Optimal treatment for small HCC (&lt;3 cm): Resection, liver transplantation, or locoregional therapy?

Wu, Xiao; Lokken, R. Peter; Mehta, Neil

doi:10.1016/j.jhepr.2023.100781

Cited by 6 publications

(4 citation statements)

References 99 publications

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“…The difference between elderly and non-elderly HCC patients is that surgery was consistently superior to RFA for small HCC of less than 3 cm. In non-elderly HCC, there is no statistical difference of OS between RFA and surgery in small HCC of less than 3 cm [32,33]. Therefore, it is better to perform the surgery more aggressively for early-stage HCC in elderly patients, where performance is good and life expectancy is expected to be long.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Yoo,

Koo,

Choi

et al. 2024

Current Oncology

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Although the disease burden of elderly cancer patients is rapidly increasing, reliable scientific information, value and preference information of domestic patients, and standardized guidelines for determining the treatment of elderly cancer patients are lacking. The aim of this study is to compare the therapeutic effects of radiofrequency ablation (RFA) and surgery in hepatocellular carcinoma (HCC) patients aged 65 years or older. For the meta-analysis, the databases including PubMed (MEDLINE), EMBASE, OVID Medline, and the Cochrane Library were systematically searched. After the abstract-based review by two investigators, selected manuscripts were read in detail. The surgery group showed higher overall survival (OS) (HR 1.44, 95% CI 1.22–1.70) and disease-free survival (DFS) (HR 1.40, 95% CI 1.00–1.97) than the RFA group. This was also shown in small HCC of less than 3 cm (OS, HR 1.42, 95% CI 1.00–2.03; DFS, HR 1.32, 95% CI 0.91–1.91). This might be related to the high local recurrence in the RFA group (OR 4.90, 95% 2.16–11.08). On the other hand, adverse events were significantly lower in the RFA group (OR 0.22, 95% CI 0.14–0.36), which led to a decrease in the duration of hospital stay (mean difference −14.88 days, 95% CI −22.44–−7.32). In elderly HCC patients, survival in the surgery group was significantly higher than in the RFA group, but various complications tended to increase; so, appropriate patient selection is required.

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Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Yoo,

Koo,

Choi

et al. 2024

Current Oncology

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“…Thermal ablation using microwave ablation (MWA) or radiofrequency ablation (RFA) is the current standard curative therapy for non-surgical candidates with early-stage HCC ≤ 3 cm [ 6 ]. Larger tumour size (> 3 cm) and certain anatomical locations (subphrenic, subcapsular, in close proximity to large vessels or central biliary structures) have been associated with higher local failure rates and increased complication rates [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of Standard Of Care versus RadioAblaTion in Early Stage HepatoCellular Carcinoma (SOCRATES HCC)

Wigg,

Tibballs,

Woodman

et al. 2024

BMC Cancer

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Background Therapeutic options for early-stage hepatocellular carcinoma (HCC) in individual patients can be limited by tumor and location, liver dysfunction and comorbidities. Many patients with early-stage HCC do not receive curative-intent therapies. Stereotactic ablative body radiotherapy (SABR) has emerged as an effective, non-invasive HCC treatment option, however, randomized evidence for SABR in the first line setting is lacking. Methods Trans-Tasman Radiation Oncology Group (TROG) 21.07 SOCRATES-HCC is a phase II, prospective, randomised trial comparing SABR to other current standard of care therapies for patients with a solitary HCC ≤ 8 cm, ineligible for surgical resection or transplantation. The study is divided into 2 cohorts. Cohort 1 will compromise 118 patients with tumors ≤ 3 cm eligible for thermal ablation randomly assigned (1:1 ratio) to thermal ablation or SABR. Cohort 2 will comprise 100 patients with tumors > 3 cm up to 8 cm in size, or tumors ≤ 3 cm ineligible for thermal ablation, randomly assigned (1:1 ratio) to SABR or best other standard of care therapy including transarterial therapies. The primary objective is to determine whether SABR results in superior freedom from local progression (FFLP) at 2 years compared to thermal ablation in cohort 1 and compared to best standard of care therapy in cohort 2. Secondary endpoints include progression free survival, overall survival, adverse events, patient reported outcomes and health economic analyses. Discussion The SOCRATES-HCC study will provide the first randomized, multicentre evaluation of the efficacy, safety and cost effectiveness of SABR versus other standard of care therapies in the first line treatment of unresectable, early-stage HCC. It is a broad, multicentre collaboration between hepatology, interventional radiology and radiation oncology groups around Australia, coordinated by TROG Cancer Research. Trial registration anzctr.org.au, ACTRN12621001444875, registered 21 October 2021.

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“…Liver cancer ranks as the second leading cause of cancer-related mortality and stands as the seventh most common cancer globally, remaining an ongoing global health threat. 1 Hepatocellular carcinomas (HCCs) measuring 3 cm or less, accounting for up to 30% of cases, 2 are typically recommended for curative treatments such as resection, local ablation therapy (LAT), or liver transplantation in most guidelines. 3 - 5 Where curative treatments are deemed unfeasible, transarterial chemoembolization (TACE) stands out as the leading alternative treatment option.…”

mentioning

confidence: 99%

“…In the context of small HCC, decision-making involves consideration of various factors, including tumor size (≤2 cm, 2–3 cm), candidacy for liver transplantation, hepatic reservoir function, performance status, tumor location, and socioeconomic considerations. 2 Although radiofrequency ablation (RFA) serves as the best alternative modality for resection, there are still limitations that render RFA unsuitable in certain cases despite advances in technique. In Lim's study, the most common reason for the inability to perform RFA was invisibility, constituting more than half of the cases, consistent with findings from previous studies.…”

mentioning

confidence: 99%

Investigating Alternative Treatment Options Unfeasible for Local Ablation Therapy in Patients with Small Solitary Hepatocellular Carcinomas

Lee,

Kim

2024

Gut and Liver

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Optimal treatment for small HCC (<3 cm): Resection, liver transplantation, or locoregional therapy?

Cited by 6 publications

References 99 publications

Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

A randomised controlled trial of Standard Of Care versus RadioAblaTion in Early Stage HepatoCellular Carcinoma (SOCRATES HCC)

Investigating Alternative Treatment Options Unfeasible for Local Ablation Therapy in Patients with Small Solitary Hepatocellular Carcinomas

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