Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series

Abstract

The purpose of this study was to evaluate the long-term survival results and complications of percutaneous radiofrequency ablation (RFA) in patients with early-stage hepatocellular carcinoma (HCC). Between April 1999 and May 2005, 570 patients with 674 early-stage HCCs underwent percutaneous RFA as a first-line treatment option in a single institution. We evaluated the effectiveness rates, local tumor progression rates, survival rates, and complications. We also assessed the prognostic values of survival rates by using Cox proportional hazard models. The primary technique effectiveness rate was 96.7% (652 of 674). The cumulative rates of local tumor progression at 1, 2, and 3 years were 8.1%, 10.9%, and 11.8%, respectively. The cumulative survival rates at 1, 2, 3, 4, and 5 years were 95.2%, 82.9%, 69.5%, 60.8%, and 58.0%, respectively. Patients with Child-Pugh class A cirrhosis, of younger age (<or=58 years), or having lower AFP level (<or=100 microg/L) demonstrated better survival results (P < 0.05). A total of 11 major complications (1.9% per treatment) were found during the follow-up period. There was no procedure-related death. Percutaneous RFA can be used successfully as a first-line treatment modality for early-stage HCCs. Child-Pugh class, age, and AFP level before RFA were significant prognostic predictors of long-term survival.

Incidence of new foci of hepatocellular carcinoma after radiofrequency ablation: role of multidetector CT

“…segments VIII, VII and VI, no segments were spared. These findings are consistent with the literature, which indicates a high rate of intrahepatic HCC recurrence at sites other than that of the RFA, with percentages ranging from 40.6% to 53% [2,6,14,15]. In this respect, there is evidence that recurrence in a different hepatic segment, associated with the presence of distant metastases, has a significant negative influence on overall survival; hence, constant monitoring and aggressive treatment may be indicated in patients with intrahepatic recurrence in a different segment in order to optimise the benefits of RFA [6,7].…”

“…a At 18-month computed tomography after radiofrequency ablation, a roundish hyperattenuating mass of 2.1 cm is appreciable in segments VI-VII during the arterial phase (arrow); b during the portal-venous phase, the lesion shows a clearcut washout with a peripheral hyperattenuating rim (arrow). [2,6,14,15]. A tale proposito, vi è evidenza che la recidiva in un ditor found to correlated significantly with the development of new HCC nodules was proximity to the hepatic capsule (p<0.018) ( Table 5).…”

“…La termoablazione mediante radiofrequenza (RFTA) è sempre più frequentemente impiegata come trattamento percutaneo di scelta per quei pazienti affetti da epatocarcinoma (HCC) in stadio precoce, allorquando la resezione chirurgica o il trapianto di fegato sono opzioni non praticabili o non disponibili, garantendo un eccellente controllo locale di malattia a fronte di accettabili tassi di morbilità e mortalità [1][2][3]. Un'accurata valutazione della risposta terapeutica è di cruciale importanza, considerato che, mentre un trattamento completo migliora significativamente la sopravvivenza dei pazienti, l'identificazione di tessuto tumorale vitale pone, di norma, la precisa indicazione ad un nuovo trattamento [4].…”

“…Radiofrequency ablation (RFA) is increasingly being used as the percutaneous treatment of choice for patients with early-stage hepatocellular carcinoma (HCC) in whom surgical resection or liver transplantation are not feasible or available, as it guarantees excellent local control with acceptable morbidity and mortality rates [1][2][3]. An accurate assessment of response to treatment is essential considering that, although complete treatment significantly increases patient survival, evidence of viable tumour tissue typically represents a precise indication for repeated treatment [4].…”

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

“…RFA has recently gained wide acceptance worldwide, mainly due to its relatively low level of invasiveness, ease of use and effectiveness (9,10). The incidence of local tumor progression of HCC reportedly ranges between 0.9 and 31.3% (5,9,(11)(12)(13)(14)(15)(16)(17)(18). Local tumor recurrence may occur due to untreated satellite lesions, which are too small to detect on imaging prior to RFA (19).…”