Background Liver transplantation is the treatment of choice in HCC and liver failure and RFA has been established as a bridging treatment for selected patients on LT waiting lists. This study investigated the outcomes of patients with HCC treated with RFA either as a bridge to transplantation or as a primary treatment to control local disease in those not eligible for transplantation. Methods Patients with HCC undergoing RFA over a 6 year period in a single centre were included. Primary outcomes were local recurrence at the RFA site and disease free survival in the group on imaging. In transplant recipients the native hepatectomy histology was reviewed for evidence of active disease at the site of RFA. Results 111 patients (84 m:27 f) with 120 de novo HCCs underwent RFA, with a mean size of 19.5mm [6-38mm] . Follow up varied from 7 ->76 months. Radiological recurrence at the site of the RFA was seen in 5.4%, at a median 463[26-1054] days following RFA. Recurrence of HCC at remote sites was seen in 19 patients (17.1%). Death primarily caused by HCC or liver disease was seen in 10 patients and 1 patient died whilst awaiting LT, overall survival is shown in figure 1. 16 of 24 patients listed underwent OLT. Analysis of histology from explanted livers showed evidence of residual disease in 2 cases, one was 20 days post RFA and showed features of ablation with small areas of viable tumour, the other showed a small satellite nodule, invisible on radiological imaging. Conclusion Our data supports the use of RFA in HCC as both a treatment and bridge to transplantation. The low rate of local recurrence raises the possibility that patients undergoing RFA with good synthetic liver function should be regarded as having potentially curative treatment and be removed from LT waiting lists with a view to salvage transplantation for recurrent disease.
|Publication status||Published - 2017|