How big is the liver cancer that can be treated by radiofrequency ablation?
In the early years, due to the limitation of ablation equipment and technology, the scope of ablation was limited, and the doctors’ technology was not up to a very skillful level, so the indications for ablation of liver cancer in the early years were less than 3cm, but many liver cancers were found to be more than 3cm, which led to many liver cancer patients not being treated by this minimally invasive and advanced technology. As a result, many liver cancer patients could not be treated by this minimally invasive and advanced technology. Later, with the advancement of machines and improvement of physicians’ skills, many scholars agreed to raise the indications for ablation of liver cancer to 5cm, and ablation therapy has become increasingly popular among doctors and patients, but ablation therapy for liver cancer above 5cm has always been controversial. However, ablation of hepatocellular carcinoma larger than 5 cm has been controversial.
In order to give more patients with intermediate and advanced hepatocellular carcinoma a chance to be ablated, our department started to try to apply radiofrequency ablation to the treatment of large hepatocellular carcinoma or even giant hepatocellular carcinoma in 2004.
The following is a case of giant hepatocellular carcinoma in which one radiofrequency ablation was performed after two TACEs and the tumor was completely inactivated. This typical case suggests that it is questionable to consider the size of tumor as an absolute contraindication to ablation treatment. In fact, we have completely ablated many cases of giant liver cancer over the years and benefited many patients. We believe that under the premise of successful TACE procedure and good communication between doctors and patients, it is feasible for ablative doctors with advanced equipment and rich experience to perform ablative treatment for large liver cancer or even giant liver cancer, which will play an important role in the treatment of giant liver cancer.
Case sharing.
The patient, 42 years old, was found to have a huge hepatocellular carcinoma in the right liver with a maximum diameter of 16cm by ultrasound, CT and MRI examination due to abdominal pain in 2008, and was admitted to the Department of Hepatobiliary Surgery.
Later, the tumor was resected, and on the first postoperative review, no surviving tumor was found in the liver.
In the MRI enhanced arterial phase, the right liver tumor was obviously enhanced with clear boundary, and there were multiple subfoci around the tumor, and the portal vein was obviously compressed, and the tumor in the portal phase was low signal, which is a typical manifestation of hepatocellular carcinoma.
In the enhanced arterial phase of MRI, the right liver tumor was obviously strengthened with clear boundary, and there were multiple subfoci around the tumor, the portal vein was obviously compressed, and the tumor in the portal phase showed low signal, which was typical of hepatocellular carcinoma.
In the enhanced arterial phase of MRI, the right liver tumor was obviously strengthened with clear boundary, and there were multiple subfoci around the tumor, the portal vein was obviously compressed, and the tumor in the portal phase showed low signal, which was typical of hepatocellular carcinoma.
In the enhanced arterial phase of MRI, the right liver tumor was obviously enhanced with clear boundary, and there were multiple subfoci around the tumor, the portal vein was obviously compressed, and the tumor in the portal phase showed low signal, which was typical of hepatocellular carcinoma.
In the enhanced arterial phase of MRI, the right liver tumor was obviously enhanced with clear boundary, and there were multiple subfoci around the tumor, the portal vein was obviously compressed, and the tumor in the portal phase showed low signal, which was typical of hepatocellular carcinoma.
In the enhanced arterial phase of MRI, the right liver tumor was obviously enhanced with clear boundary, and there were multiple subfoci around the tumor, the portal vein was obviously compressed, and the tumor in the portal phase showed low signal, which was typical of hepatocellular carcinoma.
In MRI enhanced arterial phase, the right liver tumor was obviously enhanced with clear boundary, and there were multiple subfoci around the tumor, the portal vein was obviously compressed, and the tumor in the portal phase showed low signal, which is typical of hepatocellular carcinoma.
The above is the preoperative MRI
At that time, the patient had poor liver function, poor nausea, fatigue, wasting and low albumin, so the first TACE could not be completely embolized.
