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F9-4 Percutaneous microwave coagulation therapy for hepatocellular carcinoma (HCC)
Clinical and Research Forum/International Hepatology Communications 3 Suppl. (1995) $5-$36
F9-1
HEPATOCELLULAR
CARCINOMA
K.Okita ist Dept. of I n t e r n a l M e d i c i n e , S c h o o l of M e d i c i n e , Ube, J a p a n
IN JAPAN
Yamaguchi
Univ.
The m o r t a l i t y rate for p a t i e n t s w i t h h e p a t o c e l l u far c a r c i n o m a ( H C C ) in J a p a n is e x t r e m e l y high such as 20 cases per i 0 0 , 0 0 0 p o p u l a t i o n . T h e r e f o r e , the e s t a b l i s h m e n t of s t r a t e g i e s for the e a r l y d e t e c t i o n and t r e a t m e n t of this e n t i t y d e m a n d s the h i g h e s t p r i o r i t y a m o n g h e p a t o l o g i s t s w o r k i n g in this area. R e c e n t l y the d e f i n i t i v e d i a g n o s i s of small HCC lesions, less than 20 mm in d i a m e t e r , has b e c o m e p o s s i b l e t h r o u g h the i n c r e a s i n g l y w i d e s p r e a d a v a i l a b i l i t y of h i g h l y s e n s i t i v e d i a g n o s t i c i m a g i n g e q u i p ment and the t e c h n i q u e of u l t r a s o u n d - g u i d e d liver tumor b i o p s y . The c o n c e p t of e a r l y HCC has b e e n established. R e g a r d i n g its b i o l o g i c a l b e h a v i o r a l t r a c t s such as less m a l i g n a n c y , slow g r o w t h and less m e t a s t a s i s ; n e w t h e r a p e u t i c m o d a l i t i e s have b e e n developed. Among them percutaneous ethanol inject i o n ( P E I ) has s h o w n i t s e l f to be equal to s u r g i c a l treatment. As for a d v a n c e d l a r g e r HCC; e n c a p s u l a t e d HCC is c h a r a c t e r i s t i c a n d t h e r e f o r e the r e s u l t s of t r a n s a r t e r i a l e m b o l i z a t i o n and c h e m o l i p i o d o l i z a t i o n have been anticipated. However, their t h e r a p e u t l c r e s u l t s are not s a t i s f a c t o r y so far. The b i o l o g i c a l c h a r a c t e r of HCC in J a p a n will be s u m m e r i z e d c o n v e n i e n t l y for ease of u n d e r s t a n d i n g the t o p i c s that will be d i s c u s s e d [n this session.
~f%
I%
~-,~ P E R C U T A N E O U S A C E T I C A C I D I N J E C T I O N (PAIl FOR SMALL IIEPATOCELLULAR CARCINOMA (IICC) IN C O M P A R I S O N WITII P E R C U T A N E O U S ETIIANOL I N J E C T I O N (PEI). K. O h n i s h i , II. Y o s h i o k a , F. Y a m a g i s h i , S. Itoh, K. F u j i w a r a . 3rd Dept of M e d i c i n e , S a i t a m a M e d i c a l School, Saitama, J a p a n Aim: To a s s e s s the e f f i c a c y of u l t r a s o u n d - g u i d e d PAl in the t r e a t m e n t of small HCC in c o m p a r i s o n w i t h PEI. M e t h o d s : F r o m A u g u s t 1993 to N o v e m b e r 1994, 38 p a t i e n t s w i t h one to four IICCs < 3 cm e n t e r e d a trial. Nineteen patients [24 tumors) a n d 19 p a t i e n t s (23 tumors) w e r e t r e a t e d by PAl u s i n g 50% a c e t i c a c i d and PEI u s i n g a b o s o l u t e ethanol, r e s p e c t i v e l y . If there was no e v i d e n c e of v i a b l e HCC at b i o p s y , CT, MRI and a n g i o g r a p h y , PAI or PEI was d i s c o n t i n u e d . Results: T h e r e w e r e no s i g n i f i c a n t d i f f e r e n c e s of age, sex ratio, C h i l d g r a d e and size of t u m o r b e t w e e n PAI and PE{ g r o u p s . Tile n u m b e r of t ~ e a t m e n t s e s s i o n s a n d tile volume injected needed to control small HCC adequately were significantly less in PAl t h a n PEI (2.3 + 1.0 vs 3.6 ÷ 1.4, p < 0.01; 4.0 ± 2.3 ml vs 11.4 ± 6.8 ml, p < 0.01). None of the t u m o r s t r e a t e d w i t h PAl g r e w a g a i n w h i l e local r e c u r r e n c e o c c u r r e d in 2 p a t i e n t s after PEI. A n e w IICC o c c u r r e d in 3 p a t i e n t s after PEI but not a f t e r PAI. The I - y e a r s u r v i v a t rate a n d the 1 - y e a r c a n c e r - f r e e s u r v i v a l rate were b e t t e r in PAl g r o u p than PEI g r o u p (100% vs 86%, p=N8; I00% vs 62%, p < 0.025). C o n c l u s i o n : PAl m a y p r o v e to be s u p e r i o r to PEI in tile t r e a t m e n t of small HCC.
