In cell biology, it has been known that microwave (MW) has non-thermal effect on cell cycle or cell proliferation. Recently, the next generation microwave heating apparatus (NGMW), which uses semiconductor with digital technology, has been developed. It is much easier to control power of MW, compared to conventional MW. We used this machine to examine the non-thermal effect on cell cycle. When HL-60 human leukemic cells were exposed to 20 or 40 Watts of MW at 37 or 42oC for 30 minutes, percentage of S-phase fraction in DNA histogram, analyzed by flow cytometry, increased dramatically (p = 0.026). When the same experiments were done using Propidium iodide (PI) and MIB-1 double staining, cycling cells increased significantly (p = 0.005). It is suggested that MW has non-thermal effect on cell cycle.
We started microwave ablation therapy of liver tumors under MR image guidance with an open configuration MR scanner. The combination of these two was quite feasible. At the beginning, preparations of MR compatible electrodes and a noise-eliminating filter were required. After the measurements against the noise, microwave irradiation did not disturb MR images and temperature changes could be monitored using MR temperature maps, which were useful for the real-time evaluation of therapeutic effects. In addition, MR temperature maps could be used to investigate the condition of microwave ablation with newly developed instruments and applications. The encounter of microwave ablation with MR imaging made a breakthrough in the image-guided minimally invasive therapy. Further developments of new technologies for therapeutic procedures are expected from this combination.
This review described diagnosis and treatment of hepatocellular carcinoma. Hepatocellular carcinoma commonly develops in patients with chronic hepatitis caused by hepatitis C and hepatitis B virus. Ultrasound imaging, computerized tomography and magnetic resonance imaging are useful for disclosing hepatocellular carcinoma. Surgical resection, percutaneous needle therapy, transarterial therapy and systematic chemotherapy are used to treatment of hepatocellular carcinoma.
The treatment of metastatic cancer has developed significantly over the past decade. Median survival time after chemotherapy was reported to be 12 months for gastric cancer. Several clinical trials reported for more than 2 years by introduction of molecular targeting agents, such as bevacizumab, cetuximab and panitumumab for colorectal cancer. In this article we review various treatment options, including cytotoxic and molecular targeted agents, currently available for patients with gastric or colorectal cancer in Japan.
In this report, we suggest a probable treatment with microwave tissue coagulation (MTC) aimed at curing jaundice and early-stage bile duct carcinoma in elderly patients. Here we report cases of 2 jaundice patients with bile duct carcinoma in the far advanced stage of progression, who survived for more than 4 years after percutaneous transhepatic cholangioscopy (PTCS) and radiography-guided MTC. Long-term survival of over 10 years was achieved in jaundice patients with unresectable bile duct carcinoma and poor health after performing PTCS and radiography-guided MTC. MTC may be an alternative palliative treatment for jaundice patients in the far advanced stage of progression and may afford survival of over 4 years.
We have performed transurethral microwave tissue coagulation (MTC) for urinary bladder cancer, and especially applied MTC to small tumors of outpatients without anesthesia. We have used a rigid cystoscope which is 7 mm in diameter. In this report, 93-year-old man was performed MTC with a flexible cystoscope. The flexible cystoscope, CYF-5A (OLYMPUS) was used. It is 5.5 mm in diameter and have a 2 mm working channel, and the microwave applicator is 1.8 mm in diameter. Reccurent tumors of bladder neck and posterior wall were treated. Both tumors were 2 mm, and coagulated once and twice for 5 seconds at the energy of 50 Watts. This procedure is less painful than that with a rigid cystoscope, and it can be performed immediately after cystoscopy.
Objective: To compare microwave endometrial ablation (MEA) using a new curved applicator with conventional surgical procedures in 53 patients with menorrhagia. Study Design: Thirty seven patients received MEA and 16 patients received conventional surgical procedures. Using a visual analog scale (VAS), MEA patients rated their menorrhagia, dysmenorrhea, and feelings of satisfaction from the procedure. The patients' intraoperative blood loss, operating time, and length of hospital stay were compared. Results: Following MEA, the VAS scores were significantly decreased in the MEA patients for menorrhagia (p<0.0001) and dysmenorrhea (p<0.0001). The average VAS score regarding feelings of satisfaction for MEA was 9.1 (full score = 10). Mean blood loss, operating time, and mean length of hospital stay were significantly decreased in the MEA group compared to the conventional surgical procedure group (p<0.0001). Conclusion: MEA successfully controlled menorrhagia and achieved a high rate of satisfaction among patients.
