Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.

Rossi, Santiago E.; Buscarini, E.; Garbagnati, F; Stasi, Martina Di; Quaretti, Pietro; Rago, M.; Zangrandi, Adriano; Andreola, S; Silverman, Daniel; Buscarini, L

doi:10.2214/ajr.170.4.9530052

Cited by 554 publications

(323 citation statements)

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“…23 Other authors have reported similarly good results with radio-frequency thermal tumor ablation. 44 If such techniques can achieve results equal to resection in the local control of the tumor (and therefore in the recurrence rate), applying them to our model would probably not change the results of our analysis. In fact, percutaneous techniques of tumor destruction may be better than surgery in terms of early mortality and preservation of liver function, 2 factors favoring a strategy of salvage transplantation.…”

Section: Discussionmentioning

confidence: 96%

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

et al. 2000

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Two treatments are accepted for patients with solitary hepatocellular carcinoma Յ5 cm in size and with preserved hepatic function: (1) liver resection, which can be performed without delay but has a high recurrence rate, and (2) liver transplantation, which has a better long-term survival, but is not easily available because grafts are scarce. A third possibility is to offer liver resection first and liver transplantation for tumor recurrence or deteriorating liver function (''salvage'' transplantation). We investigated the implications of such a strategy with a Markov-based decision analytic model. Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide, and its incidence is increasing in the western world because of the epidemics of the hepatitis C virus. 1 In patients aged less than 65 years, 2 therapies are currently accepted for early HCC (Յ5 cm): partial hepatectomy (PH) and orthotopic liver transplantation (OLT). 2,3 Although studies comparing the 2 treatments are retrospective and concern patients with disparate tumor characteristics and liver function, 4-6 it is agreed that OLT is preferable to partial hepatectomy in patients with hepatic insufficiency and in patients with more than 1 tumor, in whom the results of liver resection are poor.Patients with single tumors and preserved liver function present a therapeutic dilemma. Partial hepatectomy can cure the tumor immediately, with low mortality. The underlying cirrhosis, however, is responsible for a high recurrence rate, and the patient is exposed to the long-term complications of portal hypertension and hepatocellular failure. 7 OLT, by treating both the tumor and the cirrhosis, offers a better long-term survival. The tumor, however, can outgrow the criteria accepted for transplantation while waiting for donor organs, affecting the ultimate outcome as shown in a previous analysis. 2 For patients with a single resectable HCC, an alternative strategy to either partial hepatectomy or OLT would be to offer resection first and transplantation if the tumor recurs or if the liver function deteriorates (salvage OLT). Before such a strategy can be tested in a prospective controlled trial, the present study examines its implications in terms of patient outcome, graft use, and costs, using a decisional analysis model based on the data available in the literature. PATIENTS AND METHODS Decision Analytic ModelWe investigated the impact of 2 options: (1) primary liver transplantation and (2) partial hepatectomy followed by salvage liver transplantation (Fig. 1A) in patients with compensated cirrhosis and solitary HCC Յ5 cm in diameter, with a Markov simulation (Decision Maker 7

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Section: Discussionmentioning

confidence: 96%

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

et al. 2000

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“…3,4 When surgery is not possible, there are several minimally invasive options for chemical or thermal tumor ablation. [5][6][7][8] One of the most effective is radiofrequency ablation (RFA), 9 which is now considered potentially curative for early-stage HCCs in patients with or without surgical prospects. 3,4,[10][11][12] Local tumor control and survival are the parameters most widely used to assess the efficacy of surgical and nonsurgical treatments for HCC.…”

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confidence: 99%

Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: A long-term cohort study

et al. 2011

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In most patients with cirrhosis, successful percutaneous ablation or surgical resection of hepatocellular carcinoma (HCC) is followed by recurrence. Radiofrequency ablation (RFA) has proven effective for treating HCC nodules, but its repeatability in managing recurrences and the impact of this approach on survival has not been evaluated. To this end, we retrospectively analyzed a prospective series of 706 patients with cirrhosis (ChildPugh class B7) who underwent RFA for 859 HCC 35 mm in diameter (1-2 per patient). The results of RFA were classified as complete responses (CRs) or treatment failures. CRs were obtained in 849 nodules (98.8%) and 696 patients (98.5%). During follow-up (median, 29 months), 465 (66.8%) of the 696 patients with CRs experienced a first recurrence at an incidence rate of 41 per 100 person-years (local recurrence 6.2; nonlocal 35). Cumulative incidences of first recurrence at 3 and 5 years were 70.8% and 81.7%, respectively. RFA was repeated in 323 (69.4%) of the 465 patients with first recurrence, restoring disease-free status in 318 (98.4%) cases. Subsequently, RFA was repeated in 147 (65.9%) of the 223 patients who developed a second recurrence after CR of the first, restoring disease-free status in 145 (98.6%) cases. Overall, there were 877 episodes of recurrence (1-8 per patient); 577 (65.8%) of these underwent RFA that achieved CRs in 557 (96.5%) cases. No procedure-related deaths occurred in 1,921 RFA sessions. Estimated 3-and 5-year overall and disease-free (after repeated RFAs) survival rates were 67.0% and 40.1% and 68.0 and 38.0%, respectively. Conclusion: RFA is safe and effective for managing HCC in patients with cirrhosis, and its high repeatability makes it particularly valuable for controlling intrahepatic recurrences. (HEPATOLOGY 2011;53:136-147)

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“…2 In a second article, in which the treatment was performed with a modified technology (expandable needle) to obtain a greater necrosis volume, we repeated the same concept, remarking that a multidisciplinary approach is mandatory. 3 We recall that our results of metastasis RF treatment were very good in a short time (we obtained an apparent complete ablation in approximately 90% of the treated patients); however, in a mean follow-up of 12 months, only 20% of them were alive and disease free. Moreover, in the same period, 2 patients (18%) died.…”

mentioning

confidence: 65%

“…Now, with modified technology (expandable needle electrode, cooled-tip needle electrode), lesions of 2 cm can be completely ablated in only one session, with a safety margin of 0.5 cm; lesions up to 3.5 cm can be ablated in no more than two sessions. 3,4 The problem of tumor seeding after PEI is well documented: the seeding incidence accounts for 1 patient/1000 sessions 5 ; the same problem probably exists also for RF therapy, but up to now no data were available in the literature, with the exception of these 2 present patients. In 1 patient, tumor seeding was probably bound to the very high number of sessions because of PEI.…”

mentioning

confidence: 96%

Percutaneous ultrasound-guided radiofrequency ablation of liver tumors

Buscarini

1999

Liver Transpl

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Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.

Cited by 554 publications

References 0 publications

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: A long-term cohort study

Percutaneous ultrasound-guided radiofrequency ablation of liver tumors

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