Treatment of hepatocellular carcinoma in compensated cirrhosis with radio-frequency thermal ablation (RFTA): a prospective study

Cammà, Calogero; Marco, Vito Di; Orlando, Ambrogio; Sandonato, Luigi; Casaril, Andrea; Parisi, P.; Alizzi, Silvia; Sciarrino, Elio; Virdone, Roberto; Pardo, Salvatore; Bona, Danilo Di; Licata, Anna; Latteri, Federica; Cabibbo, Giuseppe; Montalto, Giuseppe; Latteri, M; Nicoli, N; Craxı̀, Antonio

doi:10.1016/j.jhep.2004.11.042

Cited by 104 publications

(75 citation statements)

References 15 publications

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“…A low mortality rate after RFA was reported, ranging from 0% to 2.9%. 5,7,20,21,23,27,34,35 The mortality rate related to surgical resection was 3.1%, which is comparable to other studies (0%-15%). [36][37][38][39] These results demonstrate that RFA combined with TACE is safe.…”

Section: Discussionsupporting

confidence: 83%

“…5,[20][21][22][23][24][25][26][27] Surprisingly, a histological study in patients who underwent liver transplantation after an RFA procedure revealed residual tumor tissue in 37% and 71% of patients with HCC 3 cm and HCC >3 cm, respectively. 28 The combination with TACE is expected to reduce such microscopic local tumor progression.…”

Section: Discussionmentioning

confidence: 99%

“…33 The major complication rate after RFA was 1.5%, which is comparable to the rates in other studies (1.9%-16%). 5,7,20,21,23,27,34,35 RFA-related death was observed in 1 (0.8%) patient. A low mortality rate after RFA was reported, ranging from 0% to 2.9%.…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

Kagawa

Koizumi

Kojima

et al. 2010

Cancer

104

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the Tokai RFA Study Group BACKGROUND: Radiofrequency ablation (RFA) is becoming a well-known local therapy for hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) is expected to enhance the effects of subsequent RFA by reducing arterial blood flow. However, the long-term efficacy of this combined therapy has not been elucidated. In this study, the survival rates of patients who received TACE combined with RFA (TACE þ RFA) were compared with those of patients treated surgically. METHODS: The study included consecutive patients who received TACE þ RFA or surgical resection as the initial curative treatment for HCC between 2000 and 2005 at Tokai University Hospital. Inclusion criteria were a single HCC 50 mm or up to 3 HCCs 30 mm, presence of cirrhosis classified as Child-Pugh class A, no vascular invasion, and no extrahepatic metastasis. RESULTS: Sixty-two patients (23 women, 39 men; aged 67.5 AE 8.4 years [mean AE standard deviation]) received TACE þ RFA, and 55 patients (15 women, 40 men; aged 66.1 AE 8.4 years) underwent surgical resection. Median follow-up periods were similar (50 months in the TACE þ RFA group vs 49 months in the resection group). The probabilities of overall survival at 1, 3, and 5 years in the TACE þ RFA group (100%, 94.8%, and 64.6%, respectively) were similar (P ¼ .788) to those in the resection group (92.5%, 82.7%, and 76.9%, respectively). Two major RFA-related complications were observed (1.5%). CONCLUSIONS: RFA combined with TACE is an efficient and safe treatment that provides overall survival rates similar to those achieved with surgical resection. Cancer 2010;116;3638-44.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

Kagawa

Koizumi

Kojima

et al. 2010

Cancer

104

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“…The reported 3-year survival rate averaged above 60% and the 5-year overall survival rate ranged from 18% to 51.6%. [35][36][37] Liang et al 38 found similar overall survival after percutaneous RFA and repeat partial hepatectomy for recurrent HCC in comparable patients within Milan. Further, RFA was less invasive and less morbid.…”

Section: Radiofrequency Ablationmentioning

confidence: 92%

Treatment Algorithms for Managing Hepatocellular Carcinoma

Saraswat

Pandey

Shetty

2014

Journal of Clinical and Experimental Hepatology

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Early diagnosis and aggressive therapy improves outcome in hepatocellular carcinoma (HCC). Several potentially curative as well as palliative treatment options are available for patients. The choice of therapy is influenced by factors such as extent of tumor and severity of underlying liver dysfunction as well as availability of resources and of expertise. A systematic, algorithmic approach would ensure optimal therapy for each patient and is likely to improve outcomes. Even after receiving therapy for HCC, patients remain at risk for recurrent HCC as well as progression of underlying cirrhosis. Proper assessment and monitoring is needed for the underlying liver disease, which may progress to liver failure and have a major impact on long-term survival. Comprehensive care for patients with cirrhosis includes interventions such as antiviral therapy for HBV and HCV, abstention from alcohol, management of fatty liver disease, endoscopic surveillance and treatment for complications of portal hypertension and, if indicated, immunization against HAV and HBV. An algorithmic approach is useful for choosing the most appropriate treatment option for the individual patient from among the various options that are available. The general consensus is that the BCLC system should be preferred for staging HCC as it is useful in predicting outcomes and planning treatment. The BCLC system classifies patients with HCC into five categories: very early, early, intermediate, advanced, and terminal. It incorporates data on tumor status (number and size of nodules, vascular invasion, extra-hepatic spread), liver function (CTP status, presence of portal hypertension) and overall health status (constitutional symptoms, cancer symptoms, performance status). Treatment allocation according to sub-class of patients is a merit of the BCLC system; a few limitations have been noted, particularly with respect to patients with BCLC stage B and C disease. The treatment algorithm as per BCLC system is summarized in this review. ( J CLIN EXP HEPATOL 2014;4:S80-S89)

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“…Cammà et al [39] who followed a large cohort (more than 200) of patients with small (<5 cm) HCC in compensated cirrhosis treated by radiofrequency thermal ablation (RFTA), reported that the 3-year recurrence rate of new lesions was 34%, quite similar to that of a previous study on percutaneous ethanol injection (PEI) (41%) of the same group [40], and also similar to that found in the study by Lencioni et al [41], in which the 2-year recurrence rate of patients treated by radiofrequency thermal ablation was 36%. Therefore, all these data underscore, from a practical point of view, the need for adjuvant therapy (tertiary prevention) in the effort to prolong survival and reduce recurrence rates.…”

Section: Tertiary Chemopreventionmentioning

confidence: 98%

Does chemotherapy prevent HCV-related hepatocellular carcinoma? Cons

Craxı̀¹,

Cammà²

2010

Digestive and Liver Disease

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The accuracy and the reliability of well-recognized clinical, virologic, histologic, and molecular risk factors for hepatocellular carcinoma (HCC) are still insufficient. Thus, accurate risk prediction of cancer development in individual patients with the aim of selecting high risk cohorts of patients for HCC chemoprevention programs remains an elusive goal. Future directions in chemoprevention of HCC will be in the development of molecular risk models and of new chemopreventive agents. Studies examining multiple genes and proteins (genomics and proteomics) in the same HCCs will be required to evaluate this possibility thoroughly. A strategy aiming at preventing chronic liver disease of any etiology (HCV and HBV infection, alcohol, obesity, others) may be required to prevent HCC in low and intermediate incidence areas, and hence, worldwide. In the setting of secondary chemoprevention, literature data pooling suggests a slight preventive effect of interferon (IFN) on HCC development in patients with HCV-related cirrhosis. The magnitude of this effect is low, and the observed benefit might be due to spurious associations. The preventive effect is limited to sustained virological responders to IFN. So, there is no sound evidence to support a recommendation for widespread use of IFN to prevent HCC in HCV-related cirrhosis. In the setting of tertiary chemoprevention, the risk of recurrence of HCC may be reduced by IFN treatment in selected patient populations. Further large-scale multicenter randomized controlled trials may prove useful to evaluate the benefit on overall survival.

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Treatment of hepatocellular carcinoma in compensated cirrhosis with radio-frequency thermal ablation (RFTA): a prospective study

Cited by 104 publications

References 15 publications

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

Treatment Algorithms for Managing Hepatocellular Carcinoma

Does chemotherapy prevent HCV-related hepatocellular carcinoma? Cons

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