• Home
  • RISORSE
  • Casi clinici e letteratura scientifica

Hepatocellular carcinoma tumor thrombus entering the inferior vena cava treated with percutaneous RF ablation: a case report.

Gatti P1, Giorgio A2, Ciracì E1, Roberto I1, Anglani A3, Sergio S4, Rizzello F5, Giorgio V6, Semeraro S7.

Author information:
1. Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy.
2. Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy.
3. Radiodiagnostic Unit, Ostuni Hospital, Ostuni, BR, Italy.
4. Interventional Radiology Unit, Perrino Hospital, Brindisi, Italy.
5. Anesthesiology and Reanimation Unit, Ostuni Hospital, Ostuni, BR, Italy.
6. Pediatric Gastroenterology Unit, Policlinico Gemelli, Sacred Heart University, Rome, Italy. 7. Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy. Questo indirizzo email è protetto dagli spambots. È necessario abilitare JavaScript per vederlo..

Abstract

PURPOSE:

Hepatocellular carcinoma (HCC) is the most common form of liver cancer. In advanced cancer stages (metastatic disease and/or vascular invasion), the generally accepted standard of care is systemic therapy using sorafenib as first-line treatment and, recently, regorafenib and nivolumab as second-line treatment, but the quality of life and the prognosis of patients remain very poor. Our paper reports a case of US-guided radiofrequency ablation (RFA) of both intraparenchymal HCC and inferior vena cava tumor thrombus.

METHODS:

We treated a patient with HCC associated with tumor thrombus extending into vena cava after failure of sorafenib therapy using US-guided radiofrequency ablation (RFA).

RESULTS:

A good radiological and clinical response was observed in association with excellent tolerability. The patient has been followed up for 15 months from the ablation, is alive, and is in a good clinical condition without evidence of tumor recurrence.

CONCLUSION:

This is the first case in which this minimally invasive percutaneous procedure has been successfully used to treat an HCC thrombus entering the vena cava.
PMID: 30864004

Ultrasound-guided percutaneous irreversible electroporation of hepatic and abdominal tumors not eligible for surgery or thermal ablation: a western report on safety and efficacy.

Giorgio A1, Amendola F2, Calvanese A3, Ingenito E3, Santoro B4, Gatti P5, Ciracì E5, Matteucci P6, Giorgio V7.

Author information:
1. Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy. Questo indirizzo email è protetto dagli spambots. È necessario abilitare JavaScript per vederlo..
2. Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
3. Oncology Unit, Tortorella Clinical Institute, Salerno, Italy.
4. Interventional Ultrasound Unit, Athena Clinical Institute, Caserta, Italy.
5. Internal Medicine Unit, Ostuni Hospital, Ostuni (BR), Italy.
6. Radiation Therapy Unit, Campus Biomedico University, Rome, Italy.
7. Pediatric Gastroenterology Unit, Fondazione Policlinico A.Gemelli IRCCS, Department of Woman and Child Health and Public Health; Roma- Italy, Rome, Italy.

Abstract

PURPOSE:

To report our first results on sixteen patients affected by liver and abdominal malignant tumors, unfit for surgery or thermal ablation, treated with US-guided percutaneous irreversible electroporation (IRE).

METHODS:

From June 2014 to December 2016, all patients meeting the inclusion criteria (malignant hepatic or abdominal tumors not eligible for resection or thermal ablation) and not meeting the exclusion criteria (heart arrhythmia, pro-hemorrhagic hematological alterations, tumor size > 8 cm, presence of a biliary metallic stent) referred to our institutions were prospectively enrolled to undergo percutaneous US- guided irreversible electroporation (IRE). Sixteen patients (age range 59-68 years, mean 63; 7 females) with 18 tumors (diameter range 1.3-7.5 cm) fulfilled the inclusion criteria and were included in the study. Data concerning efficacy (tested by a 1-week CEUS and a 4-week enhanced CT and/or enhanced MRI) and safety were recorded during a 18-month follow up.

RESULTS:

All patients completed a 35-50-min procedure without complications. One patient with 6 cm Klatskin tumor also underwent a second session for 1 month. A 1-week CEUS and a 4-week e-CT and/or e-MRI arterial phase contrast enhancement analysis showed an overall reduction of arterial flow with confirmation of unenhanced lesions for seven nodules. After 1-18 months of follow up, no major

complications were recorded and no tumor-related death occurred. The lesions of two patients disappeared 3 and 6 months after their treatment, respectively.

