Masayuki Wakabayashi

Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma

Background. The authors have used percutaneous microwave coagulation therapy (PMCT) as a new percutaneous local treatment for single unresectable hepatocellular carcinoma (HCC) measuring 2 cm or less in greatest dimension (small HCC). PMCT was used to attempt a cure of the disease. In this study, the efficacy of this treatment was assessed.

Percutaneous microwave coagulation therapy for patients with small hepatocellular carcinoma

The authors compared the efficacy of percutaneous microwave coagulation therapy (PMCT) and percutaneous ethanol injection therapy (PEIT) in the treatment of patients with cirrhosis and a solitary nodular hepatocellular carcinoma (HCC) ≤ 2 cm in greatest dimension.

Percutaneous microwave coagulation therapy for solitary metastatic liver tumors from colorectal cancer: a pilot clinical study

Objective:Percutaneous microwave coagulation therapy (PMCT) was performed for metachronous small solitary liver tumors measuring ≤3.0 cm in diameter that had metastasized from colorectal cancer. PMCT was used for local control of the lesions, and the efficacy of this treatment was assessed.Methods:In 15 patients, a microwave electrode (specially designed for this purpose, 25 cm long and 2.0 mm thick) was inserted percutaneously into the tumor area under ultrasonic guidance. Microwaves at 80 watts were used to irradiate the tumor and the surrounding area.Results:Thirteen of the 15 metastatic tumors were radically ablated by 3–10 applications of microwave irradiation. Although the follow-up period was short (9–37 months), 10 patients survived. No recurrence has been detected in the treated area (except two foci where PMCT was insufficient), and no serious side effects or complications were encountered during or after the PMCT. In four of the five nonsurviving patients, death was due to metastases to the bone, brain, lung, or other areas of the liver despite complete local tumor control by PMCT.Conclusion:PMCT is a safe and effective treatment for metachronous small liver tumors that have metastasized from colorectal cancer.

Percutaneous transhepatic microwave coagulation therapy for hepatocellular carcinoma proliferating in the bile duct.

Hepatocellular carcinoma (HCC) often invades the portal system or hepatic veins. Along with recent increases in the incidence of HCC, there have been several reports of HCC proliferating in the bile duct and causing obstructive jaundice (1-4). Since radical hepatectomy is rarely possible in these cases, conservative therapy is the sole therapeutic modality. Transcatheter arterial embolization (TAE) is reported to be effective in some cases, but the number of studies is limited and the efficacy of the procedure has not been established (5-7). Surgical treatment was not possible and TAE we found to be ineffective in the present case of HCC proliferating in the bile duct. We applied percutaneous ethanol injection therapy (PEIT) (8, 9), percu taneous t ranshepat ic microwave coagulat ion therapy (PTMCT), and radiotherapy, and the combination produced satisfactory clinical results. To our knowledge, this is the first reported case in which local treatment was successfully applied to HCC that had infiltrated the bile duct.

Lewis Y antigen expression in hepatocellular carcinoma. An immunohistochemical study.

Background. The altered expression of the Lewis blood group‐related antigens during malignant transformation can be used clinically as a tumor marker or as a prognostic indicator. The Lewis Y (LeY) antigen, which is one of the Type 2 human blood group‐related antigens, also is thought to behave as an oncodevelopmental cancer‐associated antigen. In this study, the authors examined the association between human LeY antigen expression and the clinicopathologic features of HCC, including its proliferative activity.

Hepatic infarction following percutaneous ethanol injection therapy for hepatocellular carcinoma

We report on two patients who developed hepatic infarction after undergoing percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma (HCC). In both cases, liver function parameters deteriorated immediately after the ethanol injection, and enhanced computed tomography images showed a wedge-shaped avascular low-density area due to hepatic infarction. In one patient, PEIT was performed for a nodule treated with transcatheter arterial infusion (TAI) using a suspension of styrene maleic acid neocarzinostatin (SMANCS) 4 weeks before. In the other patient, TAI with SMANCS had been carried out 14 months previously for a different nodule in the same segment where the nodule treated with PEIT was located. When PEIT is used for patients with HCC who have previously undergone TAI, especially with SMANCS, PEIT may induce hepatic infarction.

Development of local necrosis and side-effects after hepatic injections of acetic acid solutions

Abstract Acetic acid injection therapy has recently been studied as a treatment for hepatocellular carcinoma. Since trials of this therapy have just begun, both basic and clinical studies of it are presently required. Therefore, the efficacy and safety of this therapy as a treatment for hepatocellular carcinoma were examined in rats. When acetic acid was injected into normal rat liver, the extent of necrosis at the site of injection expanded in a dose-dependent manner. At concentrations of 30% and above, acetic acid began to prove fatal, and mortality increased in a dose-dependent fashion. At a concentration of 45% and above, all rats died within 2 days after injection due to acute multi-organic circulatory failure. On histological examination, distinct thorombus formation was observed in the liver. We conclude that additional detailed examination of the effects of various amounts and concentrations of acetic acid and of the effects of acetic acid injection on other organs should be performed prior to clinical application of this therapy.

Usefulness of the high sensitivity PIVKA-II measurement method in diagnosis of hepatocellular carcinoma: A comparison with the conventional method

Abstract We investigated a new PIVKA-II assay kit (Eizai, ED-008) that incorporates the use of an improved secondary antibody compared with the conventional EIA method, and is highly sensitive to PIVKA-II (sensitivity: 0,0125 AU/ml). Using this new kit, we measured plasma PIVKA-II levels in 76 subjects in whom the conventional PIVKA-II assay was negative (≤ 0.0625 AU/ml). There were 30 patients with HCC, 14 patients with liver cirrhosis (six with α-fetoprotein ≥ 50 ng/ml), 11 patients with chronic active hepatitis C, 11 patients with chronic inactive hepatitis C, and ten healthy volunteers. The new assay kit detected PIVKA-II (≥ 0.0125 AU/ml) in 11 patients with HCC (36.7%), and one patient with liver cirrhosis (7.1%), but was negative in the patients with chronic active or inactive hepatitis C and the controls. Among the 11 HCC patients positive for PIVKA-II, the plasma α-fetoprotein level was greater than 100 ng/ml in two patients (18.2%), while it was above this level in three of the 19 patients negative for PIVKA-II. The mean size of the main tumor in the patients positive and negative for PIVKA-II was 2.16 + 0.87 cm and 2.62 + 1.50 cm, respectively, with no significant difference between the groups (P = 0.47). However, in seven patients positive for PIVKA-II, the tumor size was less than 2 cm. This assay also showed a high specificity for HCC (0.98). We concluded that this assay may allow PIVKA-II to be used as a more effective indicator of HCC.