Radiofrequency Ablation of Small Hepatocellular Carcinoma in Cirrhotic Patients Awaiting Liver Transplantation

Abstract

RFA is a safe and effective treatment of small HCC in cirrhotics awaiting OLT, although tumor size (>3 cm) and time from treatment (>1 year) predict a high risk of tumor persistence in the targeted nodule. RFA should not be considered an independent therapy for HCC.

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

“…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.…”

Actual therapeutic efficacy of pre-transplant treatment on hepatocellular carcinoma and its impact on survival after salvage living donor liver transplantation

“…Therefore, the effect of pre-LT therapy on HCC and the outcome of LT for HCC, especially within the Milan criteria, have been reported with mixed results. [8][9][10][11][12][13][14][15] EGUCHI et al…”

Bridge Treatments for HCC in the Waiting List for Liver Transplantation

“…These studies show that complete tumor necrosis (evaluated on the explanted liver) may be achieved in 47-75% of the cases with a mean value of 58% [25][26][27][28][29]. A clear different effectiveness can be demonstrated analysing tumors of different size.…”

“…However, only two studies provided data about the effectiveness of RFA in avoiding patients' drop out from LT waiting list due to tumor progression. The rate has been found to be 0% in one study [25] and 12% in another one [26].…”