Outcomes of radiofrequency ablation as first-line therapy for hepatocellular carcinoma less than 3 cm in potentially transplantable patients

Abstract

Background & Aim: Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC) 3cm. Disease recurrence is common, and in some patients will occur outside transplant criteria. We aimed to assess the incidence and risk factors for recurrence beyond Milan criteria (MC) in potentially transplantable patients treated with RFA as first-line therapy.Methods: We performed a retrospective cohort study of potentially transplantable patients with new diagnoses of unifocal HCC 3cm that underwent RFA as first-line therapy between 2000-2015. We defined potentially transplantable patients as those aged <70 years without any comorbidities that would preclude transplant surgery. Incidence of recurrence beyond MC was compared across two groups according to HCC diameter at the time of ablation: (HCC 2cm vs. HCC>2cm). Competing risks Cox regression was used to identify predictors of recurrence beyond MC. Results: We included 301 patients (167 134 HCC>2cm). Recurrence beyond MC respectively (p=0.01). The 1-, 3-and 5-years actuarial survival after RFA was 98.2%, 86.2% and (p=0.01). Tumor size >2cm [HR 1.94 (95%CI 1.25-3.02)] and alpha fetoprotein levels at the time of ablation [100-1000ng/mL: HR 2.05 (95%CI 1.10-3.83)] were found to be predictors of post-RFA recurrence outside MC. Conclusion: RFA for single HCC 3cm provides excellent short-to medium-term survival.However, we identified patients at higher risk of recurrence beyond MC. For these patients, liver transplantation should be considered right after the first HCC recurrence after RFA. HighlightsMost transplantable RFA will eventually develop recurrent HCC distant to the ablation site.Many transplantable patients treated with HCC will recur beyond the Milan criteria despite close post-RFA surveillance, losing the opportunity for cure.Transplantable patients with tumors >2cm and higher serum alpha fetoprotein have higher risk of recurrence beyond Milan criteria. Highlightswill eventually develop recurrent HCC distant to the ablation site.Many transplantable patients treated with HCC will recur beyond the Milan criteria despite close post-RFA surveillance, losing the opportunity for cure.Transplantable patients with tumors >2cm and higher serum alpha fetoprotein have higher risk of recurrence beyond Milan criteria.

Evaluation of a serum tumour marker‐based recurrence prediction model after radiofrequency ablation for hepatocellular carcinoma

“…International practice guidelines for HCC, including those from the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver (EASL) recommend RFA for the treatment of patients with small, early‐stage HCC . However, relatively frequent tumour recurrences after RFA compared to hepatic resection which could limit the therapeutic efficacy of RFA have been reported, and several studies have been conducted to analyse the risk factors and patterns of recurrence after RFA …”

Sub-Lethal Hyperthermia Enhances Anticancer Activity of Doxorubicin in Chronically Hypoxic HepG2 Cells Through ROS-Dependent Mechanism

“…Thermal ablation (predominantly radiofrequency ablation (RFA) and microwave ablation (MWA)), has shown excellent therapeutic e cacy in hepatocellular carcinoma and is a commonly used therapy following surgery and embolotherapy (transarterial chemoembolization/transarterial embolization, TACE/TAE) [3][4][5]. Considerable studies have shown that RFA can achieve complete necrosis in most lesions smaller than 3 cm in diameter [6,7]. However, for lesions more than 3 cm in diameter, especially for those over 5 cm, complete necrosis cannot be obtained in a minority of patients, even if the procedure is repeated.…”

Safety and efficacy of thermal ablation for subpleural lung cancers

“…Thermal ablation is a minimally invasive method and is widely used as an effective and safe therapy for liver cancer . It was recently shown as an appropriate alternative for patients with lung cancer who refuse surgery or who are at high risk of post‐thoracotomy morbidity .…”

“…Thermal ablation is a minimally invasive method and is widely used as an effective and safe therapy for liver cancer. 6 It was recently shown as an appropriate alternative for patients with lung cancer who refuse surgery or who are at high risk of post-thoracotomy morbidity. 7,8 Thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), has emerged as a promising treatment for unresectable lung cancer, in line with several recent studies on the ablation of lung cancers.…”