NEW YORK (Reuters Health) The first report of 10-year outcomes of hepatocellular carcinoma treated by percutaneous radio frequency ablation (RFA) indicates that about 1 in 4 patients survive for that long.
RFA might be a first-line treatment for selected patients with early-stage HCC, conclude the authors of the report in the American Journal of Gastroenterology online December 13.
Dr. Shuichiro Shiina and colleagues at the Graduate School of Medicine of the University of Tokyo, Japan, note that RFA has become widely adopted for cases of unresectable hepatocellular carcinoma, and there have been several reports of 5-year outcomes with the technique. In the current paper, they report rates of progression, recurrence, and survival in a 10-year case series from their tertiary referral center.
Between 1999 and 2009, the team performed 2982 RFA treatments in 1170 primary HCC patients. Each treatment consisted of repeated procedures as needed, aimed at achieving complete tumor necrosis on CT imaging. Thus, a total of 4514 procedures were performed. This resulted in complete ablation of 99.4% of treated tumors.
Complications such as GI perforation, hemoperitoneum, hepatic infarction or neoplastic seeding occurred in 67 of the 4514 procedures (1.5%), the report indicates.
Median follow-up was 38 months. Local tumor progression was only 3.4% at 10 years, the researchers found. However, distant recurrence occurred in 78.1% at 5 years and 80.8% at 10 years.
Overall survival was 60.2% at 5 years and 27.3% at 10 years. Hepatocellular carcinoma was the cause of death in 55.8% of cases, Dr. Shiina and colleagues report.
Compared to patients with tumors smaller than 2 cm, outcomes were worse in patients with tumors between 2 and 5 cm but not in those with tumors over 5 cm, the authors note. This is probably because the number of patients with tumors > 5.0 cm (n = 35) were not large enough for the difference to be statistically significant, they comment
Summing up, they conclude, Our 10-year clinical experience shows that RFA could be locally curative, resulting in survival for as long as 10 years, and was a safe procedure.
Reference:
Radiofrequency Ablation for Hepatocellular Carcinoma: 10-Year Outcome and Prognostic Factors
Am J Gastroenterol 2011.
