A Medical Device Daily

Three-year data shows that radio frequency (RF) ablation is as effective as surgical resection for overall survival and tumor recurrence, for the treatment of single small hepatocellular carcinoma in patients with liver cirrhosis, according to a study presented at the Society of Interventional Radiology's (SIR; Fairfax, Virginia) 31st annual scientific meeting held in Toronto from March 30 through today.

Surgical resection is considered the first-line treatment for patients with small uninodular hepatocellular carcinoma and well-compensated liver cirrhosis, that is, patients who still have good liver function.

In this less-invasive method, a needle is guided through the skin and into the tumor. Heat is applied, killing the cancerous cells and sparing healthy tissue.

One-hundred-sixty-two patients with 38 surgical cases and 124 RF ablation cases were evaluated in this matched, case-control study. Survival rates were 72% at three years in the RF group, vs. 65% at three years in the surgical group.

RF ablation “is increasingly accepted as the best treatment option for patients with early-stage hepatocellular carcinoma when surgical resection is precluded,“ said interventional radiologist and principal investigator Riccardo Lencioni, MD, professor of radiology at the University of Pisa (Pisa, Italy). He said the study “shows that patients who receive radio frequency ablation can have the same life expectancy as patients in similar condition who undergo surgery.“

RF energy also can be given without affecting the patient's overall health; most people can resume normal activities in a few days.

In other news from SIR:

• Endocare (Irvine, California) reported that the findings of three clinical papers related to the company's cryoablation technology were presented at the meeting by Stephen Solomon, MD, associate member, Department of Radiology, Memorial Sloan-Kettering Cancer Center (New York).

The abstracts “indicate that, when properly administered, cryoablation is an effective ablative technique for renal, lung and liver tumors, as long as protocols are tailored to the patient and tumor and patient selection guidelines are optimized,“ Solomon said. “It is also interesting that our animal work suggests that although cryoablation only physically treats the specific tumor site targeted, in combination with immunotherapy agents, the immune effect may be able to treat systemic metastases throughout the body.“

The first clinical paper presented, “Immunotherapy in Combination with Cryotherapy in a Mouse Model of Metastatic Colon and Renal Cancer,“ found that mice whose tumors were treated with cryoablation showed a survival advantage compared to mice treated with surgery. The results suggest a systemic immune effect may occur on tumor metastases following cryoablation and warrant further study.

The second paper, “Percutaneous CT-Guided Cryoablation for Localized Renal Cell Carcinoma: Factors Influencing Success,“ evaluated the factors that influence the initial success rate and complication rate of percutaneous computed tomography (CT)-guided cryoablation of localized renal cell carcinoma tumors. Twenty-one patients with a total of 23 tumors were treated with percutaneous CT-guided cryoablation under conscious sedation. The technique proved to be successful for guiding probe placement and monitoring ice ball formation. Results determined that tumor location and size were the major determinants for achieving tumor eradication.

The last paper, “Thermal Map of Two Adjacent CryoProbes to Create Overlapping Ablations,“ questioned how close two overlapping ablation probes need to be to treat tumors larger than a single probe ablation treatment zone. The study concluded that appropriate spacing between two CryoProbes is necessary to create successful overlapping ablations and different protocols should be employed when treating different tissues.

• In research done at Yale University (New Haven, Connecticut), the use of a foam product enabled treatment of the smallest varicose veins, improving this non-surgical strategy for men and women.

In men, enlarged varicose veins in the scrotum, known as varicoceles, may cause pain, testicular atrophy or fertility problems. In women, enlarged varicose veins in the pelvis can cause disabling chronic pelvic pain, known as pelvic congestion syndrome. The embolization procedure closes off the faulty veins so they can no longer enlarge with blood, alleviating the symptoms in both men and women.

In this research, foam was used to close off the small collateral vessels in the faulty veins that were previously unreachable. The new foam agent, Sotradecol, has recently become available in the U.S.

“This simple and elegant embolization technique allows us to treat testicular atrophy in young boys, reverse infertility in some men, and relieve debilitating pain in women – all non-surgically,“ said study author Robert White Jr., MD, director of the Yale Vascular Malformation Center.

• Research on a non-surgical treatment for children with juvenile idiopathic arthritis in their subtalar ankle joint showed a 91% clinical improvement that lasted a mean of 1.3 years after corticosteroid was injected directly into the inflamed joint using fluoroscopy for precise needle placement. The subtalar joint is a triple-faceted joint that is complex and difficult to treat with traditional methods.

Fifty-five subtalar injections were performed on 38 children; the treatment was technically successful in 100% of the cases. Clinical improvement was observed after 50 of 55 injections (91%).

“With this image-guided technique we now have an accurate way to treat this disease in its earliest stage. We hope to be able to alleviate pain and to prevent irreversible deformity before the bones fuse together,“ said study author and interventional radiologist Kevin Baskin, MD, of Children's Hospital of Philadelphia.