Early-stage hepatocellular carcinoma in patients with cirrhosis

Long-term results of percutaneous image-guided radiofrequency ablation

Riccardo Lencioni, Dania Cioni, Laura Crocetti, Chiara Franchini, Clotilde Della Pina, Jacopo Lera, Carlo Bartolozzi

Research output: Contribution to journalArticle

618 Citations (Scopus)

Abstract

PURPOSE: To perform a prospective, intention-to-treat clinical trial to determine the long-term survival rates of patients with hepatic cirrhosis and early-stage hepatocellular carcinoma (HCC) in whom percutaneous image-guided radiofrequency (RF) ablation was used as the sole first-line anticancer treatment. MATERIALS AND METHODS: The study was performed with approval of the ethics committee, and written informed consent was obtained for all patients. From June 1, 1996, to January 1, 2003, 206 patients (143 men, 63 women; age range, 51-81 years; mean age, 67 years ± 7) who were excluded from surgery and who had Child class A or B cirrhosis with either a single HCC less than or equal to 5 cm in diameter or multiple (as many as three) HCCs less than or equal to 3 cm in diameter each were enrolled. RF ablation was performed in 187 (91%) of 206 patients; 19 (9%) were excluded from RF treatment because of unfavorable tumor location. Follow-up ranged from 3 to 78 months (mean, 24 months ± 21) and included measurement of α-fetoprotein level, ultrasonography at 3-month intervals, and spiral computed tomography at 6-month intervals. Patients were observed for recurrence of the treated tumor and for the emergence of new HCC tumors. Survival probabilities were estimated with the Kaplan-Meier method, and differences between survival curves were evaluated with the log-rank test. RESULTS: At the end of the study, 145 patients were alive, and 61 were dead. In the intention-to-treat analysis, overall survival rates were 97% at 1 year, 67% at 3 years, and 41% at 5 years. Median survival was 49 months. In the 187 patients treated with RF ablation, overall survival rates were 97% at 1 year, 71% at 3 years, and 48% at 5 years. Median survival was 57 months. The difference between the two survival curves was not statistically significant (P = .5094). Survival of patients treated with RF ablation was dependent on Child class (P = .0006) and tumor multiplicity (P = .0133). Patients who had Child class A cirrhosis with solitary HCC (n = 116) had 1-, 3-, and 5-year survival rates of 100%, 89% and 61%; median survival was 65 months. The 1-, 3-, and 5-year recurrence rates were 14%, 49%, and 81% for the emergence of new tumors and 4%, 10%, and 10% for local tumor progression. CONCLUSION: RF ablation is an effective first-line treatment for cirrhotic patients with early-stage HCC who were excluded from surgery.

Original languageEnglish (US)
Pages (from-to)961-967
Number of pages7
JournalRadiology
Volume234
Issue number3
DOIs
StatePublished - Mar 2005
Externally publishedYes

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Hepatocellular Carcinoma
Fibrosis
Survival
Survival Rate
Neoplasms
Fetal Proteins
Recurrence
Ethics Committees
Intention to Treat Analysis
Spiral Computed Tomography
Informed Consent
Liver Cirrhosis
Ultrasonography
Therapeutics
Clinical Trials

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Lencioni, R., Cioni, D., Crocetti, L., Franchini, C., Della Pina, C., Lera, J., & Bartolozzi, C. (2005). Early-stage hepatocellular carcinoma in patients with cirrhosis: Long-term results of percutaneous image-guided radiofrequency ablation. Radiology, 234(3), 961-967. https://doi.org/10.1148/radiol.2343040350

Early-stage hepatocellular carcinoma in patients with cirrhosis : Long-term results of percutaneous image-guided radiofrequency ablation. / Lencioni, Riccardo; Cioni, Dania; Crocetti, Laura; Franchini, Chiara; Della Pina, Clotilde; Lera, Jacopo; Bartolozzi, Carlo.

In: Radiology, Vol. 234, No. 3, 03.2005, p. 961-967.

Research output: Contribution to journalArticle

Lencioni, R, Cioni, D, Crocetti, L, Franchini, C, Della Pina, C, Lera, J & Bartolozzi, C 2005, 'Early-stage hepatocellular carcinoma in patients with cirrhosis: Long-term results of percutaneous image-guided radiofrequency ablation', Radiology, vol. 234, no. 3, pp. 961-967. https://doi.org/10.1148/radiol.2343040350
Lencioni, Riccardo ; Cioni, Dania ; Crocetti, Laura ; Franchini, Chiara ; Della Pina, Clotilde ; Lera, Jacopo ; Bartolozzi, Carlo. / Early-stage hepatocellular carcinoma in patients with cirrhosis : Long-term results of percutaneous image-guided radiofrequency ablation. In: Radiology. 2005 ; Vol. 234, No. 3. pp. 961-967.
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abstract = "PURPOSE: To perform a prospective, intention-to-treat clinical trial to determine the long-term survival rates of patients with hepatic cirrhosis and early-stage hepatocellular carcinoma (HCC) in whom percutaneous image-guided radiofrequency (RF) ablation was used as the sole first-line anticancer treatment. MATERIALS AND METHODS: The study was performed with approval of the ethics committee, and written informed consent was obtained for all patients. From June 1, 1996, to January 1, 2003, 206 patients (143 men, 63 women; age range, 51-81 years; mean age, 67 years ± 7) who were excluded from surgery and who had Child class A or B cirrhosis with either a single HCC less than or equal to 5 cm in diameter or multiple (as many as three) HCCs less than or equal to 3 cm in diameter each were enrolled. RF ablation was performed in 187 (91{\%}) of 206 patients; 19 (9{\%}) were excluded from RF treatment because of unfavorable tumor location. Follow-up ranged from 3 to 78 months (mean, 24 months ± 21) and included measurement of α-fetoprotein level, ultrasonography at 3-month intervals, and spiral computed tomography at 6-month intervals. Patients were observed for recurrence of the treated tumor and for the emergence of new HCC tumors. Survival probabilities were estimated with the Kaplan-Meier method, and differences between survival curves were evaluated with the log-rank test. RESULTS: At the end of the study, 145 patients were alive, and 61 were dead. In the intention-to-treat analysis, overall survival rates were 97{\%} at 1 year, 67{\%} at 3 years, and 41{\%} at 5 years. Median survival was 49 months. In the 187 patients treated with RF ablation, overall survival rates were 97{\%} at 1 year, 71{\%} at 3 years, and 48{\%} at 5 years. Median survival was 57 months. The difference between the two survival curves was not statistically significant (P = .5094). Survival of patients treated with RF ablation was dependent on Child class (P = .0006) and tumor multiplicity (P = .0133). Patients who had Child class A cirrhosis with solitary HCC (n = 116) had 1-, 3-, and 5-year survival rates of 100{\%}, 89{\%} and 61{\%}; median survival was 65 months. The 1-, 3-, and 5-year recurrence rates were 14{\%}, 49{\%}, and 81{\%} for the emergence of new tumors and 4{\%}, 10{\%}, and 10{\%} for local tumor progression. CONCLUSION: RF ablation is an effective first-line treatment for cirrhotic patients with early-stage HCC who were excluded from surgery.",
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T1 - Early-stage hepatocellular carcinoma in patients with cirrhosis

T2 - Long-term results of percutaneous image-guided radiofrequency ablation

AU - Lencioni, Riccardo

AU - Cioni, Dania

AU - Crocetti, Laura

AU - Franchini, Chiara

AU - Della Pina, Clotilde

AU - Lera, Jacopo

AU - Bartolozzi, Carlo

PY - 2005/3

Y1 - 2005/3

N2 - PURPOSE: To perform a prospective, intention-to-treat clinical trial to determine the long-term survival rates of patients with hepatic cirrhosis and early-stage hepatocellular carcinoma (HCC) in whom percutaneous image-guided radiofrequency (RF) ablation was used as the sole first-line anticancer treatment. MATERIALS AND METHODS: The study was performed with approval of the ethics committee, and written informed consent was obtained for all patients. From June 1, 1996, to January 1, 2003, 206 patients (143 men, 63 women; age range, 51-81 years; mean age, 67 years ± 7) who were excluded from surgery and who had Child class A or B cirrhosis with either a single HCC less than or equal to 5 cm in diameter or multiple (as many as three) HCCs less than or equal to 3 cm in diameter each were enrolled. RF ablation was performed in 187 (91%) of 206 patients; 19 (9%) were excluded from RF treatment because of unfavorable tumor location. Follow-up ranged from 3 to 78 months (mean, 24 months ± 21) and included measurement of α-fetoprotein level, ultrasonography at 3-month intervals, and spiral computed tomography at 6-month intervals. Patients were observed for recurrence of the treated tumor and for the emergence of new HCC tumors. Survival probabilities were estimated with the Kaplan-Meier method, and differences between survival curves were evaluated with the log-rank test. RESULTS: At the end of the study, 145 patients were alive, and 61 were dead. In the intention-to-treat analysis, overall survival rates were 97% at 1 year, 67% at 3 years, and 41% at 5 years. Median survival was 49 months. In the 187 patients treated with RF ablation, overall survival rates were 97% at 1 year, 71% at 3 years, and 48% at 5 years. Median survival was 57 months. The difference between the two survival curves was not statistically significant (P = .5094). Survival of patients treated with RF ablation was dependent on Child class (P = .0006) and tumor multiplicity (P = .0133). Patients who had Child class A cirrhosis with solitary HCC (n = 116) had 1-, 3-, and 5-year survival rates of 100%, 89% and 61%; median survival was 65 months. The 1-, 3-, and 5-year recurrence rates were 14%, 49%, and 81% for the emergence of new tumors and 4%, 10%, and 10% for local tumor progression. CONCLUSION: RF ablation is an effective first-line treatment for cirrhotic patients with early-stage HCC who were excluded from surgery.

AB - PURPOSE: To perform a prospective, intention-to-treat clinical trial to determine the long-term survival rates of patients with hepatic cirrhosis and early-stage hepatocellular carcinoma (HCC) in whom percutaneous image-guided radiofrequency (RF) ablation was used as the sole first-line anticancer treatment. MATERIALS AND METHODS: The study was performed with approval of the ethics committee, and written informed consent was obtained for all patients. From June 1, 1996, to January 1, 2003, 206 patients (143 men, 63 women; age range, 51-81 years; mean age, 67 years ± 7) who were excluded from surgery and who had Child class A or B cirrhosis with either a single HCC less than or equal to 5 cm in diameter or multiple (as many as three) HCCs less than or equal to 3 cm in diameter each were enrolled. RF ablation was performed in 187 (91%) of 206 patients; 19 (9%) were excluded from RF treatment because of unfavorable tumor location. Follow-up ranged from 3 to 78 months (mean, 24 months ± 21) and included measurement of α-fetoprotein level, ultrasonography at 3-month intervals, and spiral computed tomography at 6-month intervals. Patients were observed for recurrence of the treated tumor and for the emergence of new HCC tumors. Survival probabilities were estimated with the Kaplan-Meier method, and differences between survival curves were evaluated with the log-rank test. RESULTS: At the end of the study, 145 patients were alive, and 61 were dead. In the intention-to-treat analysis, overall survival rates were 97% at 1 year, 67% at 3 years, and 41% at 5 years. Median survival was 49 months. In the 187 patients treated with RF ablation, overall survival rates were 97% at 1 year, 71% at 3 years, and 48% at 5 years. Median survival was 57 months. The difference between the two survival curves was not statistically significant (P = .5094). Survival of patients treated with RF ablation was dependent on Child class (P = .0006) and tumor multiplicity (P = .0133). Patients who had Child class A cirrhosis with solitary HCC (n = 116) had 1-, 3-, and 5-year survival rates of 100%, 89% and 61%; median survival was 65 months. The 1-, 3-, and 5-year recurrence rates were 14%, 49%, and 81% for the emergence of new tumors and 4%, 10%, and 10% for local tumor progression. CONCLUSION: RF ablation is an effective first-line treatment for cirrhotic patients with early-stage HCC who were excluded from surgery.

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