Wednesday, May 23, 2012

Radiofrequency Ablation Is Locally Curative for Hepatocellular Carcinoma

Radiofrequency Ablation Is Locally Curative for Hepatocellular Carcinoma
Also, 5-year survival was similar for RFA and surgical resection in select patients.

Liver transplantation and surgical resection are considered curative in the management of hepatocellular carcinoma (HCC). However, these modalities are not always applicable (e.g., cases of liver-donor shortages or ineligibility for surgical resection because of underlying liver dysfunction/portal hypertension). Randomized trial findings suggest that radiofrequency ablation (RFA) has similar survival benefits to surgical resection (Ann Surg 2006; 243:321).

To estimate survival of patients undergoing RFA, investigators studied 10 years of follow-up data for 1170 patients who were ineligible for surgical resection or liver transplant or had refused surgery and had no extrahepatic tumor burden. The main study outcomes were HCC recurrence and overall survival. Tumor markers were measured monthly, and imaging (computed tomography or ultrasound) was performed every 4 months.

Of 2982 RFA treatments performed, complete tumor ablation was achieved in 99.4%, with 67 complications and 1 death. At 5 and 10 years, local recurrence rates were 3.2% for both, and distant recurrence rates were 74.8% and 80.8%, respectively. Five- and 10-year survival rates were 60.2% and 27.3%, respectively. Patients with tumor size ≤3 cm had significantly higher survival than patients with larger tumors at 5 years (65.1% vs. 46.5%) and 10 years (30.7% vs. 18.6%). Among 237 patients who were deemed good candidates for surgical resection but refused surgery, 5-year survival after RFA was 75.9% — similar to that of patients with HCC who undergo surgical resection.

Comment: Although this observational study contains inherent selection bias and lacks a comparative arm, its results suggest that radiofrequency ablation is a safe and viable option for patients with cirrhosis and early-stage HCC, with a 5-year survival that is similar to surgical resection. Because many patients with cirrhosis cannot safely undergo hepatic resection, RFA could be a reasonable alternative.

Atif Zaman, MD, MPH

Published in Journal Watch Gastroenterology May 18, 2012

Shiina S et al. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol 2012 Apr; 107:569.

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