Effectiveness and safety of high-intensity focused ultrasound in treatment of hepatocellular carcinoma adjacent to large vessels / 肿瘤

ABSTRACT

Objective: To analyze the efficacy and safety of high-intensity focused ultrasound (HIFU) in the treatment of hepatocellular carcinoma adjacent to large vessels. Methods: Sixty patients with hepatocellular carcinoma underwent HIFU treatment. The alpha-fetoprotein (AFP) level was examined before and after HIFU treatment in patients whose AFP level was >20 μg/L before HIFU. The ablation of tumor and the perfusion of large vessels adjacent to tumor were examined by contrast agent-enhanced MRI after HIFU treatment. The postoperative adverse reactions were observed and the clinical follow-up was conducted. Results: All 60 patients completed HIFU treatment successfully. In 42 patients with AFP level > 20 μg/L before HIFU, the postoperative level of AFP was significantly lower than the preoperative level [(277.8±59.2) μg/L vs (614.1±130.9) μg/L, P = 0.012]. The imaging examination results showed that the complete tumor necrosis was achieved in 41 lesions (64.1%) 1 month after HIFU treatment. The remaining 23 lesions (35.9%) were ablated in more than 50% of the tumor volume. The enhanced MRI images showed that the perfusion of major blood vessels adjacent to tumor was maintained. The major adverse reactions were pain in the treatment area, fever and transient elevation of serum transaminases. All adverse effects were relieved after symptomatic treatment. Hepatorrhexis, intraperitoneal hemorrhage and other severe complications were not observed. During the follow-up, 26 patients (43.3%) died. the overall survival rates at 1, 2, 3, 4 and 5 years were 71.3%, 53.2%, 41.8%, 33.4% and 33.4%, respectively. Conclusion: HIFU can be safe and effective in the treatment of hepatocellular carcinoma adjacent to large vessels, and no damages to the surrounding major blood vessels are observed.