Showing posts with label liver cancer treatment-radiofrequency ablation (RFA). Show all posts
Showing posts with label liver cancer treatment-radiofrequency ablation (RFA). Show all posts

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.

Monday, January 9, 2012

Radiofrequency ablation appears to have similar effectiveness to surgical resection for treating early-stage hepatocellular carcinomas

Surgery, RFA Had Similar Outcomes for Early HCC

Elsevier Global Medical News

SAN FRANCISCO – Radiofrequency ablation appears to have similar effectiveness to surgical resection for treating early-stage hepatocellular carcinomas, based on a randomized trial of 168 patients.

Researchers at Southwest Hospital in Chongqing, China, compared radiofrequency ablation (RFA) with surgical resection. Each treatment group consisted of 84 patients, and each patient had either one or two tumors that were less than 4 cm in diameter, said Dr. Ma Kuansheng at the annual meeting of the American Association for the Study of Liver Diseases.

In the surgical resection group, 81 patients (96%) were alive at 1 year, 74 (88%) at 2 years, and 63 (75%) at 3 years.

In the RFA group, 78 (93%) were alive at 1 year, 70 (83%) at 2 years, and 57 (68%) at 3 years. The differences between groups were not statistically significant (P = .3). Results for tumor recurrence were similar: 27 (32%) of the surgery patients had tumor recurrence within 3 years, compared with 35 (42%) of the RFA patients. Again, this difference was not statistically significant.
For treatment of one or two liver tumors less than 4 cm, “RFA provided the same overall and recurrence-free survival rates as surgical resection [and] has the advantages of minimal invasiveness and a low occurrence of complications,” said Dr. Kuansheng of the hospital’s hepatobiliary surgery department. Also, costs are lower with radiofrequency ablation, he added.

The study findings could help settle the debate about which technique is better for treating early liver cancer. “There are always arguments [about whether] you should just cut it out, [or]
try [RFA]. I think this study basically shows that there is no difference, so you should decide what’s the most economic way of dealing with this,” said Dr. Jake Liang, president of the American Association for the Study of Liver Diseases and chief of the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases. In the United States, both treatment approaches are available. However, surgery can be especially difficult in patients with cirrhosis. “Because their livers are all scarred, it’s very difficult to resect them,” commented Dr. Liang at the meeting.

Almost 10% of the RFA patients developed complications during the procedure, including two patients with hemorrhage. In contrast, complications occurred in over 20% of surgery patients,
including two with hemorrhage that required emergency laparotomy, and one patient who developed a liver abscess.

Radiofrequency ablation took an average of 41 minutes, and had a mean blood loss of 21 mL. Surgery took 141minutes on average, and blood loss was a mean of 375 mL; many of the patients needed transfusions. The average length of hospital stay was about 1 week for RFA patients vs. just over 2 weeks for surgery patients.

Eight RFA patients had residual tumor that was missed during the procedure: six with tumor under the liver capsule, one with tumor next to the gallbladder, and one with tumor adjacent to the portal vein trunk.

The investigators determined that analysis both with and without those patients did not significantly affect 3-year survival outcomes.

Most of the patients in both arms were men, with a mean age of about 50 years. A total of 85% had blood markers of hepatitis, most often hepatitis B surface antigen. There were no statistically significant baseline differences in alanine aminotransferase; alpha-fetoprotein; tumor size, number, or grade; or other characteristics that were analyzed.

The findings come at a time when liver cancer is on the rise, “mostly because of viral hepatitis,” Dr. Liang noted. “The best treatment for liver cancer is liver transplantation. You get a very high cure rate if you transplant early enough, but, obviously, not everybody can be transplanted.
There are resource issues,” he said.

Dr. Kuansheng and Dr. Liang said they
have no financial disclosures. ■

GI & Hepatology News is the official newspaper of the AGA Institute and provides the gastroenterologist with timely and relevant news and commentary about clinical developments and about the impact of health-care policy. The newspaper is led by an internationally renowned board of editors.

View Current Issue (VOL. 6 • NO. 1 • JANUARY 2012)

Hepatitis C Deaths Now Exceed HIV
The Centers for Disease Control and Prevention is poised to recommend one-time screening of all “baby boomers” for hepatitis C virus, in part because deaths associated with this infection are now more common than HIV related deaths in the United States, CDC officials said.

Noncathartic CTCb Compared Well With Colonoscopy: Pros and Cons of Methods Balanced Out.
When members of the general population were offered colorectal cancer screening, 34% agreed to noncathartic computed tomographic colonography, whereas 22% agreed to have a colonoscopy, in a study published online in the Lancet Oncology.

TNF Blockers: FDA Advises Vigilance
The Food and Drug Administration has asked manufacturers of tumor necrosis factor blockers to enhance their follow-up of pediatric and young adult patients who develop malignancies while on these treatments.

HBV Screening, Prophylaxis Needed Before Chemotherapy
In cancer patients with hepatitis B virus infection, prophylaxis to prevent its reactivation during chemotherapy lowers mortality, however, screening for the virus remains uncommon, said researchers from M.D. Anderson Cancer Center in Houston.

Program to Accredit ACOs Launches
The National Committee on Quality Assurance has launched a program to accredit accountable care organizations. The program offers three levels of accreditation based on the readiness of the ACO.