Reuters Health Information (2013-04-08): High-intensity focused ultrasound compares favorably with RFA for recurrent hepatoma
Drug & Device Development
High-intensity focused ultrasound compares favorably with RFA for recurrent hepatoma
Last Updated: 2013-04-08 15:20:21 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Survival with recurrent hepatocellular carcinoma (HCC) seems similar after high-intensity focused ultrasound (HIFU) or radiofrequency ablation (RFA), researchers say.
But the main message is that "recurrent HCC is no longer a terminal event given the advancement in different treatment modalities in recent years," Dr. Albert Chan from Queen Mary Hospital and the University of Hong Kong told Reuters Health in an email.
He calls HIFU "a truly non-invasive local ablative therapy" -- no needle puncture of the tumor is required - "with promising outcomes." He believes it could be particularly useful for patients who've already had a liver resection and are reluctant to undergo further resection for recurrent disease.
His conclusions are drawn from his group's preliminary experience with HIFU for recurrent HCC. As they explained online February 19th in Annals of Surgery, HIFU delivers a high-intensity ultrasound beam into a targeted area, causing hyperthermia and coagulation necrosis of tumor cells.
Altogether, Dr. Sheung Tat Fan and colleagues from The University of Hong Kong studied 103 patients with recurrent HCC, including 27 who underwent HIFU ablation, and 76 who had RFA, which is a common initial treatment for primary HCC.
The procedure-related morbidity did not differ significantly with HIFU (7.4%) vs RFA. That was true whether the RFA group consisted only of those having percutaneous procedures (procedure-related morbidity rate, 6.5%; p=1.0) or also included cases of RFA during open or laparoscopic surgeries (22.4%; p=0.44).
After median follow-up times of 30.3 months for HIFU and 24.6 months for RFA, 10 HIFU patients (37%) and 35 RFA patients (46%) remained free of recurrence, the authors reported.
Disease-free survival rates at one, two, and three years did not differ significantly between the HIFU group (37.0%, 25.9%, and 18.5%, respectively) and the RFA group (48.6%, 32.1%, and 26.5%, respectively).
After adjusting for Child-Pugh scores, overall one-, two- and three-year survival rates were also similar after HIFU (100%, 83.3%, and 70.2%, respectively) and RFA (96.1%, 80.1%, and 64.6%, respectively).
Tumor recurrence within 12 months after treatment of primary HCC was the only independent predictor of poor disease-free survival.
"Our preliminary experience in using HIFU for recurrent HCC is promising," the researchers conclude.
They add, "The noninvasiveness of HIFU therapy could render it an ideal bridging therapy for patients with HCC who are wait-listed for liver transplantation. With accumulating experience in the clinical application of HIFU for recurrent HCC, we anticipate to witness an extension of its role to the treatment of other liver tumors in the near future."
"We started the use of HIFU back in 2006 and initially we tended to select patients with recurrent disease or inoperable hepatocellular carcinoma," Dr. Chan said. "In addition to good liver function reserve, the tumors need to be detectable by ultrasonography and be away from gallbladder or adjacent right hepatic flexure of the colon. Hence, centrally located right liver tumor or tumor near the liver dome would be ideal for the use of HIFU."
On the other hand, he said, "Subcapsular lesions near the abdominal wall or behind the ribs may sometimes prove to be unfavorable for HIFU as the targeting could be obscured by the overlying ribs and the energy dissipated could lead to skin burn overlying the targeted area. In these situations, radiofrequency ablation is preferred."
Ann Surg 2013.