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Original Article |
1 Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, Texas 77030-4009
2 Division of Surgical Oncology, The G. Pascale National Cancer Institute, Fondazione G. Pascale, Naples 801331, Italy
3 Division of Diagnostic Radiology, The G. Pascale National Cancer Institute, Fondazione G. Pascale, Naples 801331, Italy
4 Division of Medical Oncology, The G. Pascale National Cancer Institute, Fondazione G. Pascale, Naples 801331, Italy
5 Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 13501, Houston, Texas 77030-4009
Correspondence: Address correspondence and reprint requests to: Steven A. Curley, MD; E-mail: scurley{at}mdanderson.org.
Background: Radiofrequency ablation (RFA) offers an alternative treatment in some unresectable hepatocellular carcinoma (HCC) patients with disease confined to the liver. We prospectively evaluated survival rates in patients with early-stage, unresectable HCC treated with RFA.
Methods: All patients with HCC treated with RFA between September 1, 1997, and July 31, 2002, were prospectively evaluated. Patients were treated with RFA by using a percutaneous or open intraoperative approach with ultrasound guidance and were evaluated at regular intervals to determine disease recurrence and survival.
Results: A total of 194 patients (153 men [79%] and 41 women [21%]) with a median age of 66 years (range, 39–86 years) underwent RFA of 289 sonographically detectable HCC tumors. All patients were followed up for at least 12 months (median follow-up, 34.8 months). Percutaneous and open intraoperative RFA was performed in 140 (72%) and 54 (28%) patients, respectively. The median diameter of tumors treated with RFA was 3.3 cm. Disease recurred in 103 (53%) of 194 patients, including 69 (49%) of 140 patients treated percutaneously and 34 (63%) of 54 treated with open RFA (not significant). Local recurrence developed in nine patients (4.6%). Most recurrence was intrahepatic. The overall complication rate was 12%. Overall survival rates at 1, 3, and 5 years for all 194 patients were 84.5%, 68.1%, and 55.4%, respectively.
Conclusions: Treatment with RFA can produce significant long-term survival rates for cirrhotic patients with early-stage, unresectable HCC. RFA can be performed in these patients with relatively low complication rates. Confirmation of these results in randomized trials should be considered.
Key Words: Hepatocellular cancer • Radiofrequency ablation • Survival • Unresectable • Cirrhosis
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