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. 2012 Oct;36(10):2420-7.
doi: 10.1007/s00268-012-1660-7.

Tolerance of high-intensity focused ultrasound ablation in patients with hepatocellular carcinoma

Tan To Cheung  1 , Ferdinand S K Chu, Caroline R Jenkins, Dickson S F Tsang, Kenneth S H Chok, Albert C Y Chan, Thomas C C Yau, See Ching Chan, Ronnie T P Poon, Chung Mau Lo, Sheung Tat Fan
Affiliations

Tolerance of high-intensity focused ultrasound ablation in patients with hepatocellular carcinoma

Tan To Cheung et al. World J Surg. 2012 Oct.

Abstract

Background: High-intensity focused ultrasound (HIFU) ablation is a relatively new, noninvasive way of ablation for treating hepatocellular carcinoma (HCC). Emerging evidence has shown that it is effective for the treatment of HCC, even in patients with poor liver function. There is currently no data on the safety limit of HIFU ablation in patients with cirrhosis. However, this information is vital for the selection of appropriate patients for the procedure. We analyzed HCC patients who had undergone HIFU ablation and determined the lower limit of liver function and other patient factors with which HCC patients can tolerate this treatment modality.

Methods: Preoperative variables of 100 patients who underwent HIFU ablation for HCC were analyzed to identify the risk factors in HIFU intolerance in terms of stress-induced complications. Factors that may contribute to postablation complications were compared.

Results: Thirteen (13 %) patients developed a total of 18 complications. Morbidity was mainly due to skin and subcutaneous tissue injuries (n = 9). Five patients had first-degree skin burn, one had second-degree skin burn, and three had third-degree skin burn. Four complications were grade 3a in the Clavien classification and 14 were below this grade. Univariate analysis showed that age (p = 0.022) was the only independent factor in HIFU intolerance.

Conclusions: HIFU ablation is generally well tolerated in HCC patients with cirrhosis. It is safe for Child-Pugh A and B patients and selected Child-Pugh C patients. With this new modality, HCC patients who were deemed unsalvageable by other surgical means in the past because of simultaneous Child-Pugh B or C disease now have a new hope.

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Figures

Fig. 1
Fig. 1
After general anesthesia, patient on the platform was put in the right lateral position. The transducer below the platform targeted the liver lesion through the rib spaces
Fig. 2
Fig. 2
a Computed tomography scan showing a hepatocellular carcinoma at the dome of liver. The liver is of Child-Pugh C cirrhosis with gross ascites. b Magnetic resonance imaging scan of the same patient 1 month after high-intensity focused ultrasound (HIFU) ablation. Complete ablation is noted in this scan. The patient’s liver functions did not deteriorate from their pre-HIFU status
See this image and copyright information in PMC

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