.After CIK cell infusions,the downtrend of the AFP level was observed in the study group and not in the control group.There was a significant difference in the level of AFP between different time points after CIK infusions in both groups.The 1-year recurrence rate was 7.14 % for the study group and 23.1% for the control group(P = 0.044).In subgroup analysis,for patients with a slightly high level of AFP(25 ng/mL < AFP < 37.5 ng/mL) after curative TACE plus RFA treatment,the 1-year recurrence rate was 28.57% for the study group and 80% for the control group.The time to recurrence in the study group was also longer than that in the control group(mean 10.2 months vs.6.8 months).After CIK cell infusions,the percent of CD3+CD4+ T cells and CD4+ /CD8+ T cells increased from 28.1 ± 5.9% and 0.9 ± 0.3% to 32.7 ± 3.6% and 1.2 ± 0.2%(P < 0.001 and = 0.004,respectively),while the percent of CD3+CD8+ T cells decreased from 32.9 ± 8.4% to 28.8 ± 2.2%(P = 0.046).Also the percentage of patients with hepatitis B virus(HBV)-DNA content less than 1 × 103 copies/mL was 73.5% in the study group and 9.1% in the control group.Conclusions:CIK cells transfusion may reduce the level of serum AFP and anti-HBV and decrease the 1-year recurrence rate of patients with HCC after curative TACE plus RFA.Serum AFP decrease after CIK cell treatment may serve as a useful marker for predicting immunotherapy clinical outcome in patients with HCC undergone curative minimally invasive therapy.