New considerations for an overall approach to treat hepatocellular carcinoma in cirrhotic patients

Abstract

For small tumors and compensated cirrhosis, resection or radiofrequency could represent acceptable first line treatments. In addition to permit safe and immediate tumor control, this strategy would allow a preferential redistribution of grafts to patients with decompensated cirrhosis in whom transplantation is the only possibility.

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

“…Therefore, for small (Ͻ3-5 cm) unresectable HCC, as is found in OLT candidates selected according to Milan criteria, RFA is now universally emerging as the treatment of choice. 2,[16][17][18][19][20][21] Nevertheless, RFA has not been adequately investigated as an adjunct to transplantation for patients awaiting OLT. One series including 15 patients transplanted after RFA showed a 3-year posttransplantation survival rate of 85%, with two (13%) recurrences.…”

“…At our institution, the strategy for management of HCC has evolved with a multimodality algorithmic approach similar to that adopted in other centers, [16][17][18][19][20][21] incorporating RFA as the primary treatment method. RFA is used as a first-line therapy for single tumors up to 5 cm and three or fewer tumors each up to 3 cm, except in the presence of contraindications including proximity to central bile ducts, bowel, gallbladder, inaccessibility by image guidance, or Child-Turcotte-Pugh class C cirrhosis.…”

“…[13][14][15] Recently in the United States and abroad, however, RFA has emerged as the first-line treatment for small, nonresectable cases of HCC, such as those fulfilling transplant criteria, with TACE filling a secondary role or reserved for more extensive disease. [16][17][18][19][20][21] Therefore, a potentially beneficial role of RFA while awaiting OLT has been widely discussed, [22][23][24][25][26] although it remains unsubstantiated. The present study was undertaken to assess the efficacy of RFA as a bridge to liver transplantation.…”

Comparing the Outcomes of Radiofrequency Ablation and Surgery in Patients With a Single Small Hepatocellular Carcinoma and Well-Preserved Hepatic Function

“…[16][17][18] More recently, RFA has become a popular method for treatment of HCC and has been applied as an alternative primary therapeutic modality to hepatectomy in some patients with HCC. 19 A Japanese nationwide comparative study, which was one of the most extensive surveys based on analysis of comparable patients treated by PEIT or surgery, indicated that surgery gave a better overall survival than PEIT for patients with a single clinical Stage I tumor less than 2 cm, solitary 2-to 5-cm tumors at any liver function status, or two or three tumor nodules. 20 However, there have been no substantive studies published that adequately compare the therapeutic results of RFA with those of surgical resection.…”

Current Treatment for Hepatocellular Carcinoma

“…The only proven potentially curative therapy for HCC remains surgical resection, either partial hepatectomy or orthotopic liver transplant (OLT) (Donckier et al, 2003;Lau, 2000;Ryder, 2003). Systemic and regional treatment modalities are considered to provide palliation or if a patient is unlikely to survive surgical resection because of inadequate liver function, has multiple nonresectable lesions, or requires tumor growth control while awaiting liver transplant.…”