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Original Research |
1 Department of Radiology, APHP-Hôpital Beaujon, 100 Boulevard du General
Leclerc, Clichy 92118, France.
2 Department of Pathology, APHP-Hôpital Beaujon, Clichy 92118,
France.
3 Department of Radiology, Ospedale Specializzato in Gastroenterologia
"Saverio de Bellis" IRCCS, Castellana Grotte (Bari) 70013,
Italia.
4 Istituto di Radiologia, Università di Palermo, Via del Vespro 127,
90127 Palermo, Italy.
5 Department of Hepatology, APHP-Hôpital Beaujon, Clichy 92118,
France.
6 Department of Digestive Surgery and Transplantation Unit, APHP-Hôpital
Beaujon, Clichy 92118, France.
7 INSERM unité 773, CRB3. Faculté Xavier-Bichat, 16 rue Henri
Huchart, 75018 Paris, France.
OBJECTIVE. The aims of this study were to determine the feasibility and efficacy of percutaneous radiofrequency ablation in patients with hepatocellular carcinoma waiting for liver transplantation and to compare the radiologic and pathologic findings.
SUBJECTS AND METHODS. Twenty-six patients with 35 hepatocellular carcinomas were addressed for transplantation. Complications of the procedures were recorded. Primary and secondary technique effectiveness and causes of exclusion from the waiting list were assessed. After transplantation, tumor recurrence was evaluated for at least 1 year in all patients. Radiologic-pathologic comparison of the explant was performed.
RESULTS. Percutaneous radiofrequency ablation was performed in 21 (81%) patients for 28 tumors. Both minor and major complications occurred in three patients (10% each per session). The rates of primary technique effectiveness, secondary technique effectiveness for percutaneous radiofrequency ablation alone (seven tumors), and combined percutaneous radiofrequency ablation and transcatheter arterial chemoembolization (three tumors) were 56%, 76%, and 86%, respectively. After a mean follow-up of 11.9 months, 16 patients (76%) received transplants, whereas five patients were excluded from the waiting list because of distant tumor progression (n =3, 14%) or other causes (n = 2, 10%). After transplantation, tumor recurred in one (6%) of 16 patients. Histopathologic examinations were performed for 13 (81%) of 16 patients and showed complete necrosis and satellite nodules in, respectively, 12 (75%) and seven (44%) of 16 tumors.
CONCLUSION. Percutaneous radiofrequency ablation can be performed on hepatocellular carcinoma patients waiting for transplantation, allows most patients to undergo transplantation, and does not impair posttransplantation outcomes. The procedure produces complete necrosis of the treated tumor in most cases but is associated with a high rate of satellite nodules.
Keywords: ablation • cancer • hepatocellular carcinoma • liver transplantation • radiofrequency
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