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3D visualization ablation planning system assisted microwave ablation for hepatocellular carcinoma (Diameter >3): a precise clinical application.

ABSTRACT: BACKGROUND:The aim of this retrospective study was to compare the feasibility and efficiency of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional visualization ablation planning system (3DVAPS) and conventional 2D planning for hepatocellular carcinoma (HCC) (diameter?>?3?cm). METHODS:One hundred thirty patients with 223 HCC nodules (5.0?±?1.5?cm in diameter, [3.0-10.0?cm]) who met the eligibility criteria divided into 3D and 2D planning group were reviewed from April 2015 to August 2018. Ablation parameters and oncological outcomes were compared, including overall survival (OS), recurrence-free survival (RFS), and local tumor progression (LTP). Multivariate analysis was performed on clinicopathological variables to identify the risk factors for OS and LTP. RESULTS:The median follow-up period was 21?months (range 3-44). Insertion number (5.4 ±?1.2 VS. 4.5 ±?0.9, P?=?0.034), ablation time (1249.2 ±?654.2?s VS. 1082.4 ±?584.7?s, P?=?0.048), ablation energy (57,000 ±?11,892?J VS. 42,600 ±?10,271?J, P?=?0.038) and success rate of first ablation (95.0% VS. 85.7%, P?=?0.033) were higher in the 3D planning group compared with those in 2D planning group. There was no statistical difference in OS, and RFS between the two groups (P?=?0.995, P?=?0.845). LTP rate of 3D planning group was less than that of 2D planning group (16.5% VS 41.2%, P?=?0.003). Multivariate analysis showed tumor maximal diameters (P?

SUBMITTER: An C

PROVIDER: S-EPMC6972027 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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3D visualization ablation planning system assisted microwave ablation for hepatocellular carcinoma (Diameter >3): a precise clinical application.

An Chao C Li Xin X Zhang Min M Yang Jian J Cheng Zhigang Z Yu Xiaoling X Han Zhiyu Z Liu Fangyi F Dong Linan L Yu Jie J Liang Ping P

BMC cancer 20200120 1

<h4>Background</h4>The aim of this retrospective study was to compare the feasibility and efficiency of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional visualization ablation planning system (3DVAPS) and conventional 2D planning for hepatocellular carcinoma (HCC) (diameter > 3 cm).<h4>Methods</h4>One hundred thirty patients with 223 HCC nodules (5.0 ± 1.5 cm in diameter, [3.0-10.0 cm]) who met the eligibility criteria divided into 3D and 2D planning grou ...[more]

PMID: 31959147

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Project description:ObjectivesWe aimed to compare the therapeutic outcomes of radiofrequency ablation (RFA) and microwave ablation (MWA) as first-line therapies in patients with small single perivascular hepatocellular carcinoma (HCC).MethodsA total of 144 eligible patients with small (≤ 3 cm) single perivascular (proximity to hepatic and portal veins) HCC who underwent RFA (N = 70) or MWA (N = 74) as first-line treatment were included. The overall survival (OS), disease-free survival (DFS), and local tumor progression (LTP) rates between the two ablation modalities were compared. The inverse probability of treatment weighting (IPTW) method was used to reduce selection bias. Subgroup analysis was performed according to the type of hepatic vessels.ResultsAfter a median follow-up time of 38.2 months, there were no significant differences in OS (5-year OS: RFA 77.7% vs. MWA 74.6%; p = 0.600) and DFS (5-year DFS: RFA 24.7% vs. MWA 40.4%; p = 0.570). However, a significantly higher LTP rate was observed in the RFA group than the MWA group (5-year LTP: RFA 24.3% vs. MWA 8.4%; p = 0.030). IPTW-adjusted analyses revealed similar results. The treatment modality (RFA vs. MWA: HR 7.861, 95% CI 1.642-37.635, p = 0.010) was an independent prognostic factor for LTP. We observed a significant interaction effect of ablation modality and type of peritumoral vessel on LTP (p = 0.034). For patients with periportal HCC, the LTP rate was significantly higher in the RFA group than in the MWA group (p = 0.045). However, this difference was not observed in patients with perivenous HCC (p = 0.116).ConclusionsIn patients with a small single periportal HCC, MWA exhibited better tumor control than RFA.Key points• Microwave ablation exhibited better local tumor control than radiofrequency ablation for small single periportal hepatocellular carcinoma. • There was a significant interaction between the treatment effect of ablation modality and type of peritumoral vessel on local tumor progression. • The type of peritumoral vessel is vital in choosing ablation modalities for hepatocellular carcinoma.