After active liver protection to improve immunity and nutritional support treatment, the second interventional embolization treatment was performed, and about 50 ml of iodized oil and chemotherapeutic drug suspension were injected, and the CT scan was repeated to see good iodized oil deposition and the lesion had shrunk. More than one month after the second TACE, the patient’s liver function and physical condition were significantly improved. Radiofrequency ablation therapy was then started.
After the second TACE, the lesion had good iodine oil deposition, which provided a good basis for radiofrequency ablation treatment.
The COOL-TIP cluster radiofrequency electrode punctured the tumor at multiple points and performed a long time and high-power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerable range.
The COOL-TIP cluster radiofrequency electrode punctures the tumor at multiple points and performs long time and high power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerance.
The COOL-TIP cluster radiofrequency electrode punctures the tumor at multiple points and performs a long time and high-power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerance.
The COOL-TIP cluster radiofrequency electrode punctures the tumor at multiple points and performs a long time and high-power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerance.
The COOL-TIP cluster radiofrequency electrode punctures the tumor at multiple points and performs a long time and high-power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerance.
The COOL-TIP cluster radiofrequency electrode punctures the tumor at multiple points and performs a long time and high-power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerance.
The COOL-TIP cluster radiofrequency electrode punctures the tumor at multiple points and performs a long time and high-power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerance.
The COOL-TIP cluster radiofrequency electrode punctures the tumor at multiple points and performs a long time and high-power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerance.
The COOL-TIP cluster radiofrequency electrode punctures the tumor at multiple points and performs a long time and high-power ablation treatment, aiming to achieve complete ablation of the tumor within the patient’s tolerance.
Each ablation site is firstly tested with 22G fine needle, then the cluster electrode punctures the tumor according to the location of the fine needle, and the ablation treatment is carried out after confirming the location of the RF electrode, with 200 watts of power and 12-20 minutes.
The above picture shows the ablation process.
One month after the ablation, the MRI enhanced scan did not show any enhancement of the tumor, and the tumor itself and several subfoci were completely ablated.
One month after the ablation, the MRI enhanced scan did not show any enhancement of the tumor, and the tumor itself and several subfoci were completely ablated.
The tumor itself and several subfoci were completely ablated.
The tumor itself and several subfoci were completely ablated.
The tumor itself and several subfoci were completely ablated. The portal vein compression was significantly reduced.
The lower edge of the lesion also did not show any enhancement.
No enhancement was seen at the lower edge of the lesion.
The tumor was not enhanced at all on coronal scan, suggesting complete tumor inactivation.
At this time, one year after ablation, the tumor had shrunk significantly and there was no enhancement in the tumor area, suggesting complete inactivation of the tumor and significant reduction of portal pressure.
At this time, one year after ablation, the tumor had shrunk significantly and there was no enhancement in the tumor area, suggesting complete inactivation of the tumor and significant reduction of portal vein pressure.
The patient’s AFP and liver function were normal, and he continued his antiviral treatment and was working and living normally.
After discussing with the patient and the hepatobiliary surgeon, it was decided to perform hepatectomy. On the first postoperative review, the patient recovered well and no surviving tumor was seen in the liver.
On the second review after surgery, a low-density foci were seen at the top edge of the diaphragm and tumor recurrence was considered.
TACE was performed, and the tumor at the top of the diaphragm was larger than before but with good iodine oil deposition.
The second CT-guided radiofrequency ablation was performed.
CT-guided second radiofrequency ablation.
CT-guided second radiofrequency ablation.
Review after the second radiofrequency ablation: the recurrent tumor was completely necrotic, the patient did not have hemopneumothorax, and no complications such as intestinal injury occurred.
Continued review of tumor shrunk significantly without enhancement, suggesting complete tumor inactivation.
The tumor was significantly reduced and the ablation area was basically replaced by normal liver.
Patient Onset 2008, last follow-up 2005. Currently tumor-free and living a normal working life. Continuing follow-up and antiviral therapy.