Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: A safe and effective bridge to liver transplantation

Abstract

The incidence of hepatocellular carcinoma (HCC) is increasing in the United States. Although liver transplantation is an effective means of treating selected patients, pretransplantation tumor progression may preclude some patients from undergoing transplantation. The aim of this study is to determine the safety and efficacy of percutaneous radiofrequency thermal ablation (RFA) in 33 consecutive patients with nonresectable HCC and advanced cirrhosis. Mean subject age was 57.2 ± 10.6 years, mean Child‐Turcotte‐Pugh score was 7.0 ± 1.4, and mean maximal tumor diameter was 3.6 ± 1.1 cm. Using contrast‐enhanced computed tomography and magnetic resonance imaging, 22 patients (66%) had a complete radiological response at 3 months post‐RFA, whereas 11 patients (33%) had an incomplete radiological response. During follow‐up, 18 patients (54%) experienced tumor progression and 9 subjects underwent repeated ablation for either residual disease or tumor progression. The overall actuarial patient survival rate of the 33 patients was 58% at 2 years, whereas the transplantation‐free patient survival rate was 34% at 2 years. Fifteen of 23 transplant candidates were successfully bridged to liver transplantation after a mean post‐RFA follow‐up of 7.9 ± 6. 7 months. The extent of tumor necrosis in the explant varied, but no subjects had evidence of tumor seeding on post‐RFA imaging, at liver transplantation, or in the explant. The 3‐year actuarial posttransplantation patient survival rate was 85%. Two patients have developed posttransplantation recurrence, and both had microscopic vascular invasion in their explants. In summary, our data show that RFA is a safe and effective treatment modality for patients with advanced cirrhosis and nonresectable HCC. Although the ability of RFA to prevent or delay tumor progression requires further prospective study, its favorable safety profile and promising efficacy make it an attractive treatment option for liver transplant candidates with nonresectable HCC.

Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation

“…Explant-based evaluation of RFA found in the literature have been few, small in scale, and in disagreement regarding complete necrosis rates (ranging from 21% to 75%). 22,39,46 Most recently, a larger study of 50 explants showed 55% (63% for tumors Յ3 cm) complete response rate after RFA treatment prospectively limited to a single session. 26 Our result, obtained after multiple-session treatments as needed, is not inconsistent with this finding and, we believe, reflects a local efficacy that can be realistically expected with meticulous technique 47 and close posttreatment surveillance, both of which are crucial for optimizing outcome.…”

“…[13][14][15] Recently in the United States and abroad, however, RFA has emerged as the first-line treatment for small, nonresectable cases of HCC, such as those fulfilling transplant criteria, with TACE filling a secondary role or reserved for more extensive disease. [16][17][18][19][20][21] Therefore, a potentially beneficial role of RFA while awaiting OLT has been widely discussed, [22][23][24][25][26] although it remains unsubstantiated. The present study was undertaken to assess the efficacy of RFA as a bridge to liver transplantation.…”

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

“…Several investigators have reported that percutaneous RF ablation for patients with small HCC nodules provides favorable survival with excellent local control, 15,16 and it may also be used as a bridge to liver transplantation. 17,18 The RF current emitted from the electrode is converted into heat and necrotizes the tumor. Therapeutic efficacy is considered to be more predictable with RF ablation than with PEIT, as the latter depends on diffusion of liquid ethanol in tissue.…”

Radiofrequency ablation must be assessed by pathological methods

“…In our study, the detection of RFA incomplete response by means of computed tomography scan had a 50% sensitivity and 100% specificity. The reported rates of complete pathological response in other works were variable but lower than those reported by N' Kontchou et al: 20%,3 34.2%, 4 37.5%, 5 46.7%, 6 55%, 7 70.3%, 8 and 75%. 9 In these studies, as in ours, pathological examination was performed using hematoxylin-eosin stains.…”