S25
F9.2
PRESENTSTATUS OF TRFATMENT OF SMALL HHPATOCELLUIAR CARCINOMA Masatoshi Tanaka, Kyuichi T a n i k a w a D e p a r t m e n t of Medicine, K u r u m e U n i v e r s i t y School of Medicine, Kurume, J a p a n
Background: P e r c u t a n e o u s e t h a n o l i n j e c t i o n was a d m i n i s t e r e d to t r e a t m e n t of small h e p a t o c e l l u l a r ~ a r c i n o m a d u r i n g t he last decade. Methods: Four h u n d r e d a n d s e v e n t y - n i n e cases of h e p a t o c e l l u l a r c a r c i n o m a of <3cm in d i a m e t e r a n d less t h a n 3 n o d u l e s w e re e x a m i n e d to a s c e r t a i n t he factors affecting s u r v i v a l of p a t i e n t s a f t e r i n i t i a l t r e a t m e n t . Results: C u m u l a t i v e s u r v i v a l rates of 349 patients after p e r c u t a n e o u s e t h a n o l i n j e c t i o n at 5- a n d 7-years were 47.3% a n d 28.0%, 66 p a t i e n t s a ft e r c u r a t i v e hepatic resection were 58.0% a n d 27.1% a n d 64 p a t i e n t s a ft e r t r a n s c a t h e t e r a r t e r i a l c he moe m b o l i z a t i o n w e re 9.2% a n d 4.6%, respectively. Cox's p r o p o r t i o n a l h a z a r d m o d e l i d e n t i f i e d t h a t histologic grade of t u m o r (p<0.0001), n u m b e r of t u m o r (p=0.0013), clinical stage (p=0.0001) a n d p o s t - t r e a t m e n t follow-up of p a t i e n t s e v e r y 3 m o n t h s (p<0.0001) were associated w i t h s u r v i v a l p e r i o d of p a t i e n t s a ft e r p e r c u t a n e o u s ethanol injection. Conclusion: The re was no s i g n i f i c a n t d i f f e r e n c e in s u r v i v a l ra t e of p a t i e n t s t r e a t e d by p e r c u t a n e o u s e t h a n o l i n j e c t i o n a n d h e p a t i c resection. Early d i a g n o s i s of e i t h e r a r e c u r r e n c e or a s e c ond new grow t h of h e p a t o c e l l u l a r c a r c i n o m a was one of the mos t i m p o r t a n t p r o g n o s t i c fa c t or after p e r c u t a n e o u s ethanol injection.
F9-4 Percutaneous microwave coagulation therapy for h e p a t o c e l l u l a r carcinoma (HCC). T. Seki, M. Wakabayashi, T. Nakagawa, T. Itho, M. Imamura, T. Shiro, K. Inoue 3rd Dept. of Internal Medicine, Kansai Medical Univ. Moriguchi, Japan PEIT
is occasionaly
ineffective for intracapsular or
extracapsular invasion of liver cancer cells. We designed ultrasonically guided percutaneous microwave coagulation therapy (PMCT) as a new method to induce tumor necrosis and overcome the disadvantages of PELT. In this report, the effect of PMCT was compared with t h a t of PEIT. Percutaneous local t r e a t m e n t s were performed for the 61 patients having a single HCC (tumor size < 2c m)be t w e e n Ja. 1990 and Dee. 1994. There were 31 patients treated by PMCT alone (Group M) and 30 who were treated by PEIT alone (Group E). The therapeutic results of these two groups were evaluated on the basis of survival rate, disease free survival rate, pattern of recurrences, number of times of needle insertion. For Group M and E, the 3yr survival rates ( 3 y r - d i s e a s e free s u r v i v a l rate) were 93% (47%) and 59% (37%), respectively. The recurrent rate of Group M and group E at t r e a t e d s u b s e g m e n t area w i t hi n one year after t re a t me nt was 3 % and 13%, respectively. The recurrent rate at treated subsegment area of Group M was lower than t ha t of Group E. The number of times of needle insertion for Groups M and E were 2.0-+ 1.0 and 4.5 + 1.1, re s pe c t i ve l y. Compared with PEIT, PMCT is a useful t r e a t m e n t for small HCC, it is effective in producing local necrosis of tumor tissue while minimizing the burden to the patient.