CONCLUSIONS:

IRE is a promising ablation modality in the treatment of malignant hepatic and abdominal tumors unsuitable for resection or thermal ablation.
PMID: 30843171

ABLATIVE THERAPIES FOR INTRAHEPATIC CHOLANGIOCARCINOMA 

Antonio Giorgio1, Pietro Gatti2, Paolo Matteucci3, Valentina Giorgio4

1 Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy; 2Internal Medicine Division, Ostuni Hospital, Ostuni BR, Italy;3Radiation Oncology Institute, Campus Biomedico University, Rome, Italy; 4Pediatric Gastroenterology Unit, Sacred Heart University, Policlinico Gemelli, Rome, Italy

Leggi tutto

RASSEGNA DEI LAVORI SCIENTIFICI DI Franco Brunello, Eugenio Caturelli e Antonio Giorgio

11/10/2014

1. Eugenio Caturelli, Giannini E.G., et alii (Italian Liver Cancer [ITA.LI.CA] group):Alpha-Fetoprotein Has No Prognostic Role in Small Hepatocellular Carcinoma Identified During Surveillance in Compensated Cirrhosis.  Hepatology. 2012 Oct;56(4):1371-9. doi: 10.1002/hep.25814. SCARICA IL FILE

2.Eugenio Caturelli, Giannini E.G., et alii (Italian Liver Cancer [ITA.LI.CA] group):  Ten-Year Outcome of Radiofrequency Thermal Ablation for Hepatocellular Carcinoma: An Italian ExperienceLetter to editor.Am J Gastroenterol. 2012 Oct;107(10):1588-9; author reply 1590. doi: 10.1038/ajg.2012.250.

3. Eugenio Caturelli, Giannini E.G., et alii (Italian Liver Cancer [ITA.LI.CA] group): Determinants of Alpha-Fetoprotein Levels in Patients With Hepatocellular Carcinoma Cancer. 2014 Jul 15;120(14):2150-7. doi: 10.1002/cncr.28706. Epub 2014 Apr 10. ABSTRACT

Leggi tutto

Radio Frequenza Cisti Idatidea del Fegato

Terapia percutanea ecoguidata mediante ablazione con Radio Frequenza della cisti idatidea del fegato/ esterno_parte 1

Terapia percutanea ecoguidata mediante ablazione con Radio Frequenza della cisti idatidea del fegato/ esterno_parte 2

Terapia percutanea ecoguidata mediante ablazione con Radio Frequenza della cisti idatidea del fegato/ interno_parte 3

Commento al video trattamento cisti idatidea

Il trattamento percutaneo ecoguidato delle cisti da echinococco del fegato rappresenta la più avanzata ed efficace modalità terapeutica di tale patologia. L'indicazione principale consiste nel  trattamento di cisti idatidee precedentemente trattate, senza successo, con PAIR o D-PAI  (A Giorgio et al, J Hepatol , suppl ,2009 ). Il video mostra l'introduzione di un ago-elettrodo con 9 uncini all'interno della cavità cistica, dopo aver aspirato con un catetere il liquido idatideo. Dall'ago elettrodo (2 mm di diametro ) fuoriescono gli uncini che aderiscono alla parete interna della cisti. L’accensione del generatore di radiofrequenza fa sì che gli uncini adesi distruggano la membrana proligera mediante lo sviluppo di calore. Il trattamento di fatto è del tutto simile a quello dell' HCC.

Commento al video RF del trombo neoplastico della vena

Il video presenta l'esecuzione della cosiddetta "trombectomia percutanea ecoguidata mediante radiofrequenza" del trombo neoplastico della vena porta da invasione di HCC su cirrosi (AJR , Giorgio et al ,2009 - vedi sezione lavori scientifici del sito SIEMC ). Si tratta dell'estensione massima dell'ecointerventistica nel trattamento dell'HCC avanzato. 
Nel video viene mostrata l'esecuzione di tale procedura: dapprima avviene l'inserzione dell'ago elettrodo nella parte prossimale del tronco portale principale completamente trombizzato, poi con l'inizio della procedura la vena porta diventa iperecogena. 
Successivamente senza che venga ritirato dal fegato, l'ago - elettrodo viene deviato nella parte distale del tronco portale principale. Si giunge così alla fine della procedura per cui tutta la vena porta diventa iperecogena.