Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?

Abstract

If liver transplantation is not feasible, partial resection is considered the treatment of choice for hepatocellular carcinoma (HCC) in patients with cirrhosis. However, in some centers the firstline treatment for small, single, operable HCC is now radiofrequency ablation (RFA). In the current study, 218 patients with single HCC < 2.0 cm (very early or T1 stage) underwent RFA. We assessed 2 primary end points that could be easily compared with those reported for resective surgery: (1) the rate of sustained, local, complete response and (2) the rate of treatment-related complications. The secondary end point was 5-year survival in the 100 patients whose tumors had been considered potentially operable. After a median follow-up of 31 months, sustained complete response was observed in 216 patients (97.2%). In the remaining 6, percutaneous ethanol injection, selective intraarterial chemoembolization, or resection were used as salvage therapy. Perioperative mortality, major complication, and 5-year survival rates were 0%, 1.8%, and 68.5%, respectively. Conclusion: Compared with resection, RFA is less invasive and associated with lower complication rate and lower costs. RFA is also just as effective for ensuring local control of stage T1 HCC, and it is associated with similar survival rates (as recently demonstrated by 2 randomized trials). These data indicate that RFA can be considered the treatment of choice for patients with single HCC < 2.0 cm, even when surgical resection is possible. Other approaches can be used as salvage therapy for the few cases in which RFA is unsuccessful or unfeasible. ( on the oncological assumption that resection is the more suitable option for obtaining the complete tumor ablation including a layer of tissue surrounding it. 2,3 The importance of the local complete response (in other words, the absence of residual neoplastic tissue at the site of the tumor) on the overall survival in patients with HCC had been proved not only for surgery but also for percutaneous ablation therapies (PATs). 4,5 PATs were originally reserved for HCCs that were, for one reason or another, unsuitable for resective surgery, but they are now proving their worth in small operable cases as well. 6,7 Radiofrequency ablation (RFA) is currently considered the most effective PAT, [8][9][10][11] and 2 recent randomized trials failed to reveal significant differences between the survival rates associated with resective surgery and RFA in patients with early HCC. 12,13 These considerations have led some centers to adopt RFA as first-line treatment for single HCC nodules less than 3.0 cm in diameter, [14][15][16][17] opening the debate over the best therapeutic option for these small tumors.To clarify this issue, we conducted a multicenter study that included a consecutive series of patients with single HCC 2.0 cm or less in diameter accompanying cirrhosis

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…An RCT demonstrated that the number of treatment sessions was fewer with RFA than with microwave coagulation [298], although the rates of complete therapeutic effect, major complications, and local tumor progression were not statistically different between the two therapies. In RFA, survival rates have been reported to be 39.9-68.5% at 5 years [299][300][301][302][303][304] and local tumor progression rates to be 2.4-16.9% [299][300][301]304]. Mortality and morbidity rates of RFA have been reported to be 0.9-7.9% and 0-1.5%, respectively [300][301][302][303][304][305].…”

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

“…RFA has recently gained wide acceptance worldwide, mainly due to its relatively low level of invasiveness, ease of use and effectiveness (9,10). The incidence of local tumor progression of HCC reportedly ranges between 0.9 and 31.3% (5,9,(11)(12)(13)(14)(15)(16)(17)(18). Local tumor recurrence may occur due to untreated satellite lesions, which are too small to detect on imaging prior to RFA (19).…”

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

“…[1][2][3] However, when HCC recurs and further treatment is no longer possible, liver transplantation (LT) may be considered as salvage LT. 4 There are drawbacks of pre-LT treatment for HCC during the waiting period. Dissemination 5 and implantation 6 may occur after puncture of HCC and they may form tumors after the administration of immunosuppressive drugs.…”