Reuters Health Information (2011-12-21): Long-term survival possible with radiofrequency ablation of liver tumors
Long-term survival possible with radiofrequency ablation of liver tumors
Last Updated: 2011-12-21 16:58:02 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In a study from Japan, one in four patients with hepatocellular carcinoma treated with percutaneous radiofrequency ablation (RFA) was still alive 10 years later.
"Our 10-year clinical experience shows that RFA could be locally curative, resulting in survival for as long as 10 years, and was a safe procedure," conclude the authors of the report in the American Journal of Gastroenterology online December 13.
RFA has become widely adopted for cases of unresectable hepatocellular carcinoma, and there have been several reports of five-year outcomes with the technique. Reports of 10-year outcomes are rare. Last year, Peng et al from Sun Yat-Sen University in Guangzhou, China reported a 10-year survival rate of 33.9% in 224 patients; all had well preserved liver function at baseline, and small solitary tumors.
The current paper, by Dr. Shuichiro Shiina and colleagues at the Graduate School of Medicine of the University of Tokyo, reports on progression, recurrence, and survival in a 10-year case series from their tertiary referral center.
Between 1999 and 2009, the team performed 2982 RFA treatments in 1170 primary HCC patients. Each treatment consisted of repeated procedures as needed, aimed at achieving complete tumor necrosis on CT imaging. Thus, a total of 4514 procedures were performed, resulting in complete ablation of 99.4% of treated tumors.
Complications such as GI perforation, hemoperitoneum, hepatic infarction or neoplastic seeding occurred in 67 of the 4514 procedures (1.5%), the report indicates.
Median follow-up was 38 months. Local tumor progression was only 3.4% at 10 years, the researchers found. However, rates of distant recurrence were 78.1% at five years and 80.8% at 10 years.
Overall survival was 60.2% at 5 years and 27.3% at 10 years. Hepatocellular carcinoma was the cause of death in 55.8% of cases, Dr. Shiina and colleagues report.
Compared to patients with tumors smaller than 2 cm, outcomes were worse in patients with tumors between 2 and 5 cm but not in those with tumors over 5 cm, the authors note. "This is probably because the number of patients with tumors > 5.0 cm (n = 35) were not large enough for the difference to be statistically significant," they comment.
The authors of a meta-analysis published early last year in the Journal of Hepatology, however, found that RFA is the best ablative therapy for HCC larger than 2 cm, but for smaller tumors, it's not clear whether RFA is best or whether cheaper, less invasive treatments work just as well (see Reuters Health story of January 29, 2010).
Summing up, the authors of the current report conclude, "RFA might be a first-line treatment for selected patients with early-stage HCC."
Peng et al, in last year's paper in the European Journal of Surgical Oncology, agreed. "RFA is considered to be the treatment of first choice for patients with solitary HCC (no larger than) 5 cm and well-preserved liver function," they wrote. "Surgery can be used as second-line therapy...if RFA is unfeasible."
There isn't unanimous agreement, however. This past August, a group from Taiwan reported that for patients with well preserved liver function and early or very early HCC, five-year survival was equivalent with either surgery or RFA, but disease-free survival was better with surgery. Sheng-Nan Lu et al concluded that while RFA may be an option for patients ineligible for surgery, surgery should be the first choice if liver transplantation is not an option (see Reuters Health story of August 3, 2011).
Am J Gastroenterol 2011.