Project description:BackgroundHigh early recurrence (ER) of hepatocellular carcinoma (HCC) after microwave ablation (MWA) represents a sign of aggressive behavior and severely worsens prognosis. The aim of this study was to estimate the outcome of HCC following MWA and develop a response algorithmic strategy based on multiparametric MRI and clinical variables.MethodsIn this retrospective study, we reviewed the records of 339 patients (mean age, 62 ± 12 years; 106 men) treated with percutaneous MWA for HCC between January 2014 and December 2017 that were evaluated by multiparametric MRI. These patients were randomly split into a development and an internal validation group (3:1). Logistic regression analysis was used to screen imaging features. Multivariate Cox regression analysis was then performed to determine predictors of ER (within 2 years) of MWA. The response algorithmic strategy to predict ER was developed and validated using these data sets. ER rates were also evaluated by Kaplan-Meier analysis.ResultsBased on logistic regression analyses, we established an image response algorithm integrating ill-defined margins, lack of capsule enhancement, pre-ablative ADC, ΔADC, and EADC to calculate recurrence scores and define the risk of ER. In a multivariate Cox regression model, the independent risk factors of ER (p < 0.05) were minimal ablative margin (MAM) (HR 0.57; 95% CI 0.35 - 0.95; p < 0.001), the recurrence score (HR: 9.25; 95% CI 4.25 - 16.56; p = 0.021), and tumor size (HR 6.21; 95% CI 1.25 - 10.82; p = 0.014). Combining MAM and tumor size, the recurrence score calculated by the response algorithmic strategy provided predictive accuracy of 93.5%, with sensitivity of 92.3% and specificity of 83.1%. Kaplan-Meier estimates of the rates of ER in the low-risk and high-risk groups were 6.8% (95% CI 4.0 - 9.6) and 30.5% (95% CI 23.6 - 37.4), respectively.ConclusionA response algorithmic strategy based on multiparametric MRI and clinical variables was useful for predicting the ER of HCC after MWA.

Project description:BackgroundThree-dimensional (3D) volumetric ablation margin assessment after thermal ablation of liver tumors using software has been described, but its predictive value on treatment efficacy when accounting for other factors known to correlate ablation site recurrence (ASR) remains unknown.PurposeTo investigate 3D quantitative ablation margins (3D-QAMs) as an algorithm to predict ASR within 1 year after stereotactic microwave ablation (SMWA) for colorectal liver metastases (CRLM).Materials and methodsSixty-five tumors in 47 patients from a prospective multicenter study of patients undergoing SMWA for CRLM were included in this retrospective 3D-QAM analysis. Using a previously developed algorithm, 3D-QAM defined as the distribution of tumor to ablation surface distances was assessed in co-registered pre- and post-ablation CT scans. The discriminatory power and optimal cutoff values for 3D-QAM were assessed using receiver operating characteristic (ROC) curves. Multivariable logistic regression analysis using generalized estimating equations was applied to investigate the impact of various 3D-QAM outputs on 1-year ASR while accounting for other known influencing factors.ResultsTen of the 65 (15.4%) tumors included for 3D-QAM analysis developed ASR. ROC analyses identified i) 3D-QAM <1 mm for >23% of the tumor surface, ii) 3D-QAM <5 mm for >45%, and iii) the minimal ablation margin (MAM) as the 3D-QAM outputs with optimal discriminatory qualities. The multivariable regression model without 3D-QAM yielded tumor diameter and KRAS mutation as 1-year ASR predictors. When adding 3D-QAM, this factor became the main predictor of 1-year ASR [odds ratio (OR) 21.67 (CI 2.48, 165.21) if defined as >23% <1 mm; OR 0.52 (CI 0.29, 0.95) if defined as MAM].Conclusions3D-QAM allows objectifiable and standardized assessment of tumor coverage by the ablation zone after SMWA. Our data shows that 3D-QAM represents the most important factor predicting ASR within 1 year after SMWA of CRLM.

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3D visualization ablation planning system assisted microwave ablation for hepatocellular carcinoma (Diameter >3): a precise clinical application.

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3D visualization ablation planning system assisted microwave ablation for hepatocellular carcinoma (Diameter >3): a precise clinical application.

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