Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis

Is resection still the treatment of choice?

Tito Livraghi, Franca Meloni, Michele Di Stasi, Emanuela Rolle, Luigi Solbiati, Carmine Tinelli, Sandro Rossi

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Abstract

If liver transplantation is not feasible, partial resection is considered the treatment of choice for hepatocellular carcinoma (HCC) in patients with cirrhosis. However, in some centers the first-line treatment for small, single, operable HCC is now radiofrequency ablation (RFA). In the current study, 218 patients widi single HCC ≤ 2.0 cm (very early or T1 stage) underwent RFA. We assessed 2 primary end points that could be easily compared with those reported for resective surgery: (1) the rate of sustained, local, complete response and (2) the rate of treatment-related complications. The secondary end point was 5-year survival in the 100 patients whose tumors had been considered potentially operable. After a median follow-up of 31 months, sustained complete response was observed in 216 patients (97.2%). In the remaining 6, percutaneous ethanol injection, selective intraarterial chemoembolization, or resection were used as salvage therapy. Perioperative mortality, major complication, and 5-year survival rates were 0%, 1.8%, and 68.5%, respectively. Conclusion: Compared with resection, RFA is less invasive and associated with lower complication rate and lower costs. RFA is also just as effective for ensuring local control of stage T1 HCC, and it is associated with similar survival rates (as recently demonstrated by 2 randomized trials). These data indicate that RFA can be considered the treatment of choice for patients with single HCC ≤ 2.0 cm, even when surgical resection is possible. Other approaches can be used as salvage therapy for the few cases in which RFA is unsuccessful or unfeasible.

Original languageEnglish
Pages (from-to)82-89
Number of pages8
JournalHepatology
Volume47
Issue number1
DOIs
Publication statusPublished - Jan 2008

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Hepatocellular Carcinoma
Fibrosis
Salvage Therapy
Survival Rate
Intra-Arterial Injections
Therapeutics
Liver Transplantation
Ethanol
Costs and Cost Analysis
Survival
Mortality
Neoplasms

ASJC Scopus subject areas

  • Hepatology

Cite this

Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis : Is resection still the treatment of choice? / Livraghi, Tito; Meloni, Franca; Di Stasi, Michele; Rolle, Emanuela; Solbiati, Luigi; Tinelli, Carmine; Rossi, Sandro.

In: Hepatology, Vol. 47, No. 1, 01.2008, p. 82-89.

Research output: Contribution to journalArticle

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abstract = "If liver transplantation is not feasible, partial resection is considered the treatment of choice for hepatocellular carcinoma (HCC) in patients with cirrhosis. However, in some centers the first-line treatment for small, single, operable HCC is now radiofrequency ablation (RFA). In the current study, 218 patients widi single HCC ≤ 2.0 cm (very early or T1 stage) underwent RFA. We assessed 2 primary end points that could be easily compared with those reported for resective surgery: (1) the rate of sustained, local, complete response and (2) the rate of treatment-related complications. The secondary end point was 5-year survival in the 100 patients whose tumors had been considered potentially operable. After a median follow-up of 31 months, sustained complete response was observed in 216 patients (97.2{\%}). In the remaining 6, percutaneous ethanol injection, selective intraarterial chemoembolization, or resection were used as salvage therapy. Perioperative mortality, major complication, and 5-year survival rates were 0{\%}, 1.8{\%}, and 68.5{\%}, respectively. Conclusion: Compared with resection, RFA is less invasive and associated with lower complication rate and lower costs. RFA is also just as effective for ensuring local control of stage T1 HCC, and it is associated with similar survival rates (as recently demonstrated by 2 randomized trials). These data indicate that RFA can be considered the treatment of choice for patients with single HCC ≤ 2.0 cm, even when surgical resection is possible. Other approaches can be used as salvage therapy for the few cases in which RFA is unsuccessful or unfeasible.",
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