Radiofrequency ablation of hepatocellular carcinoma in patients with decompensated cirrhosis: evaluation of therapeutic efficacy and safety.
OBJECTIVE
Our objective was to determine the therapeutic efficacy and safety of radiofrequency ablation in the treatment of hepatocellular carcinoma (HCC) in patients with decompensated cirrhosis.


METHODS
Nineteen patients with 26 HCC nodules (range, 0.8-5 cm; mean, 1.96 cm) and decompensated liver cirrhosis (mean Child score, 10.7) were treated with radiofrequency ablation using cooled-tip electrodes and a 200-W generator. Radiofrequency ablation was performed under the guidance of sonography or CT. Procedure-related complications, therapeutic efficacy, each patient's survival, changes in blood test results--that is, serum aminotransferase and bilirubin--and changes in the Child score before and after ablation therapy were analyzed. To assess the therapeutic response of the tumor to radiofrequency ablation, we performed contrast-enhanced CT after the procedure and during follow-up.


RESULTS
Complete necrosis without marginal recurrence at the 6-month follow-up was attained in 23 lesions (88.5%). During follow-up (mean, 13.3 months), one patient experienced a remote tumor recurrence in the liver. The median survival time was 12.0 +/- 1.7 months. Two patients died of liver failure--one at 2 months and one at 4 months after treatment. The other patients were followed for at least 6 months (range, 6-28 months; mean, 12 months). The first and second weeks after therapy, the serum aminotransferase and bilirubin levels were significantly higher than were pretreatment levels (p < 0.05). However, 3 weeks after therapy, those figures were nearly restored to the pretreatment levels. The mean Child scores 3 weeks after radiofrequency ablation (10.8) were similar to those before treatment (10.7).


CONCLUSIONS
Radiofrequency ablation can be used selectively for treatment of HCC in patients with decompensated cirrhosis but has the potential to aggravate the preexisting hepatic dysfunction.
Kim
Young Kon
YK
Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School, Jeonju, South Korea.
Kim
Chong Soo
CS
Chung
Gyong Ho
GH
Han
Young Min
YM
Lee
Sang Yong
SY
Jin
Gong Yong
GY
Lee
Jeong Min
JM
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged