PURPOSE: Very few patients affected by hepatocellular carcinoma can undergo surgery, though it is considered the only curative therapy. We evaluated minimally invasive, percutaneous radiofrequency interstitial thermal ablation for treatment of patients with hepatocellular carcinoma who had no surgical prospects. PATIENTS AND METHODS: Twenty-four patients (16 men and 8 women; age range, 53 to 79 years) with 25 hepatocellular carcinoma nodules of not more than 3.0-cm diameter underwent radiofrequency interstitial thermal ablation treatment with the intent to achieve a cure. In each patient, the thermal necrosis volume achieved was about double the tumor volume. RESULTS: At the end of treatment, destruction of the tumor was achieved in all but two cases in which further thermal lesions were needed. During the mean follow-up interval of 24.8 months (range, 6-64), 13 of 24 patients had recurrences, 9 of whom underwent further radiofrequency thermal ablation treatment. Radiofrequency thermal ablation was again repeated in two patients who showed a second recurrence. A total of 36 hepatocellular carcinoma nodules in 24 patients were treated. No complications were observed. Seven patients died: three due to hepatic failure with advanced cancer, three due to heart failure, and one due to pneumonia. Cumulative survival curves indicated that the median survival time was 44 months and survival rate was 0.95 the first year, 0.84 the second year, 0.67 the third year, and 0.45 the fourth and fifth years. CONCLUSIONS: Percutaneous radiofrequency thermal ablation can be considered a useful new treatment for small hepatocellular carcinoma in patients without surgical prospects. It is simple, effective, and safe, and can be repeated in case of recurrence.
PURPOSE: Very few patients affected by hepatocellular carcinoma can undergo surgery, though it is considered the only curative therapy. We evaluated minimally invasive, percutaneous radiofrequency interstitial thermal ablation for treatment of patients with hepatocellular carcinoma who had no surgical prospects. PATIENTS AND METHODS: Twenty-four patients (16 men and 8 women; age range, 53 to 79 years) with 25 hepatocellular carcinoma nodules of not more than 3.0-cm diameter underwent radiofrequency interstitial thermal ablation treatment with the intent to achieve a cure. In each patient, the thermal necrosis volume achieved was about double the tumor volume. RESULTS: At the end of treatment, destruction of the tumor was achieved in all but two cases in which further thermal lesions were needed. During the mean follow-up interval of 24.8 months (range, 6-64), 13 of 24 patients had recurrences, 9 of whom underwent further radiofrequency thermal ablation treatment. Radiofrequency thermal ablation was again repeated in two patients who showed a second recurrence. A total of 36 hepatocellular carcinoma nodules in 24 patients were treated. No complications were observed. Seven patients died: three due to hepatic failure with advanced cancer, three due to heart failure, and one due to pneumonia. Cumulative survival curves indicated that the median survival time was 44 months and survival rate was 0.95 the first year, 0.84 the second year, 0.67 the third year, and 0.45 the fourth and fifth years. CONCLUSIONS: Percutaneous radiofrequency thermal ablation can be considered a useful new treatment for small hepatocellular carcinoma in patients without surgical prospects. It is simple, effective, and safe, and can be repeated in case of recurrence.
Authors: Timothy M Pawlik; Francesco Izzo; Deborah S Cohen; Jeffery S Morris; Steven A Curley Journal: Ann Surg Oncol Date: 2003-11 Impact factor: 5.344