Single hepatocellular carcinoma ranging from 3 to 5cm: radiofrequency ablation or resection?

Lupo, L.; Panzera, Piercarmine; Giannelli, Gianluigi; Memeo, M.; Gentile, A; Memeo, V.

doi:10.1080/13651820701713758

Cited by 82 publications

(44 citation statements)

References 35 publications

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“…5). Similar findings were also noted in other reports [12,13,14,15,16,17,18]. Based on these, resection is recommended for cases with 3 or fewer tumors 3 cm or smaller in which resection is readily applicable with regard to the liver function and localization, and only a small amount of liver tissue is sacrificed, but RFA is recommended for tumors located in a deep region, when the liver function capacity is graded as Child-Pugh B, or the tumor extends over the bilateral lobes.…”

Section: Outcomes and Survival Following Rfa: Comparison With Those Asupporting

confidence: 81%

Radiofrequency Ablation for Hepatocellular Carcinoma: Updated Review in 2010

Kudo

2010

Oncology

126

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Percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) was introduced in Japan in 1999. It has been established as a main local treatment method worldwide including Japan. On comparing outcomes between resection and RFA, they were comparable when cases were limited to those with 3 or fewer tumors 3 cm or smaller in many reports, based on which RFA has become the main treatment for small HCCs. The 5-year survival rate following RFA was as high as 57% in patients registered in the Liver Cancer Study Group of Japan, 73% when cases were limited to liver damage A (Child-Pugh A), and 83.8 and 76.3% in liver damage A (Child-Pugh A) cases with a single 2-cm or smaller and 2- to 5-cm liver tumor, respectively, showing outcomes equivalent to those of resection. The outcomes at our facility were also favorable: the 5-year survival rates of Child-Pugh A liver function HCC cases with 3 or fewer tumors 3 cm or smaller following RFA and resection were 84 and 78%, respectively. Various complications and limitations of RFA have previously been reported, but the advances of physicians’ skills and development of various techniques have reduced complications and expanded the indications for RAF. TACE-combined, artificial pleural effusion- and ascites-combined, and contrast-enhanced ultrasonography-guided RFAs are good examples. Adjuvant therapy, such as interferon and molecular targeted therapies following curative therapy, is expected to further improve survival after RFA.

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Section: Outcomes and Survival Following Rfa: Comparison With Those Asupporting

confidence: 81%

Radiofrequency Ablation for Hepatocellular Carcinoma: Updated Review in 2010

Kudo

2010

Oncology

126

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“…3-6,8,18 -20 Thus, in previous series, complete ablation rates for larger HCCs (3-5 cm) after RFA seem unfavorable, ranging from 61.3% to 82.5%. 21,22 Although these results are presumably outdated thanks to recent technical progress, 23 some authors suggested that RFA could be considered as an effective first-line treatment only for very small HCC (Յ2 cm). 12 Thus, to improve local tumor control for larger nodules, the combination of RFA with TACE is increasingly advocated.…”

mentioning

confidence: 99%

Radiofrequency ablation of hepatocellular carcinoma: Long-term results and prognostic factors in 235 Western patients with cirrhosis

