title: Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) offers an alternative treatment in some unresectable hepatocellular carcinoma (HCC) patients with disease confined to the liver. We prospectively evaluated survival rates in patients with early-stage, unresectable HCC treated with RFA.
  
  
  METHODS
  All patients with HCC treated with RFA between September 1, 1997, and July 31, 2002, were prospectively evaluated. Patients were treated with RFA by using a percutaneous or open intraoperative approach with ultrasound guidance and were evaluated at regular intervals to determine disease recurrence and survival.
  
  
  RESULTS
  A total of 194 patients (153 men [79%] and 41 women [21%]) with a median age of 66 years (range, 39-86 years) underwent RFA of 289 sonographically detectable HCC tumors. All patients were followed up for at least 12 months (median follow-up, 34.8 months). Percutaneous and open intraoperative RFA was performed in 140 (72%) and 54 (28%) patients, respectively. The median diameter of tumors treated with RFA was 3.3 cm. Disease recurred in 103 (53%) of 194 patients, including 69 (49%) of 140 patients treated percutaneously and 34 (63%) of 54 treated with open RFA (not significant). Local recurrence developed in nine patients (4.6%). Most recurrence was intrahepatic. The overall complication rate was 12%. Overall survival rates at 1, 3, and 5 years for all 194 patients were 84.5%, 68.1%, and 55.4%, respectively.
  
  
  CONCLUSIONS
  Treatment with RFA can produce significant long-term survival rates for cirrhotic patients with early-stage, unresectable HCC. RFA can be performed in these patients with relatively low complication rates. Confirmation of these results in randomized trials should be considered.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, Texas, 77030-4009, USA.
authors.forename: Chandrajit P
authors.initials: CP
authors.lastname: Raut
authors.forename: Francesco
authors.initials: F
authors.lastname: Izzo
authors.forename: Paolo
authors.initials: P
authors.lastname: Marra
authors.forename: Lee M
authors.initials: LM
authors.lastname: Ellis
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Francesco
authors.initials: F
authors.lastname: Cremona
authors.forename: Paolo
authors.initials: P
authors.lastname: Vallone
authors.forename: Angelo
authors.initials: A
authors.lastname: Mastro
authors.forename: Bruno D
authors.initials: BD
authors.lastname: Fornage
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016019:Survival Analysis