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Radiofrequency Ablation Controls Liver Cancer

December 22, 2010
Written by: , Filed in: Abdominal Imaging, Interventional Radiology
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Radiofrequency ablation (RFA) can be safe and effective for managing hepatocellular carcinoma (HCC) in patients with cirrhosis, and should be the treatment of choice in cases where tumors are small and few, according to Italian researchers.

HCC—liver cancer—is the third-leading cause of cancer death worldwide, though it is much more common in areas where hepatitis B or C is prevalent, such as sub-Saharan Africa and Southeast Asia, than in the Western world. Many patients with HCC also have cirrhosis, which complicates cancer management and can itself cause death. Current guidelines recommend surgical resection of early-stage HCC for patients who have adequate liver function and chemical or thermal tumor ablation for patients where poor liver function or other factors rule out surgery.

RFA is highly repeatable, which can be a big advantage in controlling recurrences of cancerous tumors.

A research team from the Policlinico San Matteo Foundation in Pavia, Italy, led by Sandro Rossi, MD, conducted a retrospective study of 706 patients who presented with HCC from January 1998 through January 2008. Either percutaneous or laparoscopic RFA was performed.

The researchers obtained a “complete response” (no enhancing tissue at the tumor site and normalization of alpha-fetoprotein, or AFP, levels) in 696 patients (98.5 percent). Of those, 465 (66.8 percent) experienced a first recurrence during follow-up. RFA was repeated in 323 of the patients with first recurrences, restoring disease-free status in 318 cases (98.4 percent). For 223 patients, there was a second recurrence. RFA was repeated for 147 of those, again restoring disease-free status in 145 cases (98.6 percent).

No procedure-related deaths were reported, and fewer than 1 percent of sessions resulted in major complications.

Said Dr. Rossi, as quoted in a Wiley-Blackwell news release:

Our experience indicates that RFA should be the treatment of choice for patients with one or two small HCCs.

The researchers did note that the unpredictability of tumor progression, the possibility of tumor understaging, and the substantial risk of death unrelated to HCC complicate treatment planning for cirrhotic patients with HCC.

“Further research focusing on identifying tumor cell markers and genetic profiles associated with HCC growth patterns will ultimately help develop individualized treatment strategies for managing liver cancer,” Dr. Rossi said.

The research was published in October in the online edition of the journal Hepatology and appears in the January 2011 issue.

Related seminar: Abdominal & Thoracic CT/MR/US: Optimizing Practice

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