Radiofrequency ablation of hepatocellular carcinoma in cirrhotic patients

Background/Aims: Radiofrequency ablation is useful for local destruction of primary and secondary hepatic tumors. However there is little information about long-term outcome for patients with hepatocellular carcinoma and cirrhosis. The aims of this study included the analysis of efficacy in local control of tumors, patterns of recurrence and survival rate related to severity of cirrhosis and tumor features. Methodology: From January 1998 to January 2001 we ablated 65 hepatocellular carcinomas in 53 patients with cirrhosis. Cirrhosis was related to HCV, HBV and alcohol intake in 32, 4 and. 17 patients, respectively. According to Child-Pugh classification 24 and 29 patients belong to A and B class, respectively. Patients in Child-Pugh C class were excluded from the study. The mean diameter of lesions was 4cm (range: 1-7cm). In all cases radiofrequency ablation was performed with the percutaneous approach under ultrasound guidance. Treatment efficacy was estimated with dual phase computed tomography and alpha-fetoprotein dosage. Results: Complete necrosis rate after first treatment was 90.9, 74.4 and 36.4% in hepatocellular carcinoma. smaller than 3cm, between 3 and 5cm and larger than 5cm, respectively (p=0.01). After multiple treatment complete necrosis was achieved in 100, 93 and 63.6% (p=0.01). The mean number of treatments was 1.5 (range: 1-4) per patients. Four lesions of 58 (6.8%) developed local recurrence during a mean follow-up of 18 months. No local recurrence was observed in tumors smaller than 4cm. New tumors were observed in 15 patients (28.3%). There were no treatment-related deaths and 11 patients (20.7%) suffered minor complications. The survival rate of patients after treatment was 87, 63 and 45% at 12, 24 and 36 months, respectively. Survival was. significantly related to Child-Pugh class (p=0.01). Conclusions: Radiofrequency ablation is a safe and effective treatment of hepatocellular carcinoma smaller than 5cm. with complete necrosis in most lesions. No local recurrences were observed in lesions smaller than 4cm. After 3 years survival was 83% in Child-Pugh A cirrhotic patients and 31% in Child-Pugh B patients.