Page 183 - ebook HCC

180 PROGRAMME AND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 181
FEBRUARY 13 - 16, 2014

RESECTION OR RFA AS FIRST LINE TREATMENT If a patient is not candidate for liver transplant, the availability of the pathology
FOR EARLY STAGE HCC? characteristics will not change the treatment strategy. For this reason, resection will not
offer better survival than ablation in BCLC 0 patients and RFA would become the first-line
option, leaving surgery for those patients with treatment failure. This is the major change
introduced in the BCLC in 2012 and represents a major refinement in the treatment
Alejandro Forner , Alexandre Liccioni , Alessia Gazzola , approach of patients with very early HCC.
1
1
1
Roberto Di Donato , Maria Reig 1
1
1 BCLC group. Liver Unit. Barcelona, Barcelona, Spain References:
1. Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, et al. A prospective randomized
Corresponding author’s e-mail: aforner@clinic.ub.es trial comparing percutaneous local ablative therapy and partial hepatectomy for small
hepatocellular carcinoma. Ann Surg 2006;243:321–328.
2. Cho YK, Kim JK, Kim WT, Chung JW. Hepatic resection versus radiofrequency ablation
for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology
Hepatocellular carcinoma is the sixth most frequent neoplasia worldwide and currently 2010;51:1284–1290.
constitutes the main cause of death in cirrhotics. The only chance to cure this disease
is diagnosing it at an asymptomatic, early stage, when potential curative treatments are 3. Cucchetti A, Piscaglia F, Cescon M, Colecchia A, Ercolani G, Bolondi L, Pinna AD.
Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation
available. For that reason, surveillance for HCC is accepted and is based on biannual
for early hepatocellular carcinoma. J Hepatol. 2013;59:300–7.
ultrasound. The widely application of surveillance in this population and the continuous 4. EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma.
imaging technical improvements has allowed the more frequent detection of solitary,
J Hepatol 2012;56:908-943.
small lesions (<2cm) in patients with preserved liver function. At that point, HCC may 5. Feng K, Yan J, Li X, Xia F, Ma K, Wang S, Bie P, et al. A randomized controlled trial of
have not still developed peritumoral spread, and thus, any treatment able to completely
remove the tumor has a high chance to cure the disease. Classically, liver resection has radiofrequency ablation and surgical resection in the treatment of small hepatocellular
carcinoma. J Hepatol 2012;57:794-802.
been considered the treatment of choice since it removes completely the tumor and the
surrounding liver parenchyma. If the explant analysis shows a vaguely nodular HCC with 6. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012;379:1245-1255.
7. Fuks D, Dokmak S, Paradis V, Diouf M, Durand F, Belghiti J. Benefit of initial resection
neither microvascular invasion nor satellites, the probability of early tumor recurrence of hepatocellular carcinoma followed by transplantation in case of recurrence: An
CLINICAL SPEAKERS ABSTRACTS not recommended. Ablation is based on the destruction of the tumor by the injection of 8. Germani G, Pleguezuelo M, Gurusamy K, Meyer T, Isgro G, Burroughs AK. Clinical CLINICAL SPEAKERS ABSTRACTS
is almost zero and the long- term outcome is outstanding. Percutaneous ablation has
intention-to-treat analysis. Hepatology 2012;55:132–140.
been considered the treatment of choice for early HCC when surgical resection was
outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection
several substance, mainly alcohol or acetic acid, or by temperature modification, being the
for hepatocelullar carcinoma: a meta-analysis. J Hepatol 2010;52:380–388.
radiofrequency ablation (RFA) the most widely used technique. Technical improvements
9. Huang GT, Lee PH, Tsang YM, Lai MY, Yang PM, Hu RH, et al. Percutaneous ethanol
associated with an increasing experience have allowed high rates of complete response
injection versus surgical resection for the treatment of small hepatocellular carcinoma:
after RFA, particularly in those HCC smaller than 2 cm. Since in these very early tumors
a prospective study. Ann Surg 2005;242:36–42.
(≤2cm) the probability of dissemination is very low, and the probability of complete
response with a safe margin with RFA is high (90–100%), it is likely that resection and
complete response and complications rate after radiofrequency ablation of very
RFA are similar in terms of outcome. Up to know, only three randomized-controlled trials 10. Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, Rossi S. Sustained
coming form Asia have compared both options in early HCC with contradictory results. early hepatocellular carcinoma in cirrhosis. Is resection still the treatment of choice?
Hepatology 2008;47:82-89.
Cost-effectiveness analyses using a Markov model concluded that for very early HCC
(single nodule <2cm) in Child-Pugh class A patients, RFA provided similar life-expectancy 11. N’Kontchou G, Mahamoudi A, Aout M, Ganne-Carrie N, Grando V, Coderc E, Vicaut E, et
al. Radiofrequency ablation of hepatocellular carcinoma: Long-term results and prognostic
and quality-adjusted life-expectancy at a lower cost. Several cohort studies endorse these
factors in 235 Western patients with cirrhosis. Hepatology 2009;50:1475-1483.
figures and in fact, the only advantage of surgical resection in this setting would be the 12. Rodríguez de Lope C, Tremosini S, Forner A, Reig M, Bruix J. Management of HCC.
opportunity to assess the risk of early recurrence by pathology (microvascular invasion or
J Hepatol 2012;56 Suppl:S75-87.
satellites). If a high risk of recurrence is detected in the specimen, liver transplant should 13. Sala M, Fuster J, Llovet JM, Navasa M, Sole M, Varela M, et al. High pathological risk
be indicated (the so called “ab initio” indication).
of recurrence after surgical resection for hepatocellular carcinoma: an indication for
salvage liver transplantation. Liver Transpl 2004;10:1294–1300.