Percutaneous Laser Ablation of Small Hepatocellular Carcinoma

Abstract

Hepatocellular Carcinoma (HCC) arising in cirrhosis is one of the most common malignant tumors in the world showing wide geographical variations in prevalence. In this review we will focus on Percutaneous Laser Ablation (PLA), the ablative method of choice for HCC nodules (up to 4 cm) at our Institutions.PLA was performed with a continuous-wave neodymium yttrium-aluminium-garnet laser that operated at a wavelength of 1.064 µm. According to lesion volume, one to four 300 µm optic fiber (s) advanced in 21-g needle were positioned into the target lesions under US guide. A single optimal laser illumination was considered when 1800 Joules/fiber were delivered in 6 min. at 5 W. The interventional procedure was performed under conscious sedation, on an inpatient basis. Spiral triphasic TC was used to assess effectiveness of treatment.According to our observation high rates of tumor necrosis (90%) may be achieved in small HCC nodule (up to 4 cm) with 1 to 3 illuminations in 1 to 2 sessions.In our study the mortality rate turned out to be 0.6% whereas major complications occurred in 0.4% of cases.Local tumor progression rate was of 15% and 49% respectively patients who developed new lesions within five years of follow-up.The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 89%, 75%, 52%, 43%, and 27%, respectively. The independent predictors of survival were found to be tumor grading, bilirubin levels ≤ 2.5 mg/dl and the achievement of complete tumor ablation.On the other hand, complete necrosis could be achieved more frequently due to some factors such as HCC grading (well differentiated forms at histology), lesion location, easy to reach operator's skills and in case the HCC nodule was naïve (newly diagnosed and not previously treated).Our findings suggested that PLA is an effective and safe percutaneous treatment modality for HCC nodules up to 4 cm.

Multidisciplinary decision making in the management of hepatocellular carcinoma: A hospital-based study

“…HCC patients in the early stage who are not eligible for liver transplantation or resection are preferentially treated with percutaneous ablation that is considered as a minimally invasive option with low mortality, low complication rates, and good outcomes in overall survival (20,21).…”