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

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

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related mortality and has an increasing incidence worldwide. Locoregional therapies, defined as imaging-guided liver tumour-directed procedures, play a leading part in the management of 50-60% of HCCs. Radiofrequency is the mainstay for local ablation at early stages and transarterial chemoembolization (TACE) remains the standard treatment for intermediate-stage HCC. Other local ablative techniques (microwave ablation, cryoablation and irreversible electroporation) or locoregional therapies (for example, radioembolization and sterotactic body radiation therapy) have been explored, but have not yet modified the standard therapies established decades ago. This understanding is currently changing, and several drugs have been approved for the management of advanced HCC. Molecular therapies dominate the adjuvant trials after curative therapies and combination strategies with TACE for intermediate stages. The rationale for these combinations is sound. Local therapies induce antigen and proinflammatory cytokine release, whereas VEGF inhibitors and tyrosine kinase inhibitors boost immunity and prime tumours for checkpoint inhibition. In this Review, we analyse data from randomized and uncontrolled studies reported with ablative and locoregional techniques and examine the expected effects of combinations with systemic treatments. We also discuss trial design and benchmarks to be used as a reference for future investigations in the dawn of a promising new era for HCC treatment.

Locoregional therapies in the era of molecular and immune treatments for hepatocellular carcinoma

Percutaneous treatment of hepatocellular carcinoma: State of the art and innovations.

Radiofrequency ablation is a safe and effective first-line treatment modality for patients with early-stage hepatocellular carcinoma, and the 5-year survival rate in our study (67.9%) was comparable to that of hepatic resection.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.13130940

Radiofrequency Ablation of Hepatocellular Carcinoma as First-Line Treatment: Long-term Results and Prognostic Factors in 162 Patients with Cirrhosis

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

Primary tumors of the fallopian tube are rare entities, constituting about 0.18% to 1.6% 1 of all gynecologic malignancies. Although the classic triad of abnormal vaginal bleeding, leukorrhea, and abdominal pain is said to be pathognomonic, the correct preoperative diagnosis is made in only 0.3% of cases.2 Bilateral disease is uncommon and represents less than one fourth of cases. 3 This report describes a case of fallopian tube carcinoma in a relatively young woman, diagnosed preoperatively on the basis of characteristic sonographic features.

Preoperative Sonographic Diagnosis of Primary Fallopian Tube Carcinoma

Mucinous biliary papillomatosis is a rare disorder that was first described by Caroli in 1959. 1 The disease affects mostly the extrahepatic ducts and appears in the fifth to seventh decades of life. Involvement of intrahepatic or diffuse intrahepatic and extrahepatic bile ducts is far less common; fewer than 14 cases have been described. 2 Association with biliary tract malignancies has been reported 2-4 ; hence, early recognition of the disease is important. Preoperative diagnosis of the disease is often difficult because of its nonspecific clinical manifestation and diagnostic radiologic features and criteria. We describe a case of diffuse intrahepatic and extrahepatic biliary papillomatosis diagnosed on the basis of sonographic features. The computed tomographic (CT), magnetic resonance imaging (MRI), and cholangiographic appearances of the disease are also discussed.

Jimmy H. F. Yuen

Papers

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

Preoperative Sonographic Diagnosis of Primary Fallopian Tube Carcinoma

Sonographic appearance of mucinous biliary papillomatosis