Effectiveness of Radiofrequency Ablation of Hepatocellular Carcinoma

Excerpt

We read with interest the article by Rodriguez-Sanjuan et al., “Radiological and pathological assessment of hepatocellular carcinoma (HCC) response to radiofrequency ablation. A study on removed liver after transplantation” [1]. Among 30 hepatocellular carcinoma (HCC) nodules ranging between 1.5 and 6.0 cm in diameter, the authors found that pathologic response was complete in 14 nodules (46.7%) and incomplete in 16 nodules (53.3%), and that there was no significant relationship between complete necrosis and tumor diameter. In fact, the mean diameter in cases with complete and partial necrosis was 2.86 and 3.28 cm, respectively (p not significant). Furthermore, according to the data reported in their Table 1, complete necrosis was found in 8/16 (50%) tumors up to 3 cm large, in 6/14 (43%) between 3.1 and 6.0 cm, and in 4/6 (66.7%) smaller than 2 cm [1]. These results are quite surprising considering that in tumors up to 3 cm large submitted to radiofrequency ablation (RFA) as a bridge treatment to liver transplantation, the rate of complete necrosis at explant analysis has been shown to range between 62 and 78% [2‐4], and that 3 cm is a significant risk factor for the achievement of pathologically proven complete necrosis [2, 3]. Even the rate of complete necrosis in tumors smaller than 2 cm is lower than what would be expected. In a recent article by Livraghi et al. [5], among 218 HCC nodules smaller than 2 cm treated by RFA, the rate of sustained complete necrosis at imaging evaluation was shown to be 97.2% after a mean follow-up period after ablation of 31 months. …