Abstract
Objectives: Radiofrequency ablation plays a key role in the treatment of early-stage hepatocellular carcinoma. However, it is not recommended for intermediate-stage hepatocellular carcinoma. The objective of this study was to clarify the efficacy and safety of radiofrequency ablation for treating intermediate-stage hepatocellular carcinoma. Methods: We examined the outcome of 65 consecutive patients who were treated with radiofrequency ablation with or without transarterial chemoembolization for intermediate-stage hepatocellular carcinoma. Results: With a median follow-up of 37 months, overall survival rates of 65 cases at 1, 3, 5, and 7 years were 90, 70, 51, and 36%, respectively. Multivariate analysis of clinical parameters revealed that the multicentric occurrence (MC)/intrahepatic metastasis (IM) was the only significant prognostic factor for overall survival (hazard ratio, 4.9; 95% confidence intervals, 2.1-11.4). Tumor size and tumor number were not significant factors for survival. The overall survival rates of patients with MC (n = 33) at 1, 3, 5, and 7 years were 97, 90, 80, and 59%, respectively; those for patients with IM (n = 32) were 86, 55, 14, and 8%, respectively (p < 0.0001). Two cases (4.9%) had complications of hemothorax and diaphragmatic burn; however, no major complications were observed. Conclusion: Radiofrequency ablation is safe and effective for the treatment of intermediate-stage hepatocellular carcinoma, especially for patients with MC.
Journal Section:
Clinical Study
References
1.
El-Serag HB: Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology 2012;142:1264-1273.
[PubMed]
2.
de Lope CR, Tremosini S, Forner A, Reig M, Bruix J: Management of HCC. J Hepatol 2012;56(suppl 1):S75-S87.
[PubMed]
3.
Livraghi T, Makisalo H, Line PD: Treatment options in hepatocellular carcinoma today. Scand J Surg 2011;100:22-29.
[PubMed]
4.
Kudo M: Radiofrequency ablation for hepatocellular carcinoma: updated review in 2010. Oncology 2010;78(suppl 1):113-124.
[PubMed]
5.
Minami Y, Kudo M: Radiofrequency ablation of hepatocellular carcinoma: current status. World J Radiol 2010;2:417-424.
[PubMed]
6.
Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Sato T, Masuzaki R, Kondo Y, Goto T, Yoshida H, Omata M, Koike K: Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol 2012;107:569-577.
[PubMed]
7.
Izumi N: Recent advances of radiofrequency ablation for early hepatocellular carcinoma. J Gastroenterol Hepatol 2011;26(suppl 1):115-122.
[PubMed]
8.
Lin SM: Local ablation for hepatocellular carcinoma in Taiwan. Liver Cancer 2013;2:73-83.
[PubMed]
9.
Tanaka M, Ando E, Simose S, Hori M, Kuraoka K, Ohno M, Yutani S, Harada K, Sata M: Radiofrequency ablation combined with transarterial chemoembolization for intermediate hepatocellular carcinoma. Hepatol Res 2014;44:194-200.
[PubMed]
10.
Min JH, Lee MW, Cha DI, Jeon YH, Shin SW, Cho SK, Rhim H, Lim HK: Radiofrequency ablation combined with chemoembolization for intermediate-sized (3-5 cm) hepatocellular carcinomas under dual guidance of biplane fluoroscopy and ultrasonography. Korean J Radiol 2013;14:248-258.
[PubMed]
11.
Kokudo N: Recent progress in the treatment and diagnosis of hepatocellular carcinoma. Liver Cancer 2013;2:4.
12.
Kudo M, Matsui O, Izumi N, Iijima H, Kadoya M, Imai Y, Okusaka T, Miyayama S, Tsuchiya K, Ueshima K, Hiraoka A, Ikeda M, Ogasawara S, Yamashita T, Minami T, Yamakado K: JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the Liver Cancer Study Group of Japan. Liver Cancer 2014;3:458-468.
