RFA has recently been used to treat primary liver tumors in patients at M. D. Anderson and the G. Pascale National Cancer Institute in Naples, Italy (Curley et al, 2000). The HCCs treated with RFA in this patient population ranged from 1 to 7 cm in greatest dimension. As the size of the tumor increased, the number of deployments of the multiple-array needle electrode and the total time of applying RF energy increased. Primary liver tumors tend to be highly vascular, so a vascular heat sink phenomenon may contribute to the extended ablation times.
All 110 HCC patients in the recent study were followed for a minimum of 12 months after RFA, with a median follow-up of 19 months. Percutaneous RFA was performed in 76 patients (69%), and intraoperative RFA was performed in 34 patients (31%), with 149 discrete HCC tumor nodules treated with RFA. The median diameter of tumors treated percutaneously (2.8 cm) was smaller than the median diameter of lesions treated during laparotomy (4.6 cm). Four patients of the 110, all with tumors less than 4.0 cm in diameter, had local tumor recurrence at the RFA site; all 4 patients subsequently developed recurrent HCC in other areas of the liver. New liver tumors or extrahepatic metastases developed in 50 patients (45.5%), but 56 patients (50.9%) had no evidence of recurrence. Clearly, a longer follow-up period is required to establish long-term disease-free and overall survival rates.
In this study, procedure-related complications were minimal in patients with HCC. There were no treatment-related deaths, but 12.7% of the HCC patients had complications, including symptomatic pleural effusion, fever, pain, subcutaneous hematoma, subcapsular liver hematoma, and ventricular fibrillation. In addition, 1 patient with Child's class B cirrhosis developed ascites, and another with Child's class B cirrhosis developed bleeding in the ablated tumor 4 days after RFA, necessitating hepatic arterial embolization and transfusion of 2 units of packed red blood cells. All patient events resolved with appropriate clinical management within 1 week after RFA, with the exception of the development of ascites, which resolved with the use of diuretics within 3 weeks after RFA. No patient developed thermal injury to adjacent organs or structures, hepatic insufficiency, renal insufficiency, or coagulopathy following the application of RF energy to the target tumors. The overall complication rate after RFA for HCC was low, which is particularly notable because 50 Child's class A, 31 class B, and 29 class C cirrhotic patients were treated.
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