title: Efficacy of combination therapies of percutaneous or laparoscopic ethanol-lipiodol injection and radiofrequency ablation.
abstract: Percutaneous radiofrequency ablation (RFA) is able to destroy hepatocellular carcinoma (HCC) in a few sessions without major complications. We have previously shown that not only the combined use of percutaneous ethanol injection and RFA (PEI-RFA) but also injection of mixture of ethanol and lipiodol (PELIT) was useful for the treatment of HCC. In the present study, we further developed the combined use of PELIT and RFA through percutaneous or laparoscopic approach (PELI-RFA or LELI-RFA) and evaluated its usefulness. Nineteen nodules in 18 cases were treated with PELI-RFA or LELI-RFA. In the cases treated with LELI-RFA, no bleeding and no spilling milky fluid containing tumor cells were observed from the surface of ablated tumors. In the cases sufficiently treated with PELI-RFA or LELI-RFA, the mixture of ethanol and lipiodol was accumulated in the entire region of the tumor and low-density area was observed around the lipiodol deposit by computed tomography (CT). These delineations of coagulated area were helpful to evaluate the precise area of safety margin around the tumor treated with PELI-RFA or LELI-RFA. Furthermore, the total volume of coagulated necrosis significantly and positively correlated with the product of energy requirement for ablation and the volume of ethanol injected by PELI-RFA or LELI-RFA. Among the cases treated with PELI-RFA or LELI-RFA, local recurrence emerged only in one case in whom enough safety margin could not be achieved by PELI-RFA. Therefore, it is critical to evaluate whether enough safety margin could be obtained with RFA therapy, and PELI-RFA and LELI-RFA are helpful in visualizing the safety margin area.
authors.affiliation: Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kurokohchi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Miyauchi
authors.forename: Naoki
authors.initials: N
authors.lastname: Hosomi
authors.forename: Hirohito
authors.initials: H
authors.lastname: Yoneyama
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yoshida
authors.forename: Takashi
authors.initials: T
authors.lastname: Himoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Deguchi
authors.forename: Seiji
authors.initials: S
authors.lastname: Nakai
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Inoue
authors.forename: Seishiro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kuriyama
mesh_terms: D017115:Catheter Ablation; D003287:Contrast Media / Q000008:administration & dosage*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage*; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D000431:Ethanol; D007459:Iodized Oil