F9-1
HEPATOCELLULAR
CARCINOMA
K.Okita ist Dept. of I n t e r n a l M e d i c i n e , S c h o o l of M e d i c i n e , Ube, J a p a n
IN JAPAN
Yamaguchi
Univ.
The m o r t a l i t y rate for p a t i e n t s w i t h h e p a t o c e l l u far c a r c i n o m a ( H C C ) in J a p a n is e x t r e m e l y high such as 20 cases per i 0 0 , 0 0 0 p o p u l a t i o n . T h e r e f o r e , the e s t a b l i s h m e n t of s t r a t e g i e s for the e a r l y d e t e c t i o n and t r e a t m e n t of this e n t i t y d e m a n d s the h i g h e s t p r i o r i t y a m o n g h e p a t o l o g i s t s w o r k i n g in this area. R e c e n t l y the d e f i n i t i v e d i a g n o s i s of small HCC lesions, less than 20 mm in d i a m e t e r , has b e c o m e p o s s i b l e t h r o u g h the i n c r e a s i n g l y w i d e s p r e a d a v a i l a b i l i t y of h i g h l y s e n s i t i v e d i a g n o s t i c i m a g i n g e q u i p ment and the t e c h n i q u e of u l t r a s o u n d - g u i d e d liver tumor b i o p s y . The c o n c e p t of e a r l y HCC has b e e n established. R e g a r d i n g its b i o l o g i c a l b e h a v i o r a l t r a c t s such as less m a l i g n a n c y , slow g r o w t h and less m e t a s t a s i s ; n e w t h e r a p e u t i c m o d a l i t i e s have b e e n developed. Among them percutaneous ethanol inject i o n ( P E I ) has s h o w n i t s e l f to be equal to s u r g i c a l treatment. As for a d v a n c e d l a r g e r HCC; e n c a p s u l a t e d HCC is c h a r a c t e r i s t i c a n d t h e r e f o r e the r e s u l t s of t r a n s a r t e r i a l e m b o l i z a t i o n and c h e m o l i p i o d o l i z a t i o n have been anticipated. However, their t h e r a p e u t l c r e s u l t s are not s a t i s f a c t o r y so far. The b i o l o g i c a l c h a r a c t e r of HCC in J a p a n will be s u m m e r i z e d c o n v e n i e n t l y for ease of u n d e r s t a n d i n g the t o p i c s that will be d i s c u s s e d [n this session.
~f%
I%
~-,~ P E R C U T A N E O U S A C E T I C A C I D I N J E C T I O N (PAIl FOR SMALL IIEPATOCELLULAR CARCINOMA (IICC) IN C O M P A R I S O N WITII P E R C U T A N E O U S ETIIANOL I N J E C T I O N (PEI). K. O h n i s h i , II. Y o s h i o k a , F. Y a m a g i s h i , S. Itoh, K. F u j i w a r a . 3rd Dept of M e d i c i n e , S a i t a m a M e d i c a l School, Saitama, J a p a n Aim: To a s s e s s the e f f i c a c y of u l t r a s o u n d - g u i d e d PAl in the t r e a t m e n t of small HCC in c o m p a r i s o n w i t h PEI. M e t h o d s : F r o m A u g u s t 1993 to N o v e m b e r 1994, 38 p a t i e n t s w i t h one to four IICCs < 3 cm e n t e r e d a trial. Nineteen patients [24 tumors) a n d 19 p a t i e n t s (23 tumors) w e r e t r e a t e d by PAl u s i n g 50% a c e t i c a c i d and PEI u s i n g a b o s o l u t e ethanol, r e s p e c t i v e l y . If there was no e v i d e n c e of v i a b l e HCC at b i o p s y , CT, MRI and a n g i o g r a p h y , PAI or PEI was d i s c o n t i n u e d . Results: T h e r e w e r e no s i g n i f i c a n t d i f f e r e n c e s of age, sex ratio, C h i l d g r a d e and size of t u m o r b e t w e e n PAI and PE{ g r o u p s . Tile n u m b e r of t ~ e a t m e n t s e s s i o n s a n d tile volume injected needed to control small HCC adequately were significantly less in PAl t h a n PEI (2.3 + 1.0 vs 3.6 ÷ 1.4, p < 0.01; 4.0 ± 2.3 ml vs 11.4 ± 6.8 ml, p < 0.01). None of the t u m o r s t r e a t e d w i t h PAl g r e w a g a i n w h i l e local r e c u r r e n c e o c c u r r e d in 2 p a t i e n t s after PEI. A n e w IICC o c c u r r e d in 3 p a t i e n t s after PEI but not a f t e r PAI. The I - y e a r s u r v i v a t rate a n d the 1 - y e a r c a n c e r - f r e e s u r v i v a l rate were b e t t e r in PAl g r o u p than PEI g r o u p (100% vs 86%, p=N8; I00% vs 62%, p < 0.025). C o n c l u s i o n : PAl m a y p r o v e to be s u p e r i o r to PEI in tile t r e a t m e n t of small HCC.
