Significant Long-Term Survival After Radiofrequency Ablation of Unresectable Hepatocellular Carcinoma in Patients with Cirrhosis

Abstract

Treatment with RFA can produce significant long-term survival rates for cirrhotic patients with early-stage, unresectable HCC. RFA can be performed in these patients with relatively low complication rates. Confirmation of these results in randomized trials should be considered.

Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: A long-term cohort study

“…34 Although RFA provided excellent local tumor control, %1 out of 3 patients developed some type of nonlocal recurrence each year, leading to a cumulative proportion of recurrence of almost 80% at 5 years. This figure is entirely consistent with the recurrence rates reported for RFA, other percutaneous ablative therapies, [10][11][12][16][17][18]33 and surgical resection of HCCs 3.0 cm. [14][15][16] These findings demonstrate that, regardless of how the first nodules are treated, recurrence and progression are the rule for HCC.…”

“…[1][2][3] As in previous studies, 6,[10][11][12][16][17][18] RFA of the initial HCC nodules produced CRs in over 98% of the cases, with a local recurrence rate of about 15%, even if the technique used was not performed to obtain safety margins. The latter requires multiple electrode insertions and overlapping thermal lesions 28 that are difficult to create even for skilled operators.…”

“…In fact, RFA is consistently mortality-free, 6,10,11 and fewer than 1.0% of our procedures were associated with major complications. [10][11][12][16][17][18] These rates are slightly higher than those reported for percutaneous injection therapies, 5,33 but they are far lower than those observed after surgical resection. 34 Although RFA provided excellent local tumor control, %1 out of 3 patients developed some type of nonlocal recurrence each year, leading to a cumulative proportion of recurrence of almost 80% at 5 years.…”

“…3,4,[10][11][12] Local tumor control and survival are the parameters most widely used to assess the efficacy of surgical and nonsurgical treatments for HCC. [6][7][8][9][10][11][12][13][14][15][16] Data on local control are fairly easy to interpret: disease relapse at the treated tumor site is regarded as a treatment failure. Survival data are more difficult to interpret.…”

“…[10][11][12][13][14][15][16][17][18][19] New HCC nodules can often be permanently eliminated, but others almost invariably appear. [10][11][12][13][14][15][16][17][18][19] The impact of nonlocal recurrence on survival is enormous, but has received little or no attention in most treatment efficacy studies. The outcome of the initial treatment, the time to first recurrence, and the overall survival are usually well documented, but limited data are available on the characteristics of the first recurrence, how it was managed, and whether or not the treatment was successful.…”