Clinical

Laser ablation safe, effective for small hepatocellular tumors

Last Updated: 2008-03-13 13:31:01 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Percutaneous laser ablation is a safe and effective treatment for small hepatocellular carcinoma (HCC) nodules, researchers from Italy report in the March issue of Radiology.

Dr. Vincenzo Arienti and colleagues from Maggiore Hospital in Bologna reviewed liver tumor databases from nine treatment centers. They identified 520 men and women who underwent percutaneous laser ablation between 1996 and 2004 for a total of 647 HCC nodules of any size (small, 0-3 cm; intermediate, 3-5 cm; large, greater than 5 cm; mean diameter, 3.2 cm).

The primary effectiveness rate - defined as the percentage of HCCs completely ablated after percutaneous laser ablation - was 60% in all HCCs and 81% in HCCs smaller than 3 cm, the team reports.

Major complications occurred in 15 (1.5%) of 1004 percutaneous laser ablation sessions and were associated with technical or anatomic factors, but not HCC diameter or patient characteristics.

In multivariate analysis, the likelihood of a major complication was estimated to be 22-times higher in patients with a deep nodule compared with patients with a superficial nodule, and 32-times higher if the laser energy level exceeded 7200 J, regardless of nodule size.

Minor complications -- mainly asymptomatic perihepatic fluid collection or minimal subcapsular hematoma -- occurred in 62 (6.2%) of 1004 laser ablation sessions and were associated with lower prothrombin time, higher mean bilirubin and excess energy, according to the investigators.

In this study, neither needle track seeding nor unexpected tumor spreading was observed.

Four of the 520 patients died, resulting in a mortality rate of 0.8%, which "may be comparable with the rates reported for other ablation techniques," Dr. Arienti and colleagues say. "It is important to note," they add, that all four deaths occurred in patients with advanced liver disease (cirrhosis and/or HCC) and only during the initial period (1996 to 2000) "when patients with Child-Pugh grade C, coagulation deficit, or large HCC nodules were not always excluded from treatment," they note.

Dr. Arienti and colleagues conclude that percutaneous laser ablation can be considered an alternative option to percutaneous ethanol injection and radiofrequency, "owing to its low number of complications and its primary effectiveness rate in small HCCs."

Radiology 2008;246:947-955.