A microwave applicator 4 mm in diameter inducible into myoma without a guiding needle was newly developed. Using the applicator, a feasibility study of ultrasonically guided transcervical microwave myolysis for uterine myomas was performed. After completion of microwave endometrial ablation for menorrhagia, a newly developed microwave applicator with a conic end was transcervically introduced into the uterine cavity and inserted into the myoma tissue assisted by transabdominal ultrasonic guidance. Three patients waiting for microwave endometrial ablation for menorrhagia caused by myomas entered the study. In the 3 patients, the major part consisting of a submucous myoma 5.2 to 10.8 cm in size was necrotized. The myoma shrank by 42 to 78% in the following 3 months. Ultrasonically guided transcervical microwave myolysis using a 4 mm applicator with a conic end is feasible.
Much has been learned about imaging diagnosis of hepatocellular carcinoma (HCC) from imaging and pathological observations specifically through blood flow in the affected area. In ultrasound imaging, Sonazoid®, the perflubutanemicrobubbles, being covered by the health insurance from 2007, made it possible to observe blood flow in real time and in more detail with a minimally invasive approach. It allows repetitive evaluations in the post vascular phase (Kupffer phase). Because the amount of Kupffer cells decrease in developed HCC, differentiation of malignant lesions is enabled by combining the images in the Kupffer phase with vascular architecture. Ultrasound examination provides higher spatial resolution than CT and MRI, also offers superior temporal resolution by adding contrast to it. The diagnostic capability of ultrasound imaging of HCC and its evaluation in our facility will be discussed.
Recently, the laparoscopic approach has been used more frequently for liver resection due to the rapid development of innovative laparoscopic instruments and improvements in surgical skills. To control bleeding from liver parenchyma is important in laparoscopic surgical procedures. Microwave energy is a safe and effective coagulation device to achieve good hemostasis during hepatic resection with both open and laparoscopic techniques. We describe the method of laparoscopic liver resection using flexible-type needle and spatula-type electrodes of a microwave tissue coagulator. This technique is safe and bleeding can be easily controlled.
In a laparoscopic hepatectomy (LH), we prefer to apply a pre-coagulation technique (PT) using microwaves to reduce blood loss during liver parenchymal transection. It has been presented our experience with LH to assess the short-term outcomes of LH with PT. There were divided into Pure-Lap groups and HALS/Lap-assist groups to assess postoperative outcomes. Though operative blood loss and operative duration in HALS/Lap-Assist group were higher and longer than Pure-Lap group, postoperative morbidity and hospital stay were not significant differences between 2 groups. The LH with PT and proper selection for LH approaches depend on tumor location can lead safe laparoscopic procedure and subsequently obtained good results.
Earlier diagnosis of hepatocellular-carcinoma has become possible, and resectable cases have been increasing. However, there are limitations for operation because many cases involve liver cirrhosis, and, recurrence rates after operation are high. So radiofreguency ablation(RFA) which is a less invasive treatment is the preferred method. We investigated cases of hepatic resection and RFA to ascertain which should be selected for curative treatment possible cases. The cumulative survival rate showed no difference in both groups for the patients with Child A/B, 3 cm or less in tumor diameter and 3 or less in tumor number. RFA was considered to be first choice of treatment for those cases. However, surgical resection tends to present a better long term prognosis, and should be considered for patients who are young with good liver function, and expecting a long term prognosis. Treatment should be selected on a case by case basis while considering expected survival period and QOL.
