Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: A prospective study

Vincenzo Mazzaferro, Carlo Battiston, Stefano Perrone, Andrea Pulvirenti, Enrico Regalia, Raffaele Romito, Dario Sarli, Marcello Schiavo, Francesco Garbagnati, Alfonso Marchianò, Carlo Spreafico, Tiziana Camerini, Luigi Mariani, Rosalba Miceli, Salvatore Andreola

Research output: Contribution to journalArticle

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Abstract

Objective: Determine the histologic response-rate (complete versus partial tumor extinction) after single radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC) arising in cirrhosis. Investigate possible predictors of response and assess efficacy and safety of RFA as a bridge to liver transplantation (OLT). Background: RFA has become the elective treatment of local control of HCC, although histologic data supporting radiologic assessment of response are rare and prospective studies are lacking. Prognostic impact of repeated RFA for HCC persistence is also undetermined. Methods: Percentage of RFA-induced necrosis and tumor persistence-rate at various intervals from treatment was studied in 60 HCC (median: 3 cm; Milan-Criteria IN: 80%) isolated in 50 consecutive cirrhotic patients undergoing OLT. Single-session RFA was the only treatment planned before OLT. Histologic response determined on explanted livers was related to 28 variables and to pre-OLT CT scan. Results: Mean interval RFA→OLT was 9.5 months. Post-RFA complete response rate was 55%, rising to 63% for HCC ≥3 cm. Tumor size was the only prognostic factor significantly related to response (P = 0.007). Tumor satellites and/or new HCC foci (56 nodules) were unaffected by RFA and significantly correlated with HCC >3 cm (P = 0.05). Post-RFA tumor persistence probability increased with time (12 months: 59%; 18 months: 70%). Radiologic response rate was 70%, not significantly different from histology. Major post-RFA morbidity was 8%. No mortality, Child deterioration, patient withdrawal because of tumor progression was observed. Post-OLT 3-year patient/graft survival was 83%. Conclusions: RFA is a safe and effective treatment of small HCC in cirrhotics awaiting OLT, although tumor size (>3 cm) and time from treatment (>1 year) predict a high risk of tumor persistence in the targeted nodule. RFA should not be considered an independent therapy for HCC.

Original languageEnglish
Pages (from-to)900-909
Number of pages10
JournalAnnals of Surgery
Volume240
Issue number5
DOIs
Publication statusPublished - Nov 2004

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Liver Transplantation
Hepatocellular Carcinoma
Prospective Studies
Neoplasms
Therapeutics
Child Mortality
Graft Survival
Histology
Fibrosis
Necrosis
Morbidity
Safety
Liver

ASJC Scopus subject areas

  • Surgery

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Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation : A prospective study. / Mazzaferro, Vincenzo; Battiston, Carlo; Perrone, Stefano; Pulvirenti, Andrea; Regalia, Enrico; Romito, Raffaele; Sarli, Dario; Schiavo, Marcello; Garbagnati, Francesco; Marchianò, Alfonso; Spreafico, Carlo; Camerini, Tiziana; Mariani, Luigi; Miceli, Rosalba; Andreola, Salvatore.

In: Annals of Surgery, Vol. 240, No. 5, 11.2004, p. 900-909.

Research output: Contribution to journalArticle

Mazzaferro, Vincenzo ; Battiston, Carlo ; Perrone, Stefano ; Pulvirenti, Andrea ; Regalia, Enrico ; Romito, Raffaele ; Sarli, Dario ; Schiavo, Marcello ; Garbagnati, Francesco ; Marchianò, Alfonso ; Spreafico, Carlo ; Camerini, Tiziana ; Mariani, Luigi ; Miceli, Rosalba ; Andreola, Salvatore. / Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation : A prospective study. In: Annals of Surgery. 2004 ; Vol. 240, No. 5. pp. 900-909.
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abstract = "Objective: Determine the histologic response-rate (complete versus partial tumor extinction) after single radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC) arising in cirrhosis. Investigate possible predictors of response and assess efficacy and safety of RFA as a bridge to liver transplantation (OLT). Background: RFA has become the elective treatment of local control of HCC, although histologic data supporting radiologic assessment of response are rare and prospective studies are lacking. Prognostic impact of repeated RFA for HCC persistence is also undetermined. Methods: Percentage of RFA-induced necrosis and tumor persistence-rate at various intervals from treatment was studied in 60 HCC (median: 3 cm; Milan-Criteria IN: 80{\%}) isolated in 50 consecutive cirrhotic patients undergoing OLT. Single-session RFA was the only treatment planned before OLT. Histologic response determined on explanted livers was related to 28 variables and to pre-OLT CT scan. Results: Mean interval RFA→OLT was 9.5 months. Post-RFA complete response rate was 55{\%}, rising to 63{\%} for HCC ≥3 cm. Tumor size was the only prognostic factor significantly related to response (P = 0.007). Tumor satellites and/or new HCC foci (56 nodules) were unaffected by RFA and significantly correlated with HCC >3 cm (P = 0.05). Post-RFA tumor persistence probability increased with time (12 months: 59{\%}; 18 months: 70{\%}). Radiologic response rate was 70{\%}, not significantly different from histology. Major post-RFA morbidity was 8{\%}. No mortality, Child deterioration, patient withdrawal because of tumor progression was observed. Post-OLT 3-year patient/graft survival was 83{\%}. Conclusions: RFA is a safe and effective treatment of small HCC in cirrhotics awaiting OLT, although tumor size (>3 cm) and time from treatment (>1 year) predict a high risk of tumor persistence in the targeted nodule. RFA should not be considered an independent therapy for HCC.",
author = "Vincenzo Mazzaferro and Carlo Battiston and Stefano Perrone and Andrea Pulvirenti and Enrico Regalia and Raffaele Romito and Dario Sarli and Marcello Schiavo and Francesco Garbagnati and Alfonso Marchian{\`o} and Carlo Spreafico and Tiziana Camerini and Luigi Mariani and Rosalba Miceli and Salvatore Andreola",
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T1 - Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation

