Clinical

Radiofrequency ablation effectively treats large liver tumors

Last Updated: 2004-03-19 13:50:04 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Radiofrequency ablation (RFA) using a surgical approach is a safe and effective treatment for patients with hepatocellular carcinomas (HCCs) measuring 3.1 to 8.0 centimeters in diameter, even in patients with cirrhosis and suboptimal liver function.

Lead investigator Dr. Ronnie T. P. Poon told Reuters Health that the predominant use of a surgical approach in patients with large HCCs "probably explains the much higher complete ablation rate" achieved than that seen in previous studies of percutaneous RFA for HCCs of similar size.

"Large HCCs often require more than one pass of the RFA electrode for complete ablation, even using the clustered cool-tip electrode," he pointed out, "and this is better done with surgical approach."

In reporting their findings in the March issue of the Archives of Surgery, the investigators note that high complete ablation rates (up to 95%) have been noted previously with the use of RFA for HCCs measuring 3 cm or smaller but the effectiveness for larger HCCs is less well established.

Dr. Poon from The University of Hong Kong and colleagues evaluated the results of RFA in 35 patients with HCCs 3.1 to 8.0 cm in diameter in comparison with the results of RFA in 51 patients with HCCs 3 cm or less.

The majority of patients had unresectable disease due to poor hepatic function. The choice of treatment route -- percutaneous or open surgery with a single or cluster cool-tip electrode -- was based on tumor size and position. Most patients with larger tumors underwent the open procedure.

Complete ablation rates after a single treatment session as assessed by computed tomography at one month were comparable between the two groups -- 94% in patients with HCCs 3 cm or smaller and 91% in those with tumors 3.1 to 8.0 cm. Complication rates were also comparable (12% and 17%), as were 1-year survival rates (86% and 81%).

Although studies with longer follow-up are needed, the researchers conclude,"on the basis of immediate and short-term follow-up," RFA is an option for the treatment of HCCs larger than 3 cm.

Arch Surg 2004;139:281-287.