Background and Aims: To report long-term results in treatment of intermediate hepatocellular carcinoma (HCC) in cirrhotics using new high-powered microwaves (MWS) ablation alone. Methods: This multicenter study included 215 cirrhotics (age range: 67–84 years; 137 males; 149 Child A, 66 Child B) who underwent percutaneous ultrasound-guided high-powered MWS ablation instead of transarterial chemoem-bolization. Among the patient population, 109 had a single nodule (Ø 5.3–8 cm)[groupA],70had2nodules(Ø3–6 cm) [group B] and 36 had 3–5 nodules(Ø1.5–6.8 cm) [group C]. MWS ablation efficacy was evaluated using enhanced-computed tomography and/or magnetic resonance imaging. Primary end-point was 5-year cumulative overall survival (OS). Results: On enhanced-computed tomography and/or magnetic resonance imaging, complete ablation rates were 100% for 1.5–3.5 cm nodules. In nodules >3.5–5 cm, it was 89% for the first ablation and 100% for the second. For lesions >5–8 cm, ablation was up to 92%. Overall, 1-, 3-and 5-year survival rates were 89, 60, and 21%, respectively. The cumulative OS rate of group A was 89%, 66% and 34% at 1, 3 and 5 years.The cumulative OSrate of group B was 88%,60% and 11% at 1, 3 and 5 years. The cumulative OS rate of group C was 86%, 55% and 0%. The 5-year survival rate was significantly different among the groups (p <0.001). One patient died from rupture of HCC. Upon multivariate analysis, preablation total bilirubin >1.5 mg/dL was an independent factor for predicting lower survival. Conclusions: Percutaneous MWS ablation of intermediate HCC is safe and effective in inducing large volume of necrosis in intermediate HCC nodules, providing long-term survival rates similar to transarterial chemoembolization. Pre-ablation total bilirubin >1.5 mg/dL as expression of liver function reserve is the main factor predicting a worse outcome.

Giorgio, A., Gatti, P., Montesarchio, L., Merola, M. G., Amendola, F., Calvanese, A., Iaquinto, G., Fontana, M., Ciraci, E., Semeraro, S., Santoro, B., Coppola, C., Matteucci, P., Giorgio, V., Microwave ablation in intermediate hepatocellular carcinoma in cirrhosis: An italian multicenter prospective study, <<JOURNAL OF CLINICAL AND TRANSLATIONAL HEPATOLOGY>>, 2018; 6 (3): 251-257. [doi:10.14218/JCTH.2018.00013] [http://hdl.handle.net/10807/206986]

Microwave ablation in intermediate hepatocellular carcinoma in cirrhosis: An italian multicenter prospective study

Matteucci, P.;Giorgio, V.
2018

Abstract

Background and Aims: To report long-term results in treatment of intermediate hepatocellular carcinoma (HCC) in cirrhotics using new high-powered microwaves (MWS) ablation alone. Methods: This multicenter study included 215 cirrhotics (age range: 67–84 years; 137 males; 149 Child A, 66 Child B) who underwent percutaneous ultrasound-guided high-powered MWS ablation instead of transarterial chemoem-bolization. Among the patient population, 109 had a single nodule (Ø 5.3–8 cm)[groupA],70had2nodules(Ø3–6 cm) [group B] and 36 had 3–5 nodules(Ø1.5–6.8 cm) [group C]. MWS ablation efficacy was evaluated using enhanced-computed tomography and/or magnetic resonance imaging. Primary end-point was 5-year cumulative overall survival (OS). Results: On enhanced-computed tomography and/or magnetic resonance imaging, complete ablation rates were 100% for 1.5–3.5 cm nodules. In nodules >3.5–5 cm, it was 89% for the first ablation and 100% for the second. For lesions >5–8 cm, ablation was up to 92%. Overall, 1-, 3-and 5-year survival rates were 89, 60, and 21%, respectively. The cumulative OS rate of group A was 89%, 66% and 34% at 1, 3 and 5 years.The cumulative OSrate of group B was 88%,60% and 11% at 1, 3 and 5 years. The cumulative OS rate of group C was 86%, 55% and 0%. The 5-year survival rate was significantly different among the groups (p <0.001). One patient died from rupture of HCC. Upon multivariate analysis, preablation total bilirubin >1.5 mg/dL was an independent factor for predicting lower survival. Conclusions: Percutaneous MWS ablation of intermediate HCC is safe and effective in inducing large volume of necrosis in intermediate HCC nodules, providing long-term survival rates similar to transarterial chemoembolization. Pre-ablation total bilirubin >1.5 mg/dL as expression of liver function reserve is the main factor predicting a worse outcome.
Inglese
Giorgio, A., Gatti, P., Montesarchio, L., Merola, M. G., Amendola, F., Calvanese, A., Iaquinto, G., Fontana, M., Ciraci, E., Semeraro, S., Santoro, B., Coppola, C., Matteucci, P., Giorgio, V., Microwave ablation in intermediate hepatocellular carcinoma in cirrhosis: An italian multicenter prospective study, <<JOURNAL OF CLINICAL AND TRANSLATIONAL HEPATOLOGY>>, 2018; 6 (3): 251-257. [doi:10.14218/JCTH.2018.00013] [http://hdl.handle.net/10807/206986]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/206986
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