T2 - A prospective study

AU - Mazzaferro, Vincenzo

AU - Battiston, Carlo

AU - Perrone, Stefano

AU - Pulvirenti, Andrea

AU - Regalia, Enrico

AU - Romito, Raffaele

AU - Sarli, Dario

AU - Schiavo, Marcello

AU - Garbagnati, Francesco

AU - Marchianò, Alfonso

AU - Spreafico, Carlo

AU - Camerini, Tiziana

AU - Mariani, Luigi

AU - Miceli, Rosalba

AU - Andreola, Salvatore

PY - 2004/11

Y1 - 2004/11

N2 - Objective: Determine the histologic response-rate (complete versus partial tumor extinction) after single radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC) arising in cirrhosis. Investigate possible predictors of response and assess efficacy and safety of RFA as a bridge to liver transplantation (OLT). Background: RFA has become the elective treatment of local control of HCC, although histologic data supporting radiologic assessment of response are rare and prospective studies are lacking. Prognostic impact of repeated RFA for HCC persistence is also undetermined. Methods: Percentage of RFA-induced necrosis and tumor persistence-rate at various intervals from treatment was studied in 60 HCC (median: 3 cm; Milan-Criteria IN: 80%) isolated in 50 consecutive cirrhotic patients undergoing OLT. Single-session RFA was the only treatment planned before OLT. Histologic response determined on explanted livers was related to 28 variables and to pre-OLT CT scan. Results: Mean interval RFA→OLT was 9.5 months. Post-RFA complete response rate was 55%, rising to 63% for HCC ≥3 cm. Tumor size was the only prognostic factor significantly related to response (P = 0.007). Tumor satellites and/or new HCC foci (56 nodules) were unaffected by RFA and significantly correlated with HCC >3 cm (P = 0.05). Post-RFA tumor persistence probability increased with time (12 months: 59%; 18 months: 70%). Radiologic response rate was 70%, not significantly different from histology. Major post-RFA morbidity was 8%. No mortality, Child deterioration, patient withdrawal because of tumor progression was observed. Post-OLT 3-year patient/graft survival was 83%. Conclusions: RFA is a safe and effective treatment of small HCC in cirrhotics awaiting OLT, although tumor size (>3 cm) and time from treatment (>1 year) predict a high risk of tumor persistence in the targeted nodule. RFA should not be considered an independent therapy for HCC.

AB - Objective: Determine the histologic response-rate (complete versus partial tumor extinction) after single radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC) arising in cirrhosis. Investigate possible predictors of response and assess efficacy and safety of RFA as a bridge to liver transplantation (OLT). Background: RFA has become the elective treatment of local control of HCC, although histologic data supporting radiologic assessment of response are rare and prospective studies are lacking. Prognostic impact of repeated RFA for HCC persistence is also undetermined. Methods: Percentage of RFA-induced necrosis and tumor persistence-rate at various intervals from treatment was studied in 60 HCC (median: 3 cm; Milan-Criteria IN: 80%) isolated in 50 consecutive cirrhotic patients undergoing OLT. Single-session RFA was the only treatment planned before OLT. Histologic response determined on explanted livers was related to 28 variables and to pre-OLT CT scan. Results: Mean interval RFA→OLT was 9.5 months. Post-RFA complete response rate was 55%, rising to 63% for HCC ≥3 cm. Tumor size was the only prognostic factor significantly related to response (P = 0.007). Tumor satellites and/or new HCC foci (56 nodules) were unaffected by RFA and significantly correlated with HCC >3 cm (P = 0.05). Post-RFA tumor persistence probability increased with time (12 months: 59%; 18 months: 70%). Radiologic response rate was 70%, not significantly different from histology. Major post-RFA morbidity was 8%. No mortality, Child deterioration, patient withdrawal because of tumor progression was observed. Post-OLT 3-year patient/graft survival was 83%. Conclusions: RFA is a safe and effective treatment of small HCC in cirrhotics awaiting OLT, although tumor size (>3 cm) and time from treatment (>1 year) predict a high risk of tumor persistence in the targeted nodule. RFA should not be considered an independent therapy for HCC.

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