Image-Guided Ablation: Chemical Ablation and RFA - SIR Foundation
Image-Guided Ablation: Chemical Ablation and RFA - SIR Foundation
Image-Guided Ablation: Chemical Ablation and RFA - SIR Foundation
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<strong>Image</strong>-<strong>Guided</strong> <strong>Ablation</strong>:<strong>Chemical</strong> <strong>Ablation</strong> <strong>and</strong> <strong>RFA</strong>Riccardo Lencioni, MDDivision of Diagnostic <strong>and</strong> Interventional RadiologyDepartment of Oncology, Transplants, <strong>and</strong>Advanced Technologies in MedicineUniversity of Pisa, Italy
“Surgical resection, liver transplantation <strong>and</strong>percutaneous techniques achieve a high of CR inproperly selected c<strong>and</strong>idates <strong>and</strong> thus should beclassified as a curative / effective treatments”
Bruix <strong>and</strong> ShermanHepatology 2005
Survival Outcomes in PEI-Treated Pts(Retrospective Studies)Author <strong>and</strong> yearNo. ofPtsSurvival (%)1-yr 3-yr 5-yrLivraghi T et al, Radiology 1995Child A, single < 5 cmChild B, single < 5 cm293149989379634729Lencioni R et al, Cancer 1995Child A, single / multiple < 3 cmChild B, single / multiple < 3 cm64411009187535513
PEI versus Surgical Resection(Prospective, Non-R<strong>and</strong>omized Studies)90100809070806070504030206050403020101001-yr 2-yr 3-yr01-yr 3-yr 5-yrPEI 83 66 55Resection 81 73 44PEI 100 82 59Resection 96 84 61p = N.S.- Same tumor stage- Poorer liver function in PEI groupsp = N.S.Castells et al, Hepatology 1993Yamamoto et al, Hepatology 2001
PEI: Local Tumor Progression454035302520151050HCC < 3 cm 0 19 27 33 33 33Koda et al, Cancer 20000 1-yr 2-yr 3-yr 4-yr 5-yr4540353025201510500 6-mo 12-mo 18-mo 24-moHCC > 3 cm 0 11 26 38 43Khan et al, J Hepatol 2000
Lencioni R et al,Radiology 2003
EARLY-STAGE (< 5 cm) HCC IN CIRRHOSIS:LONG-TERM RESULTS OF RF ABLATIONLencioni R et al, Radiology 200510076%80Percent survival60402046%51%P = 0.0006 (log-rank test) 31%Child A patients (n = 144)Child B patients (n = 43)00 12 24 36 48 60Months
EARLY-STAGE (< 5 cm) HCC IN CIRRHOSIS:LONG-TERM RESULTS OF RF ABLATIONLencioni R et al, Radiology 2005Percent recurrence death100806040Tumor recurrenceLate treatment failure49%81%2010%10%00 12 24 36 48 60Months
Tumor RecurrenceThe majority of recurrences – <strong>and</strong> specially those thatappear early during follow-up – are due to disseminationfrom the primary tumor <strong>and</strong> not to metachronous tumorsRecurrences due to tumor dissemination have a moreaggressive biological pattern as compared to primary tumors(Bruix <strong>and</strong> Sherman, Hepatology 2005)In most tumors < 2 cm, extranodular malignant foci –satellite lesions <strong>and</strong> microscopic portal vein invasions – arelocated within 5-10 mm from the main tumor(Kojiro, Liver Transpl 2004 - Sazaki, Cancer 2005)
Sala M, Llovet JM, et al, Hepatology 2004
Sala M, Llovet JM, et al, Hepatology 2004
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