title: Non-resective ablation therapy for hepatocellular carcinoma: effectiveness measured by intention-to-treat and dropout from liver transplant waiting list.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) for patients with small hepatocellular carcinoma (HCC) is widely accepted, and the usefulness of local ablation techniques as a bridge for liver transplantation is still under investigation.
  
  
  METHODS
  From December 1997 to February 2003, patients with cirrhosis and T0-T1-T2-T3 stage HCC received multi-modality ablative therapy (MMT) for the treatment of their HCC and were evaluated for OLT; listed, and transplanted when an allograft became available. MMT included radiofrequency ablation (RFA), and/or Trans-Arterial Chemo-Embolization (TACE), and alcohol (EtOH) ablation, followed by Trans-Arterial Chemo-Infusion (TACI), with repeated treatments based on follow up hepatic magnetic resonance imaging (MRI) during the waiting period for OLT.
  
  
  RESULTS
  A total of 135 HCC patients were seen at our center within this time frame. The intention-to-treat group included 33 (24.4%) patients with T0, T1, T2, T3 HCC and cirrhosis. There were 31 men and two women. The mean age was 53.6 +/- 7.2 yr. All patients received MMT with a mean of 2.90 +/- 1.5 procedures per patient. Tumor-node-metastasis (TNM) stages at time of listing were: T0 in one patient, T1 in nine patients, T2 in 17 patients, and T3 in six patients. Twenty-eight (85%) patients have received OLT. Five (12.19%) patients were listed and removed (dropout) from the transplant waiting list after waiting 5, 5, 5, 8, and 14 months respectively. The waiting time of the HCC listed group was 9.1 +/- 14.8 months with a mean follow up of 32 months. OLT patient survival and cancer-free survival are 92.9% and 95.24%, respectively; the overall survival of intention-to-treat group was 79% at 32 months follow up. Predictors of dropout included an alpha-fetoprotein (AFP, >400 ng/mL) and T3 HCC stage.
  
  
  CONCLUSIONS
  Aggressive ablation therapy with a short transplant waiting time optimizes the use of OLT for curative intent in selective cirrhotic HCC patients.
authors.affiliation: Medical College of Virginia Hospitals/Virginia Commonwealth University Medical Center, Richmond, VA 23298-0254, USA. rafisher@hsc.vcu.edu
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.forename: D
authors.initials: D
authors.lastname: Maluf
authors.forename: A H
authors.initials: AH
authors.lastname: Cotterell
authors.forename: T
authors.initials: T
authors.lastname: Stravitz
authors.forename: L
authors.initials: L
authors.lastname: Wolfe
authors.forename: V
authors.initials: V
authors.lastname: Luketic
authors.forename: R
authors.initials: R
authors.lastname: Sterling
authors.forename: M
authors.initials: M
authors.lastname: Shiffman
authors.forename: M
authors.initials: M
authors.lastname: Posner
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D000431:Ethanol / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery / Q000628:therapy; D008113:Liver Neoplasms / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010352:Patient Dropouts; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D000970:Antineoplastic Agents; D000431:Ethanol; D004998:Ethiodized Oil