N’Kontchou¹,

Mahamoudi²,

Aout³

et al. 2009

Hepatology

412

303

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For the treatment of small hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is in some centers considered a first-line therapeutic option. However, such a strategy is still under debate with regard to tumor and patient characteristics. In this single-center study we assessed the 5-year survival and prognosis factors in 235 consecutive patients with cirrhosis (Child-Pugh A/B: 205/30) who received RFA as first-line treatment for up to three HCC <5 cm (307 tumors; mean diameter: 29 ؎ 10 mm; 53 multinodular forms). Among these patients, 67 satisfied the criteria for resection according to the Barcelona Clinic Liver Cancer. Complete ablation was obtained in 222 patients (94%). Overall, 337 RFA sessions were performed including iterative RFA for recurrence. Major complications occurred in three patients (0.9%), including one treatmentrelated death. After 27 ؎ 20 months of mean follow-up, local or distant, or both, tumor recurrence occurred in 16, 88, and 11 patients, respectively. Twenty-nine patients underwent transplantation and were removed from the study at this point. Overall 5-year, recurrence-free, and tumor-free (including results of iterative RFA) survival rates were, respectively, 40%, 17%, and 32%. The overall 5-year survival rate was 76% for operable patients. Factors associated with overall survival were prothrombin activity (hazard ratio [HR] ‫؍‬ 0.97, 0.96-0.98; P < 0.0001) and serum levels of ␣-fetoprotein (AFP) (HR ‫؍‬ 1.02, 1.02-1.02; P < 0.0001), and factors associated with tumor recurrence were multinodular forms (HR ‫؍‬ 2.34; 1.52-3.6; P ‫؍‬ 0.0001) and serum AFP levels (HR ‫؍‬ 1.015, 1.014-1.016; P ‫؍‬ 0.015). Tumor size was associated with local recurrence but not with overall and tumor-free survival. Conclusion: RFA is a safe and effective first-line treatment of HCC up to 5 cm in diameter, especially for patients with a single tumor, a low serum AFP level, and well-preserved liver function.

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“…Studies comparing the efficacy of surgery and local ablative therapies in small and medium-sized HCCs have clearly demonstrated that a wellperformed local ablation yields similar survival rates and less morbidity compared to surgery (14)(15)(16). Therefore, it is generally recognized that RFA can be used as the first-line treatment for HCC ≤5 cm.…”

Section: Discussionmentioning

confidence: 99%

Solitary huge hepatocellular carcinomas 10 cm or larger may be completely ablated by repeated radiofrequency ablation combined with chemoembolization: Initial experience with 9 patients

et al. 2011

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Abstract. The treatment of solitary huge hepatocellular carcinoma (SHHCC) larger than 10 cm remains a challenge. The aim of the present study was to assess the therapeutic effects of repeated radiofrequency ablation (RFA) combined with chemoembolization on SHHCC. This was a retrospective study based on data obtained from a prospectively collected database that included 9 SHHCC patients who underwent repeated RFA combined with chemoembolization between July 2008 and June 2011. A new management strategy for SHHCC was described. The mean tumor size of the patients was 11.5±1.0 cm. No technical failure occurred, no patient succumbed to the disease during this treatment and the median survival of all 9 patients was 34 months. Treatment of the 9 tumors required a mean of 8.2±1.5 sessions. The mean of RF applications per session was 5.3±0.9 and the mean time of one session was 165±30 min, including a mean time of RF application of 113±19 min. The SHHCCs were found to be completely ablated. The mean number of RFA for primary complete ablation was 7.0±0.9 sessions, and the mean time for primary complete ablation was 5.3±1.1 months. The overall survival rate was 100%. There were 4 actual 2-year survivors. Our data reveal that tactically and strategically performed RFA should be recommended to SHHCC patients who are not suitable or do not agree to surgery, with satisfactory efficacy and safety.

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Single hepatocellular carcinoma ranging from 3 to 5cm: radiofrequency ablation or resection?

Abstract: Even if RES seemed to promise better long-term results, in the medium term this difference had no statistical significance. Survival in this series was more closely related to the stage of the underlying liver disease than to treatment (RES/RFA).

Cited by 82 publications

References 35 publications

Radiofrequency Ablation for Hepatocellular Carcinoma: Updated Review in 2010

Radiofrequency Ablation for Hepatocellular Carcinoma: Updated Review in 2010

Radiofrequency ablation of hepatocellular carcinoma: Long-term results and prognostic factors in 235 Western patients with cirrhosis

Solitary huge hepatocellular carcinomas 10 cm or larger may be completely ablated by repeated radiofrequency ablation combined with chemoembolization: Initial experience with 9 patients

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