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

Abstract

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)

Risk factors for deterioration of long-term liver function after radiofrequency ablation therapy

“…However, since the recurrence rate of HCC following radical treatment is generally high, repeated RFA treatments are often needed. There have been reports that the application of repeated RFA for the treatment of recurrent tumors can increase the chances of long-term survival [8,9,18] . A few reports have referred to the influence of RFA on liver function.…”

“…Radiofrequency ablation (RFA) is currently recognized as an effective local treatment for HCC [5,6] and has been shown to be a relatively low risk procedure [7][8][9] . However, deterioration of liver function has been observed during the long-term follow-up of these patients [10][11][12] .…”

Radiofrequency ablation of metastatic lesions from breast cancer

“…Radiofrequency ablation (RFA) is a good alternative to resection in some patients when resection is not feasible for clinical or technical reasons [7]. RFA has in the recent years been performed under ultrasound (US) guidance [8,9] and computed tomography (CT) guidance [10] in the treatment of lung and liver metastases from BC.…”

Imaging of intrahepatic progression of hepatocellular carcinoma post transarterial chemoembolization. A long-term, prospective evaluation of contrast-enhanced ultrasonography (CEUS)

“…We believe that these limitations may be clinically relevant and merit further investigation. In the long-term course of HCC patients post interventional treatment, disease progression involving non-target tumors, or (perhaps more importantly) new lesions, is common and may have an impact on prognosis and on treatment decisions [12,13]. In early-stage HCC treated with radiofrequency ablation (RFA), distal recurrences have been observed in 10.4% and 52.5% of patients at 1 and 3 years post treatment, respectively [14].…”