Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis

Abstract

Objective: To determine the treatment efficacy, safety, local tumor control, and complications related to radiofrequency ablation (RFA) in patients with cirrhosis and unresectable hepatocellular carcinoma (HCC).

Summary background data: Most patients with HCC are not candidates for resection because of tumor size, location, or hepatic dysfunction related to cirrhosis. RFA is a technique that permits in situ destruction of tumors by means of local tissue heating.

Methods: One hundred ten patients with cirrhosis and HCC (Child class A, 50; B, 31; C, 29) were treated during a prospective study using RFA. Patients were treated with RFA using an open laparotomy, laparoscopic, or percutaneous approach with ultrasound guidance to place the RF needle electrode into the hepatic tumors. All patients were followed up at regular intervals to detect treatment-related complications or recurrence of disease.

Results: All 110 patients were followed up for at least 12 months after RFA (median follow-up 19 months). Percutaneous or intraoperative RFA was performed in 76 (69%) and 34 patients (31%), respectively. A total of 149 discrete HCC tumor nodules were treated with RFA. The median diameter of tumors treated percutaneously (2.8 cm) was smaller than that of lesions treated during laparotomy (4.6 cm). Local tumor recurrence at the RFA site developed in four patients (3.6%); recurrent HCC subsequently developed in other areas of the liver in all four. New liver tumors or extrahepatic metastases developed in 50 patients (45. 5%), but 56 patients (50.9%) had no evidence of recurrence. There were no treatment-related deaths, but complications developed in 14 patients (12.7%) after RFA.

Conclusions: In patients with cirrhosis and HCC, RFA produces effective local control of disease in a significant proportion of patients and can be performed safely with minimal complications.

Figure 1. (A) Transabdominal ultrasonography demonstrating a solitary hepatocellular carcinoma (arrow). (B) The radiofrequency ablation needle (long arrow) has been placed and the multiple array opened (short arrows) at the deep interface between tumor and hepatic parenchyma. (C) The area of tumor and liver treated with radiofrequency ablation becomes hyperechoic on ultrasound (arrow). The multiple array is subsequently retracted back into the needle electrode sheath, the needle is pulled back approximately 2 cm, and then the array is redeployed to complete the radiofrequency ablation treatment of the tumor and a rim of surrounding hepatic parenchyma.