[PubMed]
13.
Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, Matsuyama Y, Nakanuma Y, Kojiro M, Makuuchi M, Yamaoka Y: Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8,510 patients. Gastroenterology 2006;131:461-469.
[PubMed]
14.
Matsui O: Current status of hepatocellular carcinoma treatment in Japan: transarterial chemoembolization. Clin Drug Investig 2012;32(suppl 2):3-13.
[PubMed]
15.
Yamakado K, Miyayama S, Hirota S, Mizunuma K, Nakamura K, Inaba Y, Maeda H, Matsuo K, Nishida N, Aramaki T, Anai H, Koura S, Oikawa S, Watanabe K, Yasumoto T, Furuichi K, Yamaguchi M: Subgrouping of intermediate-stage (BCLC stage B) hepatocellular carcinoma based on tumor number and size and Child-Pugh grade correlated with prognosis after transarterial chemoembolization. Jpn J Radiol 2014;32:260-265.
[PubMed]
16.
Nishikawa H, Kita R, Kimura T, Ohara Y, Takeda H, Sakamoto A, Saito S, Nishijima N, Nasu A, Komekado H, Osaki Y: Transcatheter arterial chemoembolization for intermediate-stage hepatocellular carcinoma: clinical outcome and safety in elderly patients. J Cancer 2014;5:590-597.
[PubMed]
17.
Minami Y, Yagyu Y, Murakami T, Kudo M: Tracking navigation imaging of transcatheter arterial chemoembolization for hepatocellular carcinoma using three-dimensional cone-beam CT angiography. Liver Cancer 2014;3:53-61.
[PubMed]
18.
Raoul JL, Gilabert M, Piana G: How to define transarterial chemoembolization failure or refractoriness: a European perspective. Liver Cancer 2014;3:119-124.
[PubMed]
19.
Ando E, Tanaka M, Yamashita F, Kuromatsu R, Yutani S, Fukumori K, Sumie S, Yano Y, Okuda K, Sata M: Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: analysis of 48 cases. Cancer 2002;95:588-595.
[PubMed]
20.
Yamasaki T, Kimura T, Kurokawa F, Aoyama K, Ishikawa T, Tajima K, Yokoyama Y, Takami T, Omori K, Kawaguchi K, Tsuchiya M, Terai S, Sakaida I, Okita K: Prognostic factors in patients with advanced hepatocellular carcinoma receiving hepatic arterial infusion chemotherapy. J Gastroenterol 2005;40:70-78.
[PubMed]
21.
Ueshima K, Kudo M, Takita M, Nagai T, Tatsumi C, Ueda T, Kitai S, Ishikawa E, Yada N, Inoue T, Hagiwara S, Minami Y, Chung H: Hepatic arterial infusion chemotherapy using low-dose 5-fluorouracil and cisplatin for advanced hepatocellular carcinoma. Oncology 2010;78(suppl 1):148-153.
[PubMed]
22.
Yamasaki T, Sakaida I: Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma and future treatments for the poor responders. Hepatol Res 2012;42:340-348.
[PubMed]
23.
Nishikawa H, Osaki Y, Kita R, Kimura T: Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma in Japan. Cancers (Basel) 2012;4:165-183.
[PubMed]
24.
Nouso K, Miyahara K, Uchida D, Kuwaki K, Izumi N, Omata M, Ichida T, Kudo M, Ku Y, Kokudo N, Sakamoto M, Nakashima O, Takayama T, Matsui O, Matsuyama Y, Yamamoto K: Effect of hepatic arterial infusion chemotherapy of 5-fluorouracil and cisplatin for advanced hepatocellular carcinoma in the nationwide survey of primary liver cancer in Japan. Br J Cancer 2013;109:1904-1907.
[PubMed]
25.
Kudo M: Surveillance, diagnosis, treatment, and outcome of liver cancer in Japan. Liver Cancer 2015;4:39-50.
