Surgical Resection Versus Percutaneous Radiofrequency Ablation in the Treatment of Hepatocellular Carcinoma on Cirrhotic Liver

Vivarelli, Marco; Guglielmi, Alfredo; Ruzzenente, Andrea; Cucchetti, Alessandro; Bellusci, R; Cordiano, Claudio; Cavallari, Antonino

doi:10.1097/01.sla.0000129672.51886.44

Cited by 240 publications

(192 citation statements)

References 20 publications

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“…The local tumor progression rate following RFA combined with chemoembolization (combination therapy) was lower than the rates in previous studies that used RFA alone (10)(11)(12). Despite good control of treated lesions, new tumors frequently occur, resulting in high distant recurrence rates (4,6).…”

Section: Introductionmentioning

confidence: 85%

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

Beppu

Sugimoto²,

Shiraki³

et al. 2010

Int J Mol Med

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Abstract. The aim of this study was to elucidate the importance of three tumor markers, ·-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3), and des-Á-carboxy prothrombin (DCP), for detecting and predicting the recurrence of hepatocellular carcinomas (HCCs). A total of 108 patients with initial non-advanced HCC who underwent curative radiofrequency ablation (RFA) in our hospital were enrolled in this study. The effectiveness of the three tumor markers for detecting recurrence and recurrence-free survival was analyzed. Positivity of these three makers was not markedly increased at the first or second recurrence. In addition, there was no significant correlation between the initial and recurrent levels of each tumor marker. The tumor marker that was positive at the time of initial HCC was not necessarily positive at recurrence. The tumor marker levels at recurrence were not correlated with pre-ablation levels. No significant correlation was found in the tumor marker values between pre-ablation and the time of recurrence. On multivariate analysis, high AFP-L3 levels (≥10%) were significantly predictive of recurrence-free survival. All three tumor markers should be routinely measured to detect recurrence during follow-up after RFA. Especially high AFP-L3 levels should be followed closely.

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Section: Introductionmentioning

confidence: 85%

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

Beppu

Sugimoto²,

Shiraki³

et al. 2010

Int J Mol Med

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“…have provided additional local-regional treatment options for patients who are not suitable surgical candidates (13,14). However these therapies are not adequate for patients with advanced HCC.…”

Section: Efficacy Of Retronectin-activated Cytokine-induced Killer Cementioning

confidence: 99%

Efficacy of RetroNectin-activated cytokine-induced killer cell therapy in the treatment of advanced hepatocelluar carcinoma

Wang

Kellner

et al. 2016

Oncology Letters

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Abstract. The present study aimed to investigate the efficacy of RetroNectin-activated cytokine-induced killer cell (R-CIK) therapy in advanced hepatocellular carcinoma patients as compared with conventional chemotherapy, a comparison that has not yet been thoroughly studied. From January 2010 to October 2013, 74 patients with an initial diagnosis of advanced hepatocelluar carcinoma were enrolled in the study. Patients were assigned to one of two treatment arms: patients in arm 1 (n=37) received R-CIK treatment as the first line therapy, whereas those in arm 2 (n=37) received chemotherapy as the first line treatment. The primary end point measured in this study was median overall survival (mOS). Median progression-free survival time (mPFS) and 1-and 2-year survival rates were recorded as secondary end points. Kaplan-Meier analysis was performed on all mOS and mPFS data, and treatment hazard ratios were established using the Cox proportional hazards model. The 1-year survival rate in treatment arm 1 was 42.47% vs. 24.89% in arm 2 (95% CI, 24.91-59.01% vs. 12.10-40.02%, P=0.066); the 2-year survival rates were 21.24 and 5.53% (95% CI, 4.60-45.86 vs. 0.46-21.06%, P= 0.106) in arms 1 and 2, respectively; the mPFS in arm 1 was 4.37 vs. 3.90 (x 2 = 0.182, P=0.670) in arm 2; and the mOS in arm 1 was 14.03 months vs. 9.46 months(x 2 =4.406, P=0.036) in arm 2. Calculations of univariate analyses of arm 1, R-CIK cycles ≥6, KPS >70, AFP ≤400 ng/ml, and findings of no vascular invasion and no extra-hepatic metastasis were potential predictive factors (P<0.05). Calculations from multivariate analyses similarly identified these factors as potentially having predictive value (P<0.05). The main adverse effects of R-CIK therapy included fever and headache pain. R-CIK treatment may prolong mOS in advanced hepatocellular carcinoma patients compared with conventional chemotherapy. Patients who underwent ≥6 cycles of R-CIK, had KPS scores >70, AFP ≤400 ng/ml, displayed no evidence of vascular invasion, and no extra-hepatic metastasis appeared to have longer survival times compared with other cohorts in the present study.

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“…The therapeutic efficacy reported by these comparative studies of RFA and surgical resection are summarized in Table 2. [37][38][39][40][41][42] Direct comparison by a well designed randomized controlled trial is the only way to assess whether RFA might replace surgical resection for treating early stage, resectable HCC. The difference in survival between the two treatments appears to be fairly small based on the currently available data.…”

Section: Promising Long-term Survival Gainmentioning

confidence: 99%

Radiofrequency Ablation of Hepatocellular Carcinoma: Pros and Cons

Rhim

Lim

2010

Gut Liver

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Among locoregional treatments for hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) has been accepted as the most popular alternative to curative transplantation or resection, and it shows an excellent local tumor control rate and acceptable morbidity. The benefits of RFA have been universally validated by the practice guidelines of international societies of hepatology. The main advantages of RFA include 1) it is minimally invasive with acceptable morbidity, 2) it enables excellent local tumor control, 3) it has promising long-term survival, and 4) it is a multimodal approach. Based on these pros, RFA will play an important role in managing the patient with early HCC (smaller than 3 cm with fewer than four tumors). The main limitations of current RFA technology in hepatic ablation include 1) limitation of ablation volume, 2) technically infeasible in some tumors due to conspicuity and dangerous location, and 3) the heat-sink effect. Many technical approaches have been introduced to overcome those limitations, including a novel guiding modality, use of artificial fluid or air, and combined treatment strategies. RFA will continue to play a role as a representative ablative modality in the management of HCC, even in the era of targeted agents. (Gut Liver 2010;4(Suppl. 1):S113-118)

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Surgical Resection Versus Percutaneous Radiofrequency Ablation in the Treatment of Hepatocellular Carcinoma on Cirrhotic Liver

Abstract: RFA has still to be confirmed as an alternative to surgery for potentially-resectable HCCs.

Cited by 240 publications

References 20 publications

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

Efficacy of RetroNectin-activated cytokine-induced killer cell therapy in the treatment of advanced hepatocelluar carcinoma

Radiofrequency Ablation of Hepatocellular Carcinoma: Pros and Cons

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