Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Sunday, 12 / 16 / 2018

Articles

Microwave Ablation in Intermediate Hepatocellular Carcinoma in Cirrhosis: An Italian Multicenter Prospective Study

ORIGINAL ARTICLE

Microwave Ablation in Intermediate Hepatocellular Carcinoma in Cirrhosis: An Italian Multicenter Prospective Study

Antonio Giorgio1,2, Pietro Gatti3, Luca Montesarchio1, Maria Gabriella Merola6, Ferdinando Amendola1, Andrea Calvanese1, Gaetano Iaquinto5, Massimiliano Fontana5, Emanuela Ciracì3, Stefano Semeraro3, Bruno Santoro6, Carmine Coppola4, Paolo Matteucci7 and Valentina Giorgio*,8

1Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
2Department of Surgery, Interventional Ultrasound Unit, Ruesch Clinical Institute, Naples, Italy
3Department of Internal Medicine, Interventional Ultrasound Unit, Ostuni Hospital, Ostuni, Italy
4Department of Internal Medicine, Hepatology Interventional Unit, Gragnano Hospital, Gragnano, Italy
5Interventional Ultrasound Unit, S. Rita Medical-Surgical Hospital, Atripalda, Italy
6Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte, Italy
7Department of Radiation Oncology, Campus Biomedico University, Rome, Italy
8Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy

*Correspondence to: Antonio Giorgio, Tortorella Clinical Hospital, Salerno 80131, Italy. Tel: +39-081-248-3198, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2018;6(3):251-257 DOI: 10.14218/JCTH.2018.00013
Received: February 22, 2018 Accepted: April 16, 2018 Published online: July 11, 2018

Abstract

Background and Aims: To report long-term results in treatment of intermediate hepatocellular carcinoma (HCC) in cirrhotics using new high-powered microwaves (MWS) ablation alone.

Methods: This multicenter study included 215 cirrhotics (age range: 67–84 years; 137 males; 149 Child A, 66 Child B) who underwent percutaneous ultrasound-guided high-powered MWS ablation instead of transarterial chemoembolization. Among the patient population, 109 had a single nodule (Ø 5.3–8 cm) [group A], 70 had 2 nodules (Ø 3–6 cm) [group B] and 36 had 3–5 nodules (Ø 1.5–6.8 cm) [group C]. MWS ablation efficacy was evaluated using enhanced-computed tomography and/or magnetic resonance imaging. Primary end-point was 5-year cumulative overall survival (OS).

Results: On enhanced-computed tomography and/or magnetic resonance imaging, complete ablation rates were 100% for 1.5–3.5 cm nodules. In nodules >3.5–5 cm, it was 89% for the first ablation and 100% for the second. For lesions >5–8 cm, ablation was up to 92%. Overall, 1-, 3- and 5-year survival rates were 89, 60, and 21%, respectively. The cumulative OS rate of group A was 89%, 66% and 34% at 1, 3 and 5 years. The cumulative OS rate of group B was 88%, 60% and 11% at 1, 3 and 5 years. The cumulative OS rate of group C was 86%, 55% and 0%. The 5-year survival rate was significantly different among the groups (p <0.001). One patient died from rupture of HCC. Upon multivariate analysis, preablation total bilirubin >1.5 mg/dL was an independent factor for predicting lower survival.

Conclusions: Percutaneous MWS ablation of intermediate HCC is safe and effective in inducing large volume of necrosis in intermediate HCC nodules, providing long-term survival rates similar to transarterial chemoembolization. Preablation total bilirubin >1.5 mg/dL as expression of liver function reserve is the main factor predicting a worse outcome.

Keywords

Hepatocellular carcinoma, Intermediate stage, Microwaves ablation, Cirrhosis, HCC

 

 

 

Journal of Clinical and Translational Hepatology 2018 vol. 6, 251-257  [ Html ] [ PDF Full-text ]

 

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

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