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Hepatocellular Carcinoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Daniel H. Palmer, Philip J. Johnson
Image-guided ablation is regarded as the best therapeutic option for patients with small HCC not suitable for resection or transplantation. Treatment is usually performed percutaneously under ultrasound or CT guidance. Several methods for tumor destruction have been used, the most widely studied being percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA). The injection of 90 per cent ethanol under ultrasound guidance is technically straightforward, inexpensive, safe, and results in 5-year survival of 50 per cent in Child A, 30 per cent in Child B, but less than 10 per cent in Child C cirrhotics.49 Complete tumor necrosis is achieved in 70 per cent of tumors less than 3 cm in diameter, but this falls with increasing size (50 per cent in lesions 3–5 cm), probably due to the inability of the injected volume to disperse evenly throughout larger tumors that may contain fibrous septae. Radiofrequency ablation is a localized thermal treatment producing tumor destruction by heating a probe inserted into the tumor to temperatures exceeding 50°C, which can be performed percutaneously under image guidance, laparoscopically or at laparotomy.
Management of Nodal Metastasis in Thyroid Cancer
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Neeti Kapre Gupta, Ashok Shaha, Madan Laxman Kapre, Nirmala Thakkar, Harsh Karan Gupta
Percutaneous ethanol injection has been tried specifically for patients who are poor surgical candidates. Up to 80% resolution of structural nodal disease and lowering of Tg to acceptable range (<3 ng/mL) has been observed. However, multiple sessions are often required and this technique is not very effective for larger nodes (>2 cm) [32].
Thyroid nodules
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Salem I. Noureldine, Ralph P. Tufano
Percutaneous ethanol injection therapy, radiofrequency ablation, and laser ablation have each been reported as effective for treating benign and malignant thyroid nodules, as well as for locoregional control of cancer or for improving tumor-related symptoms in selected patients. Nonsurgical ablation seems likely to have a future role in managing benign and malignant thyroid nodules [26]. Its specific indications, however, remain to be determined. At present, due to small series reports from single centers, the use of these techniques should be relegated to an alternative therapy category rendered at large medical centers with the most significant experience with these techniques [27].
Risk factors influencing cure of ultrasound-guided microwave ablation for primary hyperparathyroidism
Published in International Journal of Hyperthermia, 2022
Fangyi Liu, Li Zang, Yang Liu, Xiaoling Yu, Zhigang Cheng, Zhiyu Han, Jie Yu, Ping Liang
Primary hyperparathyroidism(PHPT) is usually due to adenoma or hyperplasia of one or more parathyroid glands, which can lead to bone loss, kidney stones and other symptoms [1,2]. Parathyroidectomy is the main treatment for PHPT [3,4]. However, some patients may refuse surgery because of unsuitable physical conditions or fear of scar formation. Percutaneous ethanol injection (PEI) has been determined to be an alternative therapeutic approach in small number of cases of PHPT. However, it needs to repeat the procedure several times and the long-term efficacy is uncertain [5]. Recently, some thermal ablation techniques, including high intensity focused ultrasound (HIFU), radiofrequency ablation (RFA), microwave ablation (MWA)and laser ablation (LA) have been used as an alternative to surgery for PHPT, with the technical success rate or cure rate of 81–92% [6–11]. MWA, in particular, has high thermal efficiency and is increasingly used in the treatment of PHPT. Wei et al. reported a multicenter study of MWA for PHPT and the effective rate was 89.9% [12]. However, compared with the highest cure rate of 99.4% of surgical resection, the cure rate of MWA is slightly inferior to that of surgical resection [13]. Therefore, the purpose of the study was to evaluate the potential risk factors influencing cure rate of ultrasound-guided MWA for PHPT.
Microwave ablation shows similar survival outcomes compared with surgical resection for hepatocellular carcinoma between 3 and 5 cm
Published in International Journal of Hyperthermia, 2020
Hang Zheng, Chenghui Xu, Xueqi Wang, Jie Li, Xinya Zhao, Jianni Qi, Yuemin Feng, Qiang Zhu
Patients generally underwent CT or MRI 1–2 months postoperatively of both groups. Then patients were followed every 3 months in the first year and 3–6months thereafter. Each follow up consisted of serum chemistry evaluations including alpha-fetoprotein and at least one imagining examination (contrast-enhanced dynamic CT or MRI). Once the tumor recurred, the therapy was based on preference of patients and clinical practice of surgeons and clinicians. Repeated ablation or resection was the first choice for patients with recurrent tumors whenever possible, while percutaneous ethanol injection, TACE and other nonradical treatments were the treatment options for patients unsuitable for SR or ablation. All patients were followed up until death, 30 April 2020, or lost to follow up, whichever came first.
Comparison of albumin-bilirubin grade, platelet-albumin-bilirubin grade and Child-Turcotte-Pugh class for prediction of survival in patients with large hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation
Published in International Journal of Hyperthermia, 2019
Jia-Yan Ni, Zhu-Ting Fang, Chao An, Hong-Liang Sun, Zhi-Mei Huang, Tian-Qi Zhang, Xiong-Ying Jiang, Yao-Ting Chen, Lin-Feng Xu, Jin-Hua Huang
Contrast-enhanced CT/MRI scans were performed 1–2 weeks before the initial TACE treatment to record and evaluate tumor status in the included patients. After TACE-MWA treatment, follow-up was performed at clinical visits at monthly intervals. Physical examination, laboratory tests (e.g., total bilirubin, serum albumin, prothrombin time and serum tumor marker levels) and contrast-enhanced CT/MRI were performed. Tumor response to TACE-MWA was evaluated using contrast-enhanced CT/MRI every 4–6 weeks after treatment. Local tumor control was assessed by the multidisciplinary team of radiologists and oncologists. If there was no residual tumor and tumor progression, the follow-up tests were prolonged to every 3 months. If residual tumor and/or tumor progression were observed, repeat MWA or TACE, 125I seed implantation, cryoablation, percutaneous ethanol injection, or sorafenib therapy were performed based on a consensus decision made by the multidisciplinary team in accordance with the evaluation of tumor status based on CT/MR imaging.