Radio-Frequency Ablation (RFA); systemic chemotherapy, DC-CIK celluar therapy, traditional Chinese medicine (TCM)
Mr. Guido Rico Agreda, a 73 years-old male who was recently admitted to Beijing Puhua International Hospital for cancer treatment. Previously he underwent a right semi-colectomy (18NOV2006) and pathology examination after the diagnosis of moderately-differentiated adenocarcinoma of the colon with positive lymph node involvement (+1/20), Dukes C.
Adjuvant chemotherapy (12 cycles of 5-FU and LV civ48hs) was performed following the surgery. Serial follow-up CT scans showed progressive enlargement of peritoneal lymph nodes (excised on 16MAY2012). Right nephrectomy was also performed due to tumor adhesion and infiltration. Pathology examination showed metastatic adenocarcinoma (K-RAS exon-12 mutation).
PET-CT (07SEP2015) was positive for multiple hepatic lesions (positive for FDG uptake, SUV max 5-6.8). The largest lesion measured 4.7*3.3cm.
The hepatic lesions were treated individually with radio-frequency ablation (RFA) on 21 & 29SEP2015)..
Operation Note (21SEP2015): CT scan with chassis rotation of 16 degrees to position the metastatic lesions of right liver. The puncture point was determined along sub-scapular line, at 11-12 intercostal space. Topical povidone iodine for disinfection, local anesthesia stratification with 2% lidocaine 5 ml. The multi-electrode was punctured through the skin, re-scanned to confirm ideal compliance with the designed puncture tract. Then, the needle was further advanced 15cm to reach the target lesion. The involved area was heated to 90 degrees Centigrade for 10 minutes. Another puncture point was located along posterior axillary line, at 11-12 intercostal space. Local anesthesia was established with 2% lidocaine, 5 ml. The multi-electrode was punctured through the skin and then re-scanned to confirm ideal placement. The needle was further advanced 17cm to reach the second target lesion. The involved area was heated to 90 degrees Centigrade for 10 minutes ablation time. Then, local injection with interleukin-2 1,000,000 IU, GM-CSF 150 ug. The needle electrode was pulled out. CT scan after the procedure showed a small amount of bleeding around the ablation area. There was no pneumothorax. Surgery went smoothly. Patient had no obvious discomfort and transferred back to the ward safely.
Operation Note (2015/9/29): CT scan with chassis rotation of 15 degrees to position the metastatic lesions at the superior liver. The puncture point was determined below the right costal arch. Topical povidone-iodine for disinfection, local anesthesia followed with 2% lidocaine 5 ml. The multi-electrode was punctured through the skin, re-scanned to confirm ideal placement. The needle was further advanced 12cm to reach the target lesion. The involved area was heated to 90 degrees centigrade for lasting 15 minutes. Reference made to the preoperative CT scan, showing uneven density in the posterior area below the treated lesion (PET-CT showed no FDG uptake) (malignancy could not be excluded). This area was also ablated by heating as above for 7 min. Then, local injection with interleukin-2 1,000,000 IU, GM-CSF 150 ug was instilled. The needle electrode was then pulled out. CT scan after the procedure showed no significant bleeding around the ablation area. There was no pneumothorax. Surgery went smoothly. Patient had no obvious discomfort and transferred back to the ward safely.
Patient tolerated the above procedure quite well, and without complications.
Following the above RFA treatment, he received systemic chemotherapy (capacitabine 825-1000mg/m2 Bid, D1-14). Over the admission, immunotherapy with Cytokine-induced killer cells (CIK cells) was administered 2 times, during which time, he also received acupuncture and Chinese herbal therapy (TCM) to enhance energy, decrease toxicity, and improve his general status.
After the above 3 weeks treatment, at the time of his discharge from BPIH, Mr. Agreda’s physical condition continued to show improvement. Furthermore, he had experienced no discomfort in the course of his treatment. After completing the above RFA treatments, 80% of tumor load experienced necrosis, which would be absorbed gradually. Thus, best response would be optimally observed ~1 month later by a repeat CT or PET-CT scan. The follow-up team at BPIH will continue to follow his care, while documenting further improvement.
Pre-operation: multiple Hepatic Lesions(Hypermetabolism,Second Targtet)
CT Scan After Rf Probe Reaching Second Target;
Mr. and Mrs. Agreda remain very satisfied with the cancer treatment and service at Beijing Puhua International Hospital, and he is pleased to share his treatment experiences with prospective patients.