PERCUTANEOUS RADIOFREQUENCY ABLATION AS A FIRST LINE TREATMENT FOR HEPATOCELLULAR CARCINOMA – PROSPECTIVE COHORT STUDY FROM A TERTIARY CARE CENTRE, KERALA, INDIA
Keywords:Radiofrequency ablation, hepatocellular carcinoma, predictors, recurrence rate, event free survival
There is scarcity of Indian data on the effectiveness of radiofrequency ablation (RFA) as the first line therapy. The aim of the study was to evaluate the recurrence rate after RFA as the first-line therapy for early-stage hepatocellular carcinoma (HCC).
Materials and Methods: Hospital based prospective cohort study. The study period was from September 2016 to august 2018, during which 61 patients with early stage HCC without coagulopathy were included into the study after obtaining written consent. Image guided RFA was performed as a first-line treatment for early HCCs with a maximum diameter of 3 cm or solitary tumour with a diameter of <5 cm. Follow up was performed on day 1 post procedure to identify residue and for a period of 2 years after which results were analyzed for tumor recurrence, as well as recurrence-free survival time. Chi Square test was used to analyse the association of recurrence, event free survival and local tumour progression. Kaplan Meir survival analysis was used to find the event free survival.
Results: The recurrence rate was 54.1%. The Local Tumour Progression rate was 36.36%; and the Intra hepatic distant recurrence rate was 51.51%. The overall 2-year survival was 96.73%. The event free survival for 2 years was 17.87 months (95% CI 16.0, 19.6 months). Significant predictive factors for poor recurrence free survival were age>65 years, AFP levels >200 ng/ml and multiple tumour.
Conclusion: Percutaneous RFA can be used as first-line treatment for early stage HCC.
I. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249
II. El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007 Jun;132(7):2557–76.
III. Acharya SK. Epidemiology of hepatocellular carcinoma in India. J Clin Exp Hepatol. 2014 Aug;4(Suppl 3):S27-33.
IV. Lokesh KN, Chaudhuri T, Lakshmaiah KC, Babu KG, Dasappa L, Jacob LA, Suresh Babu MC, Rudresha AH, Rajeev LK. Advanced hepatocellular carcinoma: A regional cancer center experience of 48 cases. Indian J Cancer. 2017 Jul-Sep;54(3):526-529
V. Kumar R, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Characteristics of hepatocellular carcinoma in India: a retrospective analysis of 191 cases. QJM Mon J Assoc Physicians. 2008 Jun;101(6):479–85.
VI. Chevret S, Trinchet JC, Mathieu D, Rached AA, Beaugrand M, Chastang C. A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d’Etude et de Traitement du Carcinome Hépatocellulaire. J Hepatol. 1999 Jul;31(1):133–41.
VII. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001 Sep;35(3):421–30.
VIII. Gao J, Wang S-H, Ding X-M, Sun W-B, Li X-L, Xin Z-H, et al. Radiofrequency ablation for single hepatocellular carcinoma 3 cm or less as first-line treatment. World J Gastroenterol WJG. 2015 May 7;21(17):5287–94.
IX. Chen M-S, Li J-Q, Zheng Y, Guo R-P, Liang H-H, Zhang Y-Q, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006 Mar;243(3):321–8.
X. Lee DH, Lee JM, Lee JY, Kim SH, Yoon JH, Kim YJ, Han JK, Choi BI. Radiofrequency ablation of hepatocellular carcinoma as first-line treatment: long-term results and prognostic factors in 162 patients with cirrhosis. Radiology. 2014 Mar;270(3):900-9.
XI. Kim Y, Lim HK, Rhim H, Lee MW, Choi D, Lee WJ, et al. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol. 2013 Jan;58(1):89–97.
XII. Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, et al. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol. 2012 Apr;107(4):569–77; quiz 578.
XIII. Zytoon AA, Ishii H, Murakami K, El-Kholy MR, Furuse J, El-Dorry A, et al. Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome. Jpn J Clin Oncol. 2007 Sep;37(9):658–72.
XIV. Filippiadis DK, Kelekis NL. Percutaneous radiofrequency ablation for the treatment of hepatocellular carcinoma: long-term follow up, efficacy and prognostic factors. Ann Gastroenterol Q Publ Hell Soc Gastroenterol. 2013;26(4):368–70.
XV. Hori T, Nagata K, Hasuike S, Onaga M, Motoda M, Moriuchi A, et al. Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol. 2003;38(10):977–81.
XVI. Komorizono Y, Oketani M, Sako K, Yamasaki N, Shibatou T, Maeda M, et al. Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer. 2003 Mar 1;97(5):1253–62.
XVII. Harrison LE, Koneru B, Baramipour P, Fisher A, Barone A, Wilson D, et al. Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg. 2003 Nov;197(5):759–64.
XVIII. Lee S, Rhim H, Kim Y-S, Choi D, Lee WJ, Lim HK, et al. Percutaneous Radiofrequency Ablation of Hepatocellular Carcinomas: Factors Related to Intraprocedural and Postprocedural Pain. Am J Roentgenol. 2009 Apr 1;192(4):1064–70.
XIX. Cucchetti A, Piscaglia F, Caturelli E, Benvegnù L, Vivarelli M, Ercolani G, et al. Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol. 2009 Feb;16(2):413–22.
XX. Yamamoto J, Kosuge T, Saiura A, Sakamoto Y, Shimada K, Sano T, et al. Effectiveness of Hepatic Resection for Early-stage Hepatocellular Carcinoma in Cirrhotic Patients: Subgroup Analysis according to Milan Criteria. Jpn J Clin Oncol. 2007 Apr 1;37(4):287–95.
XXI. Kang TW, Kim JM, Rhim H, Lee MW, Kim YS, Lim HK, Choi D, Song KD, Kwon CH, Joh JW, Paik SW, Paik YH, Ahn JH. Small Hepatocellular Carcinoma: Radiofrequency Ablation versus Nonanatomic Resection--Propensity Score Analyses of Long-term Outcomes. Radiology. 2015 Jun;275(3):908-19. doi: 10.1148/radiol.15141483
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