[PubMed]
26.
Kudo M: Hepatocellular carcinoma 2009 and beyond: from the surveillance to molecular targeted therapy. Oncology 2008;75(suppl 1):1-12.
[PubMed]
27.
Kudo M: The 2008 Okuda lecture: management of hepatocellular carcinoma: from surveillance to molecular targeted therapy. J Gastroenterol Hepatol 2010;25:439-452.
[PubMed]
28.
Kudo M: Current status of molecularly targeted therapy for hepatocellular carcinoma: clinical practice. Int J Clin Oncol 2010;15:242-255.
[PubMed]
29.
Kudo M, Ueshima K: Positioning of a molecular-targeted agent, sorafenib, in the treatment algorithm for hepatocellular carcinoma and implication of many complete remission cases in Japan. Oncology 2010;78(suppl 1):154-166.
[PubMed]
30.
Lencioni R, Marrero J, Venook A, Ye SL, Kudo M: Design and rationale for the non-interventional global investigation of therapeutic decisions in hepatocellular carcinoma and of its treatment with sorafenib (GIDEON) study. Int J Clin Pract 2010;64:1034-1041.
[PubMed]
31.
Kudo M: Molecular targeted therapy for hepatocellular carcinoma: bench to bedside. Dig Dis 2011;29:273-277.
[PubMed]
32.
Kudo M: Future treatment option for hepatocellular carcinoma: a focus on brivanib. Dig Dis 2011;29:316-320.
[PubMed]
33.
Kudo M: Targeted therapy for liver cancer: updated review in 2012. Curr Cancer Drug Targets 2012;12:1062-1072.
[PubMed]
34.
Peck-Radosavljevic M: Drug therapy for advanced-stage liver cancer. Liver Cancer 2014;3:125-131.
[PubMed]
35.
Siegel AB, El-Khoueiry AB, Finn RS, Guthrie KA, Goyal A, Venook AP, Blanke CD, Verna EC, Dove L, Emond J, Kato T, Samstein B, Busuttil R, Remotti H, Coffey A, Brown RS Jr: Phase I trial of sorafenib following liver transplantation in patients with high-risk hepatocellular carcinoma. Liver Cancer 2015;4:115-125.
[PubMed]
36.
Akamatsu N, Sugawara Y, Kokudo N: Living donor liver transplantation for patients with hepatocellular carcinoma. Liver Cancer 2014;3:108-118.
[PubMed]
37.
Sugawara Y, Kokudo N: Surgical treatment of hepatocellular carcinoma: comparison of resection and transplantation. Oncology 2008;75(suppl 1):119-123.
[PubMed]
38.
Chan SC, Sharr WW, Chan AC, Chok KS, Lo CM: Rescue living-donor liver transplantation for liver failure following hepatectomy for hepatocellular carcinoma. Liver Cancer 2013;2:332-337.
[PubMed]
39.
Chan SC: Liver transplantation for hepatocellular carcinoma. Liver Cancer 2013;2:338-344.
[PubMed]
40.
Kaido T, Ogawa K, Mori A, Fujimoto Y, Ito T, Tomiyama K, Takada Y, Uemoto S: Usefulness of the Kyoto criteria as expanded selection criteria for liver transplantation for hepatocellular carcinoma. Surgery 2013;154:1053-1060.
[PubMed]
41.
Takada Y, Uemoto S: Liver transplantation for hepatocellular carcinoma: the Kyoto experience. J Hepatobiliary Pancreat Sci 2010;17:527-532.
[PubMed]
42.
Ito T, Takada Y, Ueda M, Haga H, Maetani Y, Oike F, Ogawa K, Sakamoto S, Ogura Y, Egawa H, Tanaka K, Uemoto S: Expansion of selection criteria for patients with hepatocellular carcinoma in living donor liver transplantation. Liver Transpl 2007;13:1637-1644.
[PubMed]
43.
