Short-term outcomes of radiofrequency ablation for hepatocellular carcinoma using cone-beam computed tomography for planning and image guidance.

BACKGROUND: Percutaneous radiofrequency ablation (RFA) is an effective treatment for unresectable hepatocellular carcinoma (HCC) and a minimally invasive alternative to hepatectomy for treating tumour recurrence. RFA is often performed using contrast-enhanced computed tomography (CECT) and/or ultrasonography. In recent years, angiographic systems with flat panel image detectors and advanced image reconstruction algorithms have broadened the clinical applications of cone-beam computed tomography (CBCT), including RFA. Several studies have shown the effectiveness of using CBCT for immediate treatment assessments and follow-ups. AIM: To assess the treatment response to RFA for HCC using CBCT. METHODS: Forty-eight patients (44 men; aged 37-89 years) with solitary HCC [median size: 3.2 (1.2-6.6) cm] underwent RFA and were followed for 25.6 (median; 13.5-35.2) mo. Image fusion of CBCT and pre-operative CECT or magnetic resonance imaging (MRI) was used for tumour segmentation and needle path and ablation zone planning. Real-time image guidance was provided by overlaying the three-dimensional image of the tumour and needle path on the fluoroscopy image. Treatment response was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Disease progression, death, time to progression (TTP), and overall survival (OS) were recorded. Kaplan-Meier and Cox regression analyses were performed. RESULTS: Initial post-RFA CECT/MRI showed 38 cases of CR (79.2%), 10 of PR (20.8%), 0 of SD, and 0 of PD, which strongly correlated with the planning estimation (42 CR, 87.5%; 6 PR, 12.5%; 0 SD; and 0 PD; accuracy: 91.7%, P < 0.01). Ten (20.8%) patients died, and disease progression occurred in 31 (35.4%, median TTP: 12.8 mo) patients, resulting in 12-, 24-, and 35-mo OS rates of 100%, 81.2%, and 72.2%, respectively, and progression-free survival (PFS) rates of 54.2%, 37.1%, and 37.1%, respectively. The median dose-area product of the procedures was 79.05 Gy*cm2 (range 40.95-146.24 Gy*cm2), and the median effective dose was 10.27 mSv (range 5.32-19.01 mSv). Tumour size < 2 cm (P = 0.008) was a significant factor for OS, while age (P = 0.001), tumour size < 2 cm (P < 0.001), tumour stage (P = 0.010), and initial treatment response (P = 0.003) were significant factors for PFS. CONCLUSION: Reliable RFA treatment planning and satisfactory outcomes can be achieved with CBCT.

Lactate dehydrogenase is a prognostic indicator in patients with hepatocellular carcinoma treated by sorafenib: results from the real life practice in HBV endemic area.

PURPOSE: Lactate dehydrogenase (LDH), which was an indirect marker of hypoxia, was a potentially prognostic factor in several malignancies. There is a lack of evidence about the prognostic value of serum LDH level in patients with hepatocellular carcinoma (HCC) receiving sorafenib treatment from hepatitis B virus endemic areas. MATERIALS AND METHODS: A total of 119 HBV-related HCC patients treated by sorafenib from a Chinese center were included into the study. They were categorized into 2 groups according to the cut-off value of pre-treatment LDH, which was determined by the time dependent receiver operating characteristics (ROC) curve for the overall survival. The prognostic value of LDH was evaluated. The relationships between LDH and other clinicopathological factors were also assessed. RESULTS: The cut-off value was 221 U/L. With a median follow up of 15 (range, 3-73) months, 91 patients reached the endpoint. Multivariate analysis proved that pre-treatment serum LDH level was an independent prognostic factor for both overall survival (OS) and progression-free survival (PFS). For patients whose pre-treatment LDH ≥ 221 U/L, increased LDH value after 3 months of sorafenib treatment predicted inferior OS and PFS. And patients with elevated pre-treatment LDH level predisposed to be featured with lower serum albumin, presence of macroscopic vascular invasion, advanced Child-Pugh class, advanced T category, higher AFP, and higher serum total bilirubin. CONCLUSIONS: Serum LDH level was a potentially prognostic factor in HCC patients treated by sorafenib in HBV endemic area. More relevant studies with reasonable study design are needed to further strengthen its prognostic value.

[Biodegradation Characteristics and Kinetics of p-nitrophenol by Strain Arthrobacter sp. CN2].

To investigate the application potential of the p-nitrophenol-degrading bacterium Arthrobacter sp. CN2 in practice, the effects of pH, salinity and additional carbon source were determined, and the degradation kinetics of p-nitrophenol was analyzed. Strain CN2 could degrade p-nitrophenol efficiently in a wide range of pH (7.0-8.0) and elevated salinity (0-60 g · L(-1)). Investigation of additional glucose found that 0.5% of glucose could significantly increase the degrading speed and the time to reach 90% of degradation rate was shortened by 16 hours. These results indicated that strain CN2 could degrade p-nitrophenol efficiently under different conditions and had a great potential for application in practice.

[Value of multi-slice helical CT in the diagnosis and differential diagnosis of thyroid lesions].

OBJECTIVE: To investigate the value of multi-slice helical CT in the differentiation of benign from malignant thyroid lesions. METHODS: The multi-slice helical CT images of 72 patients with 82 thyroid lesions were prospectively studied. The CT features including the margin, density of the lesion and cervical lymph node enlargement were evaluated double-blindly. All the image findings were compared with the pathological results, and analyzed statistically using the Chi-square test. RESULTS: Of 42 benign lesions, 38 (90.5 % ) showed well-defined margin, 13 (30. 9% ) contained low density nodular areas, 3 (7. 1% ) showed granular calcifications, and 2 (4. 8% ) had cervical lymph node enlargement. Of 40 thyroid carcinomas, 37 lesions(92.5% ) had irregular border, no lesion contained low density nodular areas, 14 (35. 0%) showed granular calcifications, and 31 (77. 5% ) had enlarged cervical lymph nodes. Nineteen lesions (55. 9% ) from 34 thyroid carcinoma patients who had undergone contrast enhanced CT scan showed complex density, while only 2(6. 3% ) of 32 benign lesions showed such findings on contrast enhancement. There were statistically significant differences between benign and malignant lesion in margin, low density nodular area, granular calcification, cervical lymph node enlargement and complex density( P <0.01). CONCLUSION: The findings of well-defined margin and low density nodular area in CT image may suggest benign thyroid lesions, whereas the presence of irregular border, granular calcifications and cervical lymph node enlargement as well as complex density may indicate thyroid malignancy.