Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results

Abstract

The aim of this study was to evaluate the effectiveness and the safety of percutaneous radiofrequency (RF) thermal ablation of hepatocellular carcinoma (HCC) in 88 patients with a long follow-up, and to compare conventional electrodes and expandable electrodes. Eighty-eight patients with 101 hepatocellular carcinoma nodules (< or = 3.5 cm in diameter) underwent RF thermal ablation by means of either conventional electrodes or an expandable electrode. Therapeutic efficacy was evaluated with dynamic contrast CT, serum alpha-feto protein level, US examination at the end of the treatment, and during follow-up. Complete necrosis was obtained in all tumor nodules in a mean number of 3.3 sessions (tumor treated by conventional electrodes) or 1.5 sessions (tumor treated by expandable electrode). The mean follow-up was 34 months; overall survival rate was 33% at 5 years. Disease-free survival at 5 years was 3%; local recurrence rate was 29% in patients treated with conventional electrodes; 14% in patients treated with the expandable electrode. Two major complications and 14 minor complications were observed. Radiofrequency thermal ablation in small HCC is very effective with a low percentage of major complications. The use of an expandable electrode substantially reduced the number of treatment sessions but did not modify the overall survival rate and the disease-free survival rate.

Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy

“…The local recurrence rates of HCC after RFA are 2.1 to 39% for variable methods, variable follow-up duration and tumor characters reported by several studies [22][23][24][25][26][27][28]. Our local tumor recurrence rates are 13.6% and 33.3% at 12 and 24 mo respectively, which are comparable with other reports.…”

RFA for Liver Tumors: Does It Really Work?

“…Like surgical resection, a 0.5-to 1-cm margin from the tumor edge is considered optimal [36]. Overall survival rates were reported to be as high as 89% and 62% at 1 and 3 years, respectively, in a group of patients undergoing RFA for lesions <3.5 cm [37] (Table 2). Unfortunately, a disease-free survival rate of 24% at 3 years is less encouraging, with local recurrence playing a large role in disease relapse.…”

“…of patients 1-yr survival 3-yr survival 5-yr survival Buscarini et al [37] 88 89% 62% 33% Lencioni et al [38] 187 97% 71% 41%…”

Ablative techniques in hepatocellular carcinoma treatment

“…Using RFA, treatment response has been found to correlate best with the size of the lesion; a complete response rate between 80%-90% in tumors up to 3 cm in diameter [24][25][26][27] , and 50%-70% in lesions between 3 and 5 cm in diameter [25,[28][29][30][31] . Five-year survival rates following RFA were reported as 48%-71% by some studies [32][33][34] .…”