Takada Y, Ito T, Ueda M, Sakamoto S, Haga H, Maetani Y, Ogawa K, Ogura Y, Oike F, Egawa H, Uemoto S: Living donor liver transplantation for patients with HCC exceeding the Milan criteria: a proposal of expanded criteria. Dig Dis 2007;25:299-302.
[PubMed]
44.
Llovet JM: Updated treatment approach to hepatocellular carcinoma. J Gastroenterol 2005;40:225-235.
[PubMed]
45.
Pons F, Varela M, Llovet JM: Staging systems in hepatocellular carcinoma. HPB (Oxford) 2005;7:35-41.
[PubMed]
46.
Bolondi L, Burroughs A, Dufour JF, Galle PR, Mazzaferro V, Piscaglia F, Raoul JL, Sangro B: Heterogeneity of patients with intermediate (BCLC B) hepatocellular carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 2012;32:348-359.
[PubMed]
47.
Bruix J, Sherman M: Management of hepatocellular carcinoma. Hepatology 2005;42:1208-1236.
[PubMed]
48.
Liver Cancer Study Group of Japan: General Rules for the Clinical and Pathological Study of Primary Liver Cancer, ed 3. Tokyo, Kanehara & Co Ltd, 2010.
49.
Kariyama K, Nouso K, Wakuta A, Kishida M, Nishimura M, Wada N, Higashi T: Percutaneous radiofrequency ablation for treatment of hepatocellular carcinoma in the caudate lobe. AJR Am J Roentgenol 2011;197:W571-W575.
[PubMed]
50.
Garwood ER, Fidelman N, Hoch SE, Kerlan RK Jr, Yao FY: Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction. Liver Transpl 2013;19:164-173.
[PubMed]
51.
Koda M, Murawaki Y, Hirooka Y, Kitamoto M, Ono M, Sakaeda H, Joko K, Sato S, Tamaki K, Yamasaki T, Shibata H, Shimoe T, Matsuda T, Toshikuni N, Fujioka S, Ohmoto K, Nakamura S, Kariyama K, Aikata H, Kobayashi Y, Tsutsui A: Complications of radiofrequency ablation for hepatocellular carcinoma in a multicenter study: an analysis of 16,346 treated nodules in 13,283 patients. Hepatol Res 2012;42:1058-1064.
[PubMed]
52.
Shimada M, Hamatsu T, Yamashita Y, Rikimaru T, Taguchi K, Utsunomiya T, Shirabe K, Sugimachi K: Characteristics of multicentric hepatocellular carcinomas: comparison with intrahepatic metastasis. World J Surg 2001;25:991-995.
[PubMed]
53.
Wakuta A, Nouso K, Kariyama K, Nishimura M, Kishida M, Wada N, Mizushima T, Higashi T, Tanimoto M: Radiofrequency ablation for the treatment of hepatocellular carcinoma with decompensated cirrhosis. Oncology 2011;81:39-44.
[PubMed]
54.
Irie T, Kuramochi M, Takahashi N: Dense accumulation of lipiodol emulsion in hepatocellular carcinoma nodule during selective balloon-occluded transarterial chemoembolization: measurement of balloon-occluded arterial stump pressure. Cardiovasc Intervent Radiol 2013;36:706-713.
[PubMed]
55.
Lencioni R, de Baere T, Burrel M, Caridi JG, Lammer J, Malagari K, Martin RC, O'Grady E, Real MI, Vogl TJ, Watkinson A, Geschwind JF: Transcatheter treatment of hepatocellular carcinoma with Doxorubicin-loaded DC Bead (DEBDOX): technical recommendations. Cardiovasc Intervent Radiol 2012;35:980-985.
[PubMed]
56.
Lencioni R: Chemoembolization in patients with hepatocellular carcinoma. Liver Cancer 2012;1:41-50.
[PubMed]
© 2015 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2015
You do not currently have access to this content.
