Radiofrequency ablation in unresectable hepatocellular carcinoma

Abstract EN

Purpose : most patients with hepatocellular carcinoma (HCC) are not candidates for resection because of tumor size, location, multimodality, or liver dysfunction associated with liver cirrhosis and hepatitis.

Radiofrequency ablation (RFA) offers an alternative treatment in some unrespectable HCC patients with disease confined to the liver.

We prospectively evaluated the local recurrence rate and the overall survival rate in patients with unrespectable HCC treated with RFA.

Patients and methods: All patients with non-metastatic unrespectable HCC referred to the National Cancer Institute (NCI) Cairo University between Jan.

2001 and Jan.

2003 were evaluated for eligibility for treatment with RFA.

Patients were treated with RFA using open or percutaneous approach with ultrasound guidance using Levee monopole array needle electrode and RF2000 generator.

Patients were evaluated at regular intervals to determine disease recurrence and survival.

Results : A total of 50 patients, 34 men (68 %) and 16 women (32 %), with a median age 55.2 years (range 23-67 years) underwent RFA for 79 HCC tumors.

All were followed up for at least one year (mean follow up 23.6 months).

Percutaneous and open intraoperative RFA was performed in 32 (68 %) and 18 (32 %) patients respectively.

Of the 18 patients treated with open RFA, 1 patient (5 %) underwent additional resection.

Median diameter of the tumors treated with percutaneous RFA was 3.5 cm while the median diameter of the tumors treated with open intraoperative approach was 5.5 cm.

There was one treatment related death in the opern intraoperative RFA group.

During a mean follow up period of 23.6 months, disease recurred in 24 of the 50 patients (48 %), including 15 (46 %) treated percutaneous and 9 of 18 (50 %) treated by the open intraoperative RFA.

The overall survival at 1, 2 years for the percutaneous RFA group was 81.2 % and 71.8 %, while in the open RFA group, it was 72 % and 50 %.

Conclusions : treatment with RFA can produce significant survival improvement in some patients with non-metastatic HCC who are considered unrespectable because of multifocal disease, proximity of the tumor to key vascular or biliary structure, or inadequate functional hepatic reserve to allow safe hepatic resection.