Friday, December 17, 2010

Radiofrequency ablation :Hepatocellular carcinoma in patients with cirrhosis

Radio Ablation Safe, Effective in Liver Cancer Patients

By Michael Smith, North American Correspondent, MedPage Today
Published: December 17, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Radiofrequency ablation is safe and effective in managing hepatocellular carcinoma in patients with cirrhosis, Italian researchers reported.

In particular, it can be used repeatedly to treat the frequent recurrences associated with the disease in cirrhotic patients, according to Sandro Rossi, MD, of Foundation Policlinico San Matteo in Pavia, Italy, and colleagues.

For patients with one or two small carcinoma nodules, Rossi and colleagues argued online in Hepatology, "our experience indicates that (radiofrequency ablation) should be the treatment of choice."Action Points

Explain that radiofrequency ablation is safe and effective in managing hepatocellular carcinoma in patients with cirrhosis, including those who have frequent recurrences.

Note that there were no procedure-related deaths.

The findings come from a prospective cohort of 706 patients treated with the procedure -- either percutaneously or laparascopically -- at two Italian public hospitals from January 1988 through January 2008.

While it's known that radiofrequency ablation is effective at treating hepatocellular carcinoma nodules, it remained unclear how well it would work in managing repeated recurrences or how it would affect survival, Rossi and colleagues noted.

Survival in particular is a difficult issue, since the risk of death is affected by the outcome of the initial treatment but also by such things as tumor characteristics, liver function, performance status, and age, they noted.

To address these issues, they looked back at records of the cohort, whose recurrences were managed according to a pre-set protocol that, among other things, mandated repeat radiofrequency ablation if the new nodule met the original criteria for the study.

Initial results were good, the researchers reported. Fifty-four patients with single subcapsular nodules had a laparoscopic procedure, and 53 had a complete response. In the remaining 652 patients, a total of 805 nodules were treated, with complete responses in 796 nodules and 643 patients.

As expected, recurrences were common. During a median follow-up of 29 months, 465 (or 66.8%) of the patients with an initial complete response had a recurrence, for an incidence rate of 41 per 100 person-years. The cumulative incidences of first recurrence at three and five years were 70.8% and 81.7%, respectively.

Of those, Rossi and colleagues reported, 323 patients (or 69.4%) were re-treated with radiofrequency ablation and 318 (or 98.4%) had disease-free status restored.

Subsequently, the treatment was repeated in 147 (or 65.9%) of the 223 patients who developed a second recurrence, and 145 (or 98.6%) were again disease-free.

Over the study period, there were 877 episodes of recurrence (ranging from one to eight per patient) and 577 led to repeated radiofrequency ablation that achieved complete responses in 557 cases (or 96.5%), the researchers reported.

Overall, there were 1,921 radiofrequency ablation sessions and no procedure-related deaths, they reported.

Rossi and colleagues estimated three- and five-year overall survival rates at 67.0% and 40.1%, respectively, and disease-free survival (after repeated ablation treatments) at 68.0 and 38.0%, respectively.

The study was supported by the IRCCS Policlinico San Matteo Foundation in Pavia, Italy. The researchers said they had no conflicts to report.

No comments:

Post a Comment