Progress in diagnosis and treatment strategies for multiple primary lung cancer / 中国胸心血管外科临床杂志

@#Multiple primary lung cancer is a special type of lung cancer. Its detection rate is increasing year by year, and there is no clear diagnosis and treatment strategy, which makes the diagnosis and treatment become a hotspot in clinical work. The molecular genetics is gradually changing the status quo of relying only on imaging and tumor-free interval to distinguish lung metastasis from multiple primary lung cancer, and it is an effective method for differential diagnosis and prediction of biological behavior of lung cancer. Based on our experience and other studies, it is recommended that surgical treatment should be preferred when there is no contraindication. The advantages and disadvantages of bilateral thoracoscopic surgery for bilateral multiple primary lung cancer during the same period are discussed, and its feasibility and safety are confirmed. For the lesions that cannot be completely resected, active surgical local treatment is recommended. The diagnosis and treatment of multiple primary lung cancer is still a clinical difficulty, and we hope that our research can provide theoretical and practical guidance for clinicians.

Role of interventional therapy in the downstaging of advanced liver cancer / 临床肝胆病杂志

Interventional therapy has become an important palliative therapy for advanced liver cancer, and meanwhile, interventional therapy is playing an important role in the downstaging of liver cancer. Local interventional therapy can help patients meet the criteria for transplantation or resection by reducing tumor volume and number in patients with advanced liver cancer. Interventional downstaging techniques include transarterial chemotherapy, drug-eluting beads, transarterial radioembolization, and various ablation techniques (radiofrequency ablation, microwave ablation, cryoablation, and ethanol ablation). No consensus has been reached on the optimal interventional downstaging strategy, while high-level evidence-based clinical studies are needed to screen out the optimal candidates for different methods and evaluate the complexity, safety, and long-term efficacy of subsequent liver transplantation after interventional downstaging therapy, so as to improve the effect of interventional therapy in the downstaging of advanced liver cancer.

The optimal treatment for recurrent hepatocellular carcinoma / 中国实用外科杂志

High recurrence rate and metastasis rate after primary surgery for hepatocellular carcinoma have been restricting the long-term survival of patients. For the treatment of recurrent hepatocellular carcinoma, comprehensive treatment based on surgery is the main strategy. For patients who are unsuitable for surgery,local ablation,TACE,radiotherapy, systemic chemotherapy, targeted therapy,immunotherapy,traditional Chinese medicine and optimal supportive therapy are effective measures,which can delay disease progression and improve patient survival. According to the patient's characteristics and individual differences,the multidisciplinary treatment model should be adopted to optimize the treatment effect and reduce side effects,which will benefit the patients with better medical experience and longer overall survival rate.

Transcatheter arterial chemoembolization combined with local ablation in treatment of large hepatocellular carcinoma: a review of current status and perspectives / 中华肝胆外科杂志

Large hepatocellular carcinoma,of which diameter is considered to be ≥ 5 cm,has mostly invaded vascular system or been liver function reserve loss when found,resulting in opportunities to surgical therapy are lost.Combined interventional therapy based on transcatheter arterial chemoembolization (TACE) has become one of the main treatments for the surgically unresectable large hepatocellular carcinoma.In particular,TACE combined local ablation has gradually replaced the interventional therapy model of TACE alone.The current combination therapy is mainly sequential combination.With the development of imaging equipment,real-time synchronization is becoming increasingly important and has become one of the current research hotspots.This article focuses on the research status and perspectives of image guidance,local ablation methods,the order of the joint,the number of times and the timing of the joint situation of TACE combined local ablation in treatment of large hepatocellular carcinoma.

Percutaneous Dual-Switching Monopolar Radiofrequency Ablation Using a Separable Clustered Electrode: A Preliminary Study

OBJECTIVE: To prospectively evaluate the safety and therapeutic effectiveness of dual-switching monopolar (DSM) radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), and to retrospectively compare the results with those of single-switching monopolar (SSM) RFA in a historical control group. MATERIALS AND METHODS: This study was approved by the Institutional Review Board, with informed consent obtained from all patients. Fifty-two HCC patients who underwent DSM-RFA using a separable clustered electrode and dual-generators were prospectively enrolled. Technical parameters, complications, technical success, technical effectiveness, and local tumor progression (LTP) rates were evaluated by means of post-procedural and follow-up imaging. Thereafter, the outcome of DSM-RFA was compared with those of 249 retrospectively included HCC patients treated with SSM-RFA. RESULTS: There were two major complications (3.8%, 2/52) including pleural and pericardial effusion in the DSM-RFA group. The DSM-RFA yielded a 100% technical success rate, a 98.1% technical effectiveness rate, and a 4.3% 2-year LTP rate. In a retrospective comparison between the two groups, DSM-RFA created significantly larger ablation volume (4.20 ± 2.07 cm³/min vs. 3.03 ± 1.99 cm³/min, p < 0.01), and delivered higher energy (1.43 ± 0.37 kcal/min vs. 1.25 ± 0.50 kcal/min, p < 0.01) per given time, than SSM-RFA. There was no significant difference in major procedure-related complications (3.8% vs. 4.4%) and technical effectiveness rate (98.1% vs. 96.4%) between the two groups (p = 1.00). In addition, the 2-year LTP rate of DSM-RFA and SSM-RFA were 4.3% and 10.1%, respectively (p = 0.15). CONCLUSION: DSM-RFA using a separable clustered electrode is safe and provides high local tumor control and good preliminary clinical outcome for small HCCs, which are at least comparable to those of SSM-RFA.

Application of local ablative therapies for hepatocellular carcinoma / 临床肝胆病杂志

Hepatocellular carcinoma (HCC)is a common malignant tumor in the world,and surgical resection and liver transplantation are two radical treatment modalities,but only 10%-20%of all patients can receive such treatments.In recent years,local therapies including radiofrequency ablation,microwave ablation,cryoablation,and the irreversible electroporation ablation which appeared recently have gradu-ally become the alternative therapies for the patients who are unable to undergo surgery.In addition to local tumor growth control and im-provement in survival outcomes,the ablation technology also helps to downgrade tumor for secondary resection.This article focuses on the re-search progress in radiofrequency ablation alone and in combination with other therapies in the treatment of HCC,compares radiofrequency ablation with other local ablative therapies,and briefly introduces the application of intelligent navigation technology in adjuvant ablation. With the development of medical imaging and progress in related fields,the ablation technology will be widely applied in clinical practice in the future.

The interventional treatment for hepatocellular carcinoma originating from the caudate lobe / 临床肝胆病杂志

Hepatocellular carcinoma (HCC)originating from the caudate lobe is a special-site HCC,which is rare and difficult to treat. The major therapeutic method in the past was surgical resection.In recent years,interventional treatment for HCC originating from the cau-date lobe has achieved significant progress,and good therapeutic effect has been obtained.This paper briefly introduces the anatomic fea-tures of the caudate lobe and the features of blood supply in HCC originating from the caudate lobe,reviews the research advances in the therapeutic methods of transcatheter arterial chemoembolization and local ablation for HCC originating from the caudate lobe,and points out that a combination of interventional therapies for HCC originating from the caudate lobe needs to be further investigated in clinical practice.

Interventional treatment of liver metastases / 中华消化外科杂志

Liver is one of the most predilection sites of hematogenous metastasis of a variety of malignances,especially for gastrointestinal tumors.Surgical resection was the first choice for the treatment of liver metastases,while it could not apply to patients who had multiple metastatic lesions or other organs involvement.Interventional technique has been widely recognized for the advantages of minimal trauma,little pain,quick recovery and obvious efficacy.

Recent advance of local ablation for hepatocellular carcinoma

Local ablation has been accepted in many treatment guidelines as a good alternative to curative resection or transplantation for patients with unresectable hepatocellular carcinoma (HCC). The main advantage of local ablative therapy is minimal invasiveness, guaranteeing low morbidity even for the patient with poor hepatic reserve. Furthermore, the therapeutic efficacy of local ablation, especially radiofrequency ablation (RFA), has been shown to be as effective as surgical resection for early-stage (smaller than 3 cm, less than 4 in number) HCC. The long-term outcome after radiofrequency ablation for HCC reported in large series studies were overall survival of 50% to 60% at 5 years and 27 to 32% at 10 years. Major complication rates are 0% to 2.4%. However, controversy remains regarding whether local ablation can replace surgical resection because many retrospective comparative studies have produced conflicting results. Only a well-designed randomized study will be able to clearly answer this long-standing question. During the past decade, many technical advancements in local ablation have been reported, including novel electrodes, thermal protection (i.e., artificial ascites), fusion image guidance, Sonazoid-enhanced ultrasound guidance, and emerging energy sources (i.e., microwaves, High internsity focused ultrasound, Irreversible electroporation). Local ablation is still an evolving technique in the era of minimally invasive treatment for HCC. Many more technical advances are ongoing to enhance the therapeutic efficacy of local ablation. In summary, local ablation will remain a mainstay of non-surgical treatment early stage HCC and play an important role in multidisciplinary approach for HCC management.

Is Percutaneous Ethanol Injection Therapy Still Effective for Hepatocellular Carcinoma in the Era of Radiofrequency Ablation?

Percutaneous ethanol injection (PEI) therapy has been replaced by more-effective thermal ablation techniques that have lower local recurrence rates. However, PEI therapy remains useful in certain settings. Since PEI can be performed in any portion of the liver, PEI therapy can be valuable when tumors are located in close proximity to intestinal loops or other positions that are risky for thermal local ablative techniques. PEI therapy is also valuable in other situations where radiofrequency ablation (RFA) is difficult, including technically difficult masses that are not detected with ultrasound (US), are located in the hepatic dome, in the subcapsular area, and exophytically, or are surrounded by large vessels. PEI therapy contributes to combination therapy with transcatheter arterial chemoembolization or RFA in advanced-stage hepatocellular carcinoma (HCC), and also to the treatment of large HCC or extrahepatic metastasis from HCC. These roles of PEI therapy should be stressed for the treatment of HCCs in appropriate clinical situations. This comprehensive review of articles related to PEI therapy illustrates the recent role and indications of this therapy, which is currently valuable for HCC in the era of RFA.

Role of interventional therapy in the downstaging of advanced liver cancer / 临床肝胆病杂志

Interventional therapy has become an important palliative therapy for advanced liver cancer, and meanwhile, interventional therapy is playing an important role in the downstaging of liver cancer. Local interventional therapy can help patients meet the criteria for transplantation or resection by reducing tumor volume and number in patients with advanced liver cancer. Interventional downstaging techniques include transarterial chemotherapy, drug-eluting beads, transarterial radioembolization, and various ablation techniques (radiofrequency ablation, microwave ablation, cryoablation, and ethanol ablation). No consensus has been reached on the optimal interventional downstaging strategy, while high-level evidence-based clinical studies are needed to screen out the optimal candidates for different methods and evaluate the complexity, safety, and long-term efficacy of subsequent liver transplantation after interventional downstaging therapy, so as to improve the effect of interventional therapy in the downstaging of advanced liver cancer.