30 april 2005: Bron: Radiology. 2005 May;235(2):659-67 en Zhonghua Zhong Liu Za Zhi. 2003 Jul;25(4):401-3

Combinatiebehandeling van ultra sound - RFA en TACE verlengt mediane overleving van kankerpatiënten met levertumoren met een gemiddelde grootte van 10,4 cm.!!!!! van 4 maanden naar 11,3 maanden en 1 jaars overleving van 0% naar 42,9%. Ook een eerdere studie uit 2003 geeft zelfde hoog significante resultaten.

Chinese onderzoekers waar veel gewerkt wordt met TACE methode omdat primaire leverkanker relatief veel voorkomt bij de Aziatische bevolking, hebben twee trials gedaan naar effect van combinatie behandeling van TACE en chirurgie met Ultra Sound - RFA, in feite wat dr. Vogl LITT noemt, maar Vogl dan chirurgie uitvoert met lasering i.p.v. ultra sound. Opvallend is dat deze methode ook levertumoren aanpakt met een diameter tot wel 14 cm., een omvang waar zelfs dr. Vogl niet meer aan begint. Vogl hanteert een grens van een levertumor ca. 6 cm. in doorsnee, die nog met LITT te behandelen is. Hier de vertaalde resultaten uit studie in mei 2005 te publiceren, maar waarvan abstract nu al aan ons toegestuurd. Daaronder abstract van studie uit 2003 van dezelfde onderzoekers met zelfde hoog significante resultaten.

RESULTATEN: Er werden geen ernstige complicaties gemeld na de verwijdering van de levertumoren door ultra sound techniek en ook na de TACE = Transarteriële Chemo Embolisatie werden geen onverwachte complicaties gezien. Follow-up scans toonden vaker afwezigheid of vermindering van bloedtoevoer in/naar de tumoren na de ultra sound ingreep in vergelijking met bloedtoevoer na TACE alleen. De mediane overleving was 11.3 maanden in groep 2 (Ultra sound en TACE samen) en 4.0 maanden in groep 1 (Alleen TACE) (P = .004). De 6-maanden overleving was 80.4%-85.4% in groep 2 en 13.2% in group 1 (P = .002), en de 1-jaars overleving was 42.9% en 0%, respectievelijk. Mediane vermindering in tumorgrootte gemeten als percentage van tumorgrootte vooraf aan behandeling na 1, 3, 6, en 12 maanden na behandeling, waren respectievelijk: 28.6%, 35.0%, 50.0%, en 50.0% in groep 2 en 4.8%, 7.7%, 10.0%, en 0% in groep 1 (P < .01).

Radiology. 2005 May;235(2):659-67.

Advanced hepatocellular carcinoma: treatment with high-intensity focused ultrasound ablation combined with transcatheter arterial embolization.

Wu F, Wang ZB, Chen WZ, Zou JZ, Bai J, Zhu H, Li KQ, Jin CB, Xie FL, Su HB.
Institute of Ultrasonic Engineering in Medicine and Clinical Center for Tumor Therapy of the 2nd Affiliated Hospital, Chongqing University of Medical Sciences, 1 Medical College Rd, Box 153, Chongqing 400016, China. mfengwu@yahoo.com.

PURPOSE: To evaluate ultrasonographically (US)-guided high-intensity focused ultrasound ablation combined with transcatheter arterial chemoembolization (TACE) in the treatment of stage IVA hepatocellular carcinoma (HCC).

MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. From November 1998 to May 2000, 50 consecutive patients with stage IVA HCC (TNM classification, T4N0-1M0) were alternately enrolled in one of two treatment groups: group 1 (n = 26), in which TACE was performed alone, and group 2 (n = 24), in which transcutaneous ablation of HCC with high-intensity focused ultrasound was performed 2-4 weeks after TACE. The tumors were 4-14 cm in diameter (mean, 10.5 cm). Immediate therapeutic effects were assessed at follow-up with Doppler US and computed tomography or magnetic resonance imaging. All patients were followed up for 3-24 months (mean, 8 months) to observe long-term therapeutic effects and complications in both groups. Tumor reduction rates, median survival time, and cumulative survival rates in both groups were calculated by using the unpaired Student t test and Kaplan-Meier method.

RESULTS: No severe complication was observed after focused ultrasound ablation, and no unexpected side effects were noted after TACE. Follow-up images showed absence or reduction of blood supply in the lesions after focused ultrasound ablation when compared with blood supply after TACE alone. The median survival time was 11.3 months in group 2 and 4.0 months in group 1 (P = .004). The 6-month survival rate was 80.4%-85.4% in group 2 and 13.2% in group 1 (P = .002), and the 1-year survival rate was 42.9% and 0%, respectively. Median reductions in tumor size as a percentage of initial tumor volume at 1, 3, 6, and 12 months after treatment, respectively, were 28.6%, 35.0%, 50.0%, and 50.0% in group 2 and 4.8%, 7.7%, 10.0%, and 0% in group 1 (P < .01).

CONCLUSION: The combination of high-intensity focused ultrasound ablation and TACE is a promising approach in patients with advanced-stage HCC, but large-scale randomized clinical trials are necessary for confirmation. (c) RSNA, 2005.

PMID: 15858105 [PubMed - in process]

Zhonghua Zhong Liu Za Zhi. 2003 Jul;25(4):401-3.

[High intensity focused ultrasound therapy combined with transcatheter arterial chemoembolization for advanced hepatocellular carcinoma]

[Article in Chinese]

Jin CB, Wu F, Wang ZB, Chen WZ, Zhu H.B

Clinical Center for Tumor Therapy, Second Hospital, Institute of Ultrasonic Engineering in Medicine, Chongqing Medical University, Chongqing 400010, China.

OBJECTIVE: To study high intensity focused ultrasound (HIFU) therapy combined with transcatheter arterial chemoembolization (TACE) in the treatment of patients with advanced hepatocellular carcinoma

(HCC). METHODS: Fifty patients with unresectable HCC (TNM stage IV) were randomized into a TACE (T) group and a TACE plus HIFU (T + H) group. Twenty-six patients underwent TACE alone, and 24 HIFU ablation 2 - 3 weeks after TACE. The mean follow-up time for all patients was 8.16 +/- 2.79 months (range 3 to 24 months). The median survival, 6-month-, 1-year survival rates and average survival of patients who died were calculated by Kaplan-Meier method and Fisher exact test.

RESULTS: The median survival time, 6-month and 1-year survival rates were 11.3 months, 80.4 - 85.4% and 42.9% in T + H group, in contrast to 4 months, 13.2% and 0% in T group with significant differences (P < 0.01). The average survival time of patients who died was 10.21 +/- 4.12 months in T + H group, as compared with 4.35 +/- 2.39 months in T group also with significant differences (P < 0.01).

CONCLUSION: High intensity focused ultrasound therapy (HIFU) combined with transcatheter arterial chemoembolization (TACE), being better than TACE alone, may become one of the most effective treatments for patients with unresectable HCC.

Randomized Controlled Trial
PMID: 12921577 [PubMed - indexed for MEDLINE]

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