title: Radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is widely utilized as a bridge to liver transplant with limited evidence to support efficacy. The purpose of the present study was to measure the effect of RFA on time to drop-off in HCC-listed patients.
  
  
  METHODS
  Patients with Milan criteria tumours listed between January 1999 and June 2007 were stratified into RFA (n= 77) and No Treatment groups (n= 93).
  
  
  RESULTS
  The primary effectiveness of RFA was 83% (complete radiographic response). RFA was associated with a longer median wait time to transplant (9.5 vs. 5 months). Tumour-specific drop-off events were equivalent between RFA (21%) and No Treatment (12%) groups (P= 0.11). Controlling for wait time, there was no difference in overall (P= 0.56) or tumour-specific drop-off (P= 0.94). Furthermore, there were no differences in 5-year overall or tumour-free survivals from list date or transplant. Using multivariate analysis, the likelihood of receiving a transplant and patient survivals were associated with tumour characteristics (AFP, tumour number and size) and not with bridge therapy or waiting time.
  
  
  CONCLUSIONS
  RFA allows patients to be maintained longer on the waiting list without negative consequences on drop-off or survival compared with no treatment. Post-transplant outcomes are affected more by tumour characteristics than RFA or wait time.
authors.affiliation: Liver Transplant Unit, Multiorgan Transplant Programme, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Derek A
authors.initials: DA
authors.lastname: DuBay
authors.forename: Charbel
authors.initials: C
authors.lastname: Sandroussi
authors.forename: John R
authors.initials: JR
authors.lastname: Kachura
authors.forename: Chia Sing
authors.initials: CS
authors.lastname: Ho