Purpose To compare liver resection (LR) with single-step, balloon-occluded radiofrequency (RF) ablation plus drug-eluting embolics transarterial chemoembolization in cirrhotic patients with single hepatocellular carcinoma (HCC) ≥ 3 cm. Materials and Methods From 2010 to 2014, 25 patients with compensated cirrhosis and single HCC ≥ 3 cm (median size 4.5 cm; range, 3.0–6.8 cm) not suitable for LR or liver transplantation were treated with RF ablation plus transarterial chemoembolization in a prospective observational single-center pilot study; all patients had complete tumor necrosis after treatment. A retrospective control group included 29 patients (median HCC size 4.0 cm; range, 3.0–7.4 cm) who underwent LR. RF ablation plus transarterial chemoembolization group included more patients with severe portal hypertension (65.5% vs 35.0%, P =.017). Primary endpoints were overall survival (OS) and tumor recurrence (TR) rates. Results One death and 1 major complication (4%) were observed in LR group. No major complications were reported in RF ablation plus transarterial chemoembolization group (P =.463). OS rates at 1 and 3 years were 91.8% and 79.3% in LR group and 89.4% and 48.2% in RF ablation plus transarterial chemoembolization group (P = 0.117). TR rates at 1 and 3 years were 29.5% and 45.0% in LR group and 42.4% and 76.0% in RF ablation plus transarterial chemoembolization group (P =.034). Local tumor progression (LTP) rates at 3 years were significantly lower in LR group (21.8% vs 58.1%, P =.005). Similar results were found in patients with HCC ≤ 5 cm (TR rates 35.4% vs 75.1%, P =.016; LTP 16.0% vs 55.7%, P =.013). Conclusions LR achieved lower TR and LTP rates than RF ablation plus transarterial chemoembolization, but 3-years OS rates were not statistically different between the 2 groups. RF ablation plus transarterial chemoembolization is an effective treatment option in patients with compensated cirrhosis and solitary HCC ≥ 3 cm unsuitable for LR.

Saviano, A., Iezzi, R., Giuliante, F., Salvatore, L., Mele, C., Posa, A., Ardito, F., De Gaetano, A. M., Pompili, M., Rinninella, E., Zocco, M. A., Riccardi, L., Annicchiarico, B. E., Siciliano, M., De Matthaeis, N., Grieco, A., Rapaccini, G. L., Gasbarrini, A., Liver Resection versus Radiofrequency Ablation plus Transcatheter Arterial Chemoembolization in Cirrhotic Patients with Solitary Large Hepatocellular Carcinoma, <<JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY>>, 2017; 28 (11): 1512-1519. [doi:10.1016/j.jvir.2017.06.016] [http://hdl.handle.net/10807/170722]

Liver Resection versus Radiofrequency Ablation plus Transcatheter Arterial Chemoembolization in Cirrhotic Patients with Solitary Large Hepatocellular Carcinoma

Saviano A.;Iezzi R.;Giuliante F.;Posa A.;Ardito F.;De Gaetano A. M.;Pompili M.;Rinninella E.;Zocco M. A.;Riccardi L.;Annicchiarico B. E.;De Matthaeis N.;Rapaccini G. L.;Gasbarrini A.
2017

Abstract

Purpose To compare liver resection (LR) with single-step, balloon-occluded radiofrequency (RF) ablation plus drug-eluting embolics transarterial chemoembolization in cirrhotic patients with single hepatocellular carcinoma (HCC) ≥ 3 cm. Materials and Methods From 2010 to 2014, 25 patients with compensated cirrhosis and single HCC ≥ 3 cm (median size 4.5 cm; range, 3.0–6.8 cm) not suitable for LR or liver transplantation were treated with RF ablation plus transarterial chemoembolization in a prospective observational single-center pilot study; all patients had complete tumor necrosis after treatment. A retrospective control group included 29 patients (median HCC size 4.0 cm; range, 3.0–7.4 cm) who underwent LR. RF ablation plus transarterial chemoembolization group included more patients with severe portal hypertension (65.5% vs 35.0%, P =.017). Primary endpoints were overall survival (OS) and tumor recurrence (TR) rates. Results One death and 1 major complication (4%) were observed in LR group. No major complications were reported in RF ablation plus transarterial chemoembolization group (P =.463). OS rates at 1 and 3 years were 91.8% and 79.3% in LR group and 89.4% and 48.2% in RF ablation plus transarterial chemoembolization group (P = 0.117). TR rates at 1 and 3 years were 29.5% and 45.0% in LR group and 42.4% and 76.0% in RF ablation plus transarterial chemoembolization group (P =.034). Local tumor progression (LTP) rates at 3 years were significantly lower in LR group (21.8% vs 58.1%, P =.005). Similar results were found in patients with HCC ≤ 5 cm (TR rates 35.4% vs 75.1%, P =.016; LTP 16.0% vs 55.7%, P =.013). Conclusions LR achieved lower TR and LTP rates than RF ablation plus transarterial chemoembolization, but 3-years OS rates were not statistically different between the 2 groups. RF ablation plus transarterial chemoembolization is an effective treatment option in patients with compensated cirrhosis and solitary HCC ≥ 3 cm unsuitable for LR.
Inglese
Saviano, A., Iezzi, R., Giuliante, F., Salvatore, L., Mele, C., Posa, A., Ardito, F., De Gaetano, A. M., Pompili, M., Rinninella, E., Zocco, M. A., Riccardi, L., Annicchiarico, B. E., Siciliano, M., De Matthaeis, N., Grieco, A., Rapaccini, G. L., Gasbarrini, A., Liver Resection versus Radiofrequency Ablation plus Transcatheter Arterial Chemoembolization in Cirrhotic Patients with Solitary Large Hepatocellular Carcinoma, <>, 2017; 28 (11): 1512-1519. [doi:10.1016/j.jvir.2017.06.016] [http://hdl.handle.net/10807/170722]
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