S25
F9.2
PRESENTSTATUS OF TRFATMENT OF SMALL HHPATOCELLUIAR CARCINOMA Masatoshi Tanaka, Kyuichi T a n i k a w a D e p a r t m e n t of Medicine, K u r u m e U n i v e r s i t y School of Medicine, Kurume, J a p a n
Background: P e r c u t a n e o u s e t h a n o l i n j e c t i o n was a d m i n i s t e r e d to t r e a t m e n t of small h e p a t o c e l l u l a r ~ a r c i n o m a d u r i n g t he last decade. Methods: Four h u n d r e d a n d s e v e n t y - n i n e cases of h e p a t o c e l l u l a r c a r c i n o m a of <3cm in d i a m e t e r a n d less t h a n 3 n o d u l e s w e re e x a m i n e d to a s c e r t a i n t he factors affecting s u r v i v a l of p a t i e n t s a f t e r i n i t i a l t r e a t m e n t . Results: C u m u l a t i v e s u r v i v a l rates of 349 patients after p e r c u t a n e o u s e t h a n o l i n j e c t i o n at 5- a n d 7-years were 47.3% a n d 28.0%, 66 p a t i e n t s a ft e r c u r a t i v e hepatic resection were 58.0% a n d 27.1% a n d 64 p a t i e n t s a ft e r t r a n s c a t h e t e r a r t e r i a l c he moe m b o l i z a t i o n w e re 9.2% a n d 4.6%, respectively. Cox's p r o p o r t i o n a l h a z a r d m o d e l i d e n t i f i e d t h a t histologic grade of t u m o r (p<0.0001), n u m b e r of t u m o r (p=0.0013), clinical stage (p=0.0001) a n d p o s t - t r e a t m e n t follow-up of p a t i e n t s e v e r y 3 m o n t h s (p<0.0001) were associated w i t h s u r v i v a l p e r i o d of p a t i e n t s a ft e r p e r c u t a n e o u s ethanol injection. Conclusion: The re was no s i g n i f i c a n t d i f f e r e n c e in s u r v i v a l ra t e of p a t i e n t s t r e a t e d by p e r c u t a n e o u s e t h a n o l i n j e c t i o n a n d h e p a t i c resection. Early d i a g n o s i s of e i t h e r a r e c u r r e n c e or a s e c ond new grow t h of h e p a t o c e l l u l a r c a r c i n o m a was one of the mos t i m p o r t a n t p r o g n o s t i c fa c t or after p e r c u t a n e o u s ethanol injection.
F9-4 Percutaneous microwave coagulation therapy for h e p a t o c e l l u l a r carcinoma (HCC). T. Seki, M. Wakabayashi, T. Nakagawa, T. Itho, M. Imamura, T. Shiro, K. Inoue 3rd Dept. of Internal Medicine, Kansai Medical Univ. Moriguchi, Japan PEIT
is occasionaly
ineffective for intracapsular or
extracapsular invasion of liver cancer cells. We designed ultrasonically guided percutaneous microwave coagulation therapy (PMCT) as a new method to induce tumor necrosis and overcome the disadvantages of PELT. In this report, the effect of PMCT was compared with t h a t of PEIT. Percutaneous local t r e a t m e n t s were performed for the 61 patients having a single HCC (tumor size < 2c m)be t w e e n Ja. 1990 and Dee. 1994. There were 31 patients treated by PMCT alone (Group M) and 30 who were treated by PEIT alone (Group E). The therapeutic results of these two groups were evaluated on the basis of survival rate, disease free survival rate, pattern of recurrences, number of times of needle insertion. For Group M and E, the 3yr survival rates ( 3 y r - d i s e a s e free s u r v i v a l rate) were 93% (47%) and 59% (37%), respectively. The recurrent rate of Group M and group E at t r e a t e d s u b s e g m e n t area w i t hi n one year after t re a t me nt was 3 % and 13%, respectively. The recurrent rate at treated subsegment area of Group M was lower than t ha t of Group E. The number of times of needle insertion for Groups M and E were 2.0-+ 1.0 and 4.5 + 1.1, re s pe c t i ve l y. Compared with PEIT, PMCT is a useful t r e a t m e n t for small HCC, it is effective in producing local necrosis of tumor tissue while minimizing the burden to the patient.