The incidence of non-B, non-C hepatocellular carcinoma has shown an increasing trend in the recent years. However, the &ldqup;Clinical Practice Guidelines for hepatocellular carcinoma” do not take the causes of background hepatic lesions into account when deciding the treatment methods. Therefore, we investigate the treatment methods for non-B, non-C hepatocellular carcinoma, particularly, the outcome of percutaneous ablation therapy. This study included hepatocellular carcinoma patients undergoing their initial treatment at our hospital. The patients were divided into the following groups: B group, which included patients positive for hepatitis B surface (HBs) antigens; C group, which included patients positive for hepatitis C virus (HCV) antibodies; and non-B, non-C group, which included patients negative for both HBs antigen and HCV antibodies. Most of the patients included in the non-B, non-C group had a history of heavy alcohol consumption or the complication of malignant tumors of other organs. These patients were older than those in the B group, and had low liver damage grades and more advanced tumors than those in the C group. In the initial treatment, 43% of the patients in the non-B, non-C groups underwent hepatectomy; 13%, percutaneous ablation therapy; 12%, transcatheter hepatic arterial embolization; 19%, transcatheter hepatic arterial embolization + percutaneous ablation therapy. The number of patients who underwent hepatectomy was higher in the non-B, non-C group than in the C group. In terms of the cumulative survival rate of the non-B, non-C group patients according to the type of initial treatment, there were no differences in the outcomes of hepatectomy, percutaneous ablation therapy, and transcatheter hepatic arterial embolization + percutaneous ablation therapy. Even when the investigation was limited to Stage I patients with grade A liver damage, the cumulative survival rate after hepatectomy was comparable to that after the percutaneous ablation therapy. These findings suggest that there is no need to take the causes of background hepatic lesions into consideration when deciding the treatment method for hepatocellular carcinomas, including non-B, non-C hepatocellular carcinoma.
Radiofrequency ablation (RFA) with artificial pleural effusion and/or artificial ascites has recently been recognized as a useful device for the treatment of tumors located on the liver surface and in the hepatic dome. Sixty patients (including 32 naive patients) with hepatocellular carcinoma (HCC) underwent RFA with artificial pleural effusion and/or ascites. We decided the precise indication for the use of artificial infusion according to the location of tumor. The total local recurrence rates at 1 and 2 years were 4% and 22%, respectively. The estimated survival rates of 32 naive patients at 1 and 3 years were 90% and 78%, respectively. The local recurrence rates of a tumor size of <3 cm and >=3 cm at 2 years were 22% and 17%, respectively.
Purpose: This study was designed to evaluate the influence of the rating “Lens culinaris agglutinin-reactive alphafetoprotein (AFP-L3) positive” on the outcome of treatment. Materials and methods: The study involved 232 patients with hepatocellular carcinoma rated as having liver damage class AB hepatopathy, a single tumor, tumor diameter 2 cm or smaller, no vascular invasion, and no extrahepatic lesion for whom AFP-L3 (“L3”) was measured at our hospital between 1994 and 2008. In these patients, the outcome of treatment was analyzed in relation to presence/absence (positive/negative) of L3 before treatment and post-treatment disappearance or persistence of L3 in pre-treatment L3-positive cases. Results: The cumulative survival rate was significantly lower for L3-positive cases than for L3-negative cases (p = 0.008). Neither the cumulative survival rate in L3-positive cases nor the post-treatment L3 disappearance rate in L3-positive cases before treatment differed significantly depending on the method of treatment (p = 0.7501, p = 0.3286). The cumulative survival rate was significantly higher for cases becoming L3 negative after treatment than for those failing to become L3-negative after treatment (p = 0.035). Conclusion: The prognosis was poorer in L3-positive cases than in L3-negative cases. Among L3-positive cases before treatment, the prognosis was poorer in cases failing to become L3-negative after treatment than in those becoming L3-negative after treatment.
Purpose: The long-term effect of percutaneous radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC) was retrospectively evaluated by the analysis of the overall survival (OS) rate and disease free survival rate of the patients. Patients and Methods: From 2000 to 2009, 269 patients with small HCC (3 cm or less in diameter and 1-3 lesions) were curably treated by RFA in our institution. Results: Liver damage (LD) A, B, C were 140, 115, 14, respectively. The 3, 5-year OS rates were 76% and 59%. OS rate of LD-A patients: The 3, 5-year OS rates were 86% and 71%. According multivariate analysis of prognostic factors for OS rates after treatments, age, gender, LD, PIVKA-II, AFP-L3 and solitary were significantly associated with OS rates. Conclusion: RFA was effective as hepatectomy for treatment of small HCC.
