EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

EASL–EORTC Clinical Practice Guidelines (CPG) on the management of hepatocellular carcinoma (HCC) define the use of surveillance, diagnosis, and therapeutic strategies recommended for patients with this type of cancer. This is the first European joint effort by the European Association for the Study of the Liver (EASL) and the European Organization for Research and Treatment of Cancer (EORTC) to provide common guidelines for the management of hepatocellular carcinoma. These guidelines update the recommendations reported by the EASL panel of experts in HCC published in 2001 [1]. Several clinical and scientific advances have occurred during the past decade and, thus, a modern version of the document is urgently needed. The purpose of this document is to assist physicians, patients, health-care providers, and health-policy makers from Europe and worldwide in the decision-making process according to evidencebased data. Users of these guidelines should be aware that the recommendations are intended to guide clinical practice in circumstances where all possible resources and therapies are available. Thus, they should adapt the recommendations to their local regulations and/or team capacities, infrastructure, and cost– benefit strategies. Finally, this document sets out some recommendations that should be instrumental in advancing the research and knowledge of this disease and ultimately contribute to improve patient care. The EASL–EORTC CPG on the management of hepatocellular carcinoma provide recommendations based on the level of evidence and the strength of the data (the classification of evidence is adapted from National Cancer Institute [2]) (Table 1A) and the strength of recommendations following previously reported systems (GRADE systems) (Table 1B).

http://www.bclc.cat/download/easl-guidelines.pdf

EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma European Association for the Study of the Liver ⇑ , European Organisation for Research and Treatment of Cancer

Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis.

EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma

Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: Analysis of prognostic factors

Background Local recurrence rates after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) vary from 2% to 36% in the literature. Limited data were available about the prognostic significance of local recurrence. Study Design Between April 2001 and March 2006, 273 patients with 357 hepatocellular carcinoma nodules underwent RFA, with radiologically complete tumor ablation after a single session of RFA. The risk factors of local recurrence and its impact on overall survival of patients were analyzed. Results With a median followup period of 24 months, local recurrence occurred in 35 patients (12.8%). By multivariate analysis, tumor size > 2.5 cm was the only independent risk factor for local recurrence. There was no notable difference in overall survival between patients with and without local recurrence. By multivariate analysis, local recurrence more than 12 months after RFA and complete response after additional treatment of local recurrence were associated with better overall survival in patients with local recurrence. Conclusions This study demonstrated that tumor size > 2.5 cm was the main risk factor for local recurrence after RFA of hepatocellular carcinoma. Our data suggested that additional aggressive treatment of local recurrence aimed at complete tumor response improves overall survival of patients. Late local recurrence was also associated with better prognosis, suggesting different tumor biology between early and late local recurrent tumors after RFA.

https://www.journalacs.org/article/S1072-7515(08)00073-2/pdf

Risk Factors and Prognostic Factors of Local Recurrence after Radiofrequency Ablation of Hepatocellular Carcinoma

Objective:This study aims to evaluate the outcome of patients with hepatocellular carcinoma (HCC) treated by high-intensity focused ultrasound (HIFU) in a single tertiary referral center.Background:HIFU is the latest developed local ablation technique for unresectable HCC. The initial experience on

/pdf/high-intensity-focused-ultrasound-for-hepatocellular-31fqtubkvz.pdf

High-Intensity Focused Ultrasound for Hepatocellular Carcinoma A Single-Center Experience

Complete ablation rates after a single session of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) vary from 48% to 97%. Limited data are available regarding risk factors and prognostic significance of incomplete ablation. Between April 2001 and March 2006, 298 patients underwent RFA of 393 HCC nodules with an intent of complete ablation after a single session. Risk factors for incomplete ablation and its effect on overall survival were analyzed. Two hundred seventy-three (91.6%) underwent complete tumor ablation, whereas the other 25 (8.4%) underwent incomplete tumor ablation after a single session of RFA. By multivariate analysis, tumor size >3 cm (P = .049) was found to be the only independent risk factor for incomplete ablation. There was no statistically significant difference in overall survival between patients with complete and incomplete ablation. By univariate analysis, no previous transarterial chemoembolization (TACE), preoperative serum alfa-fetoprotein ≤100 μg/mL, and complete response after further treatment of incomplete ablation were associated with better overall survival in patients with incomplete ablation. This study demonstrated that incomplete ablation after RFA of HCC was associated with tumor size >3 cm. Our data also suggest that aggressive further treatment of tumors with incomplete ablation aiming at complete tumor response improves overall survival.

Incomplete Ablation After Radiofrequency Ablation of Hepatocellular Carcinoma: Analysis of Risk Factors and Prognostic Factors

Hypothesis Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) can be performed by percutaneous or surgical approach. Tumor size is an important consideration while deciding the treatment approach. Design Case series with prospective data collection. Setting A tertiary referral center. Patients A total of 228 patients who underwent RFA of small (≤ 3 cm; n = 155) and medium (3.1-5 cm; n = 73) HCC by percutaneous or surgical approach. Main Outcome Measures Complete ablation rate, post-RFA complications, treatment-related mortality, and overall and disease-free survival. Results In patients with small HCC, the complete ablation rate was 95% with both approaches ( P  > .99). Complication rate ( P P P  = .30). In patients with medium HCC, the complete ablation rate was similar between the surgical and the percutaneous groups (92% vs 95%; P  = .48), and the complication rate was also comparable ( P  = .17). The 1-year and 3-year survival rates were 92% and 68%, respectively, in the surgical group, significantly superior to the corresponding rates of 81% and 42% in the percutaneous group ( P  = .03). Conclusions In patients with small HCC, the percutaneous approach achieved similar tumor control with lower morbidity compared with the surgical approach and should be the preferred approach provided that tumor location is suitable. For medium HCC, the surgical approach seems to achieve better overall survival and may be a preferred option.

https://jamanetwork.com/journals/jamasurgery/articlepdf/401100/soa60040_1136_1143.pdf

Helen Tung

Papers

Risk Factors and Prognostic Factors of Local Recurrence after Radiofrequency Ablation of Hepatocellular Carcinoma

High-Intensity Focused Ultrasound for Hepatocellular Carcinoma A Single-Center Experience

Incomplete Ablation After Radiofrequency Ablation of Hepatocellular Carcinoma: Analysis of Risk Factors and Prognostic Factors

Comparison of percutaneous and surgical approaches for radiofrequency ablation of small and medium hepatocellular carcinoma.