Radiofrequency Ablation of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and is increasing in incidence. The overall prognosis of patients with liver cancer is poor. The Barcelona Clinic Liver Cancer (BCLC) classification in 5 stages is endorsed by European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Disease (AASLD). This classification is recommended for treatment allocation. Because a small proportion of patients are suitable for curative surgical treatment, various locoregional therapies are widely used to manage patients with HCC. The image-guided therapies, also called interventional radiology or interventional oncology (IO) techniques consisted in percutaneous or endovascular approach. This article reviews the different IO treatments available in HCC patients and the strength of the data.

To conduct a cost-effectiveness analysis to determine whether stereotactic body radiation therapy (SBRT) is a cost-effective therapy compared with radiofrequency ablation (RFA) for patients with unresectable colorectal cancer (CRC) liver metastases.

A cost-effectiveness analysis was conducted using a Markov model and 1-month cycle over a lifetime horizon. Transition probabilities, quality of life utilities, and costs associated with SBRT and RFA were captured in the model on the basis of a comprehensive literature review and Medicare reimbursements in 2014. Strategies were compared using the incremental cost-effectiveness ratio, with effectiveness measured in quality-adjusted life years (QALYs). To account for model uncertainty, 1-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay threshold of $100,000 per QALY gained.

In base case analysis, treatment costs for 3 fractions of SBRT and 1 RFA procedure were $13,000 and $4397, respectively. Median survival was assumed the same for both strategies (25 months). The SBRT costs $8202 more than RFA while gaining 0.05 QALYs, resulting in an incremental cost-effectiveness ratio of $164,660 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of median survival from both treatments. Stereotactic body radiation therapy was economically reasonable if better survival was presumed (>1 month gain) or if used for large tumors (>4 cm).

If equal survival is assumed, SBRT is not cost-effective compared with RFA for inoperable colorectal liver metastases. However, if better local control leads to small survival gains with SBRT, this strategy becomes cost-effective. Ideally, these results should be confirmed with prospective comparative data.

Radiofrequency ablation is a minimally invasive technique that can produce tissue coagulation necrosis effectively and safely in humans with ultrasound or computed tomography guidance. The most frequent treatment site for radiofrequency ablation to date is the liver for hepatocellular carcinoma. Reviewing the history of radiofrequency ablation, we can see the evaluation of electrodes from conventional monopolar electrode to multiprobe arrays, hook expandable electrodes, and internally cooled electrodes. All of these are trying to ablate the tumor more widely and completely. From history, we also notice that the target can range from heart, neurological disorders, and thyroid diseases to a variety of other diseases, in addition to liver malignancy. Studies have already shown that radiofrequency ablation is an excellent alternative treatment for nodular thyroid disease, including benign and malignant lesions. For treatment of recurrent well-differentiated thyroid cancer, radiofrequency ablation has shown good results, such as no recurrence at treatment sites or reduced serum thyroglobulin level. The possible complications include hoarseness, hematoma, severe pain, esophageal perforation, or tracheal perforation. The reported rate for major complications in previous studies is low. Therefore, if the patients have severe comorbidity that is not suitable for reoperation for thyroid malignancy, radiofrequency ablation is a good alternative. Furthermore, radiofrequency ablation can be used for benign thyroid nodules to relieve local compressive symptoms. Some patients who receive such treatment for cosmetic reasons also show a satisfactory outcome. Here, we review previous studies about radiofrequency ablation in nodular thyroid disease in many aspects, such as ablation system, ablation techniques, ablation efficacy, and complications, both in benign thyroid nodules and recurrent thyroid cancer.

Radiofrequency Ablation is the most widely performed percutaneous treatment for Hepatocellular Carcinoma. This multicentre study was aimed at assessing the complication, overall survival and disease-free survival rates in cirrhotic patients with single Hepatocellular Carcinoma nodule ≤3 cm undergoing Radiofrequency Ablation.

Data of 365 patients (59% males; mean age 67 ± 8 years), Child–Pugh A/B, with single Hepatocellular Carcinoma nodule ≤3 cm (tumours >2–3 cm = 127/236), showing complete necrosis after Radiofrequency Ablation between 1998 and 2010 in 7 Italian Centers were retrospectively reviewed. Complication, overall survival and disease-free survival rates were analyzed as main clinical end-points.

Major complications were observed in 8 patients (2.2%) and minor complications in 23 patients (6.3%). The 3-, and 5-year overall survival rates were 80% and 64%. One hundred and seven patients (29.5%) died, being 41 deaths (38.3%) Hepatocellular Carcinoma-related. At multivariate analysis only age (p = 0.04; OR 2.29), ascites (p < 0.001; OR 3.74) and Child–Pugh class ≥B8 (p = 0.003; OR 2.42) were confirmed as independent predictors for overall survival. The disease-free survival rates at 3- and 5-year were 50%, and 41.8%.

Radiofrequency Ablation is an effective and safe tool for the treatment of single Hepatocellular Carcinoma ≤3 cm providing excellent 5-year overall survival and disease-free survival rates. Patient's age and liver status appeared as main determinants of outcome.