Purpose: As advances in surgical techniques, anesthetic procedures, and post operative care have all made surgery less hazardous recently, the number of operative patients in elderly people with hepatocellular carcinoma (HCC) is expected to increase as the population ages. In this report, we have examined how the characteristics and the outcomes of surgery in elderly patients differ from those in younger patients. Materials & methods: Between July 1994 and December 2009, 845 patients received their initial therapy for HCC in our institute. Of these 58 patients (Elder group; E group) were older than 80 years. The characteristics and therapeutic survival effect were prospectively evaluated and statistically analyzed. Results: In the background characteristics of E group and 787 younger patients less than 80 years old (Young group; Y group) who underwent microwave coagulo-necrotic therapy (MCN) or hepatic resection (HR), there were significant differences for sex and existence of viral hepatitis. There were no differences in liver function and tumor characteristics between E and Y group. Eight patients of E group who treated by HR have been doing well without any complications. The 1-, 3-, 5-, and 10-year cumulative survival rates for E and Y group were 96.9, 72.6, 41.1, -% and 95.7, 78.1, 60.5, 31.9%, respectively (p = 0.0572). No significant differences were found in cumulative survival rates, disease free survival after surgical treatment between E and Y group. Conclusion: The above results suggested that selected elderly patients with HCC benefit from surgery, irrespective of their age.
We analyzed the rates of survival and local recurrence among 89 patients with solitary hepatocellular carcinoma (HCC) who underwent thermal ablation therapies as primary treatment (naive patients). The number of patients was as follows; 35 cases in percutaneous radiofrequency ablation (RFA), 5 in laparoscopic RFA, 22 in percutaneous microwave coagulation therapy (MCT), and 54 in laparoscopic MCT. Five-year local recurrence rates were 40%, 50%, 50%, and 18% in percutaneous RFA, laparoscopic RFA, percutaneous MCT, and laparoscopic MCT, respectively, with no statistical significance. Rates of 5-year survival were 78%, 75%, 82%, and 70% in percutaneous RFA, laparoscopic RFA, percutaneous MCT, and laparoscopic MCT, respectively, with no statistical significance. Thus, percutaneous RFA, laparoscopic RFA, percutaneous MCT, and laparoscopic MCT had same effectiveness for the local treatment of HCC.
In patients with huge hepatocellular carcinoma (HCC), hepatic resection may be regarded as the only reasonable therapeutic option and expected their long-term prognosis. However, these patients often could not tolerate an extended hepatic resection owing to coexisting cirrhosis, microwave coagulation therapy (MCT) is frequently used. Large HCC, with a diameter of more than 5 cm, is frequently difficult to control with MCT. We performed MCT combined with partial tumorectomy in 2 patients with primary liver cancer 10 cm in diameter or more. Although early recurrence was observed in both patients, MCT with partial tumorectomy can be performed safety and is useful for local control, suggesting that prolonged survival can be expected due to the multidisciplinary treatment.
In the era of new chemotherapy, therapeutic efficacies of radiofrequency ablation (RFA) combined with hepatic resection for colorectal liver metastases (CRLM) are summarized. In the literatures, local recurrence rates per patient ranged from 5% to17.4%. The 3- and 5-year survival rates ranged from 38% to 47%, and 47% to 68%, respectively. In our department, from 2005 to 2009, 26 initially unresectable CRLM patients were downstaged to be resectable with chemotherapy including FOLFOX. Local recurrence was observed only in one tumor (2.5%) in 31 months. In hepatectomy only group and RFA-combination group, progression-free survivals were 21 and 23 months and overall survivals were not reached and 36 months, respectively. Synchronous RFA with hepatic resection should be selected at the timing of destruction of all CRLMs after appropriate chemotherapy.