Management of small hepatocellular carcinoma by high intensity focused ultrasound ablation in patients with cirrhosis- an Eastern experience

Abstract

Background: For most patients with small HCC hepatectomy or liver transplantation is widely accepted as a good choice of treatment. However, local ablation therapy provides a very good alternative for those who does not want or cannot tolerate a major surgical procedure. High-intensity focused ultrasound (HIFU) ablation is a non-invasive treatment for hepatocellular carcinoma (HCC). However data on long term follow up is restricted. In this study we aim to analysis the outcome for patients receiving this treatment.

Patients and Method: From Oct 2006 to Sept 2010, 1321 patients were diagnosed HCC.457 patients received surgical interventions. The clinical data were recorded prospectively in a computerized database by a single research assistant. Total 112 patients received HIFU as a treatment of HCC in Department of Surgery Queen Mary Hospital. Amongst these patients, 47 patients has HCC smaller than 3 cm. 59 patient receiving percutaneous radiofrequency ablation were selected for comparison. Preoperative variables of these patients were compared. Perioperative data and survival analysis was also compared.

Results: There were forty seven patients received HIFU therapy during this period. Total fifty two tumours were ablated by this treatment entity. The median age for the patients was 62 (range 34 years-84 years). The median tumour size was 1.5 cm (range 0.8–2.7 cm). Forty-two patients (89.4%) had one tumour on presentation. Five patients (10.6%) had two tumours on presentation. Fifty-nine patients received percutaneous RFA during this peroid. Total Sixty five tumours were ablated by this method. The median age for the patients was 60 (range 23 years-83 years). The median tumour size was 1.9 cm (range 1.0–2.8 cm). Fifty-two patients (88.1%) had one tumour on presentation. Six patients (10.2%) had two tumours on presentation. There is sixteen patients (34%) in Child Pugh B cirrhosis in the HIFU group while there was only five patients (8.5%) in Child Pugh B cirrhosis in the RFA group (p = 0.001) No statistical significant difference for Clavein-Dindo grade IIIA or above complications between these two groups were observed In the HIFU group, the one year survival was 97.4% and the three year survival was 81.2%. In the RFA group, the one year survival was 94.6% and 79.8%. (p = 0.53) In the HIFU group the one year disease free survival was 63.6% and the three year disease free survival was 25.9%. In the RFA group the one year disease free survival was 62.4% and the three year disease free survival was 34.1% (p = 0.683).