Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma

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

“…32,33 An important observation of our study is the fact that despite the tumor's size as a predictor of local recurrence, this parameter, whether considered as a continuous or discontinuous variable, and local recurrence itself, did not impact overall and tumor-free survival. Interestingly, similar results have been recently reported by Lam et al 4 The main explanations of these apparently paradoxical results are, first, that the local recurrence rate observed (11.5%) was quite low in comparison with results reported by earlier studies including medium-sized (Ͼ3-5 cm) HCCs, 22,34 presumably because RFA has improved technically 35 and technologically 23,36 over time; and second, that the majority of these local recurrences (59%) was sufficiently limited to be completely ab- lated by iterative RFA, highlighting the benefit of careful posttreatment follow-up to allow additional procedure as soon as possible. Converse to liver resection, which can only be repeated in a few distant recurrence cases, 25,26 our study clearly shows that iterative RFA is also effective to achieving complete and durable ablation in the majority of cases.…”

“…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HCCs (3-5 cm) after RFA seem unfavorable, ranging from 61.3% to 82.5%. 21,22 Although these results are presumably outdated thanks to recent technical progress, 23 some authors suggested that RFA could be considered as an effective first-line treatment only for very small HCC (Յ2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.…”

Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation†

“…Other published series were even smaller in scale, precluding meaningful analysis of clinical outcomes, or presented only in the context of overall RFA experience without a primary focus on its pretransplant role. 24,38,39 A somewhat larger study reviewed 33 patients treated with multimodality nonresective therapy while awaiting transplantation, showing 5 (12.2%) dropouts and a 79% 3-year intent-to-treat survival rate. 25 In the present study, however, only 3 patients were treated exclusively with RFA, while 16 underwent transarterial chemo-infusion, which is an unproven modality and is not considered a first-line therapy for early-stage HCC.…”

“…Explant-based evaluation of RFA found in the literature have been few, small in scale, and in disagreement regarding complete necrosis rates (ranging from 21% to 75%). 22,39,46 Most recently, a larger study of 50 explants showed 55% (63% for tumors Յ3 cm) complete response rate after RFA treatment prospectively limited to a single session. 26 Our result, obtained after multiple-session treatments as needed, is not inconsistent with this finding and, we believe, reflects a local efficacy that can be realistically expected with meticulous technique 47 and close posttreatment surveillance, both of which are crucial for optimizing outcome.…”

Model simulation and experimental validation of intratumoral chemotherapy using multiple polymer implants

“…While its ease of use and minimally invasive nature have allowed this treatment modality to reach the forefront of ablative cancer treatments, tumor recurrence has been significant, particularly when RF ablation is applied percutaneously [2,4,10]. To address this limitation, biodegradable polymer implants were designed to release chemotherapeutic drugs into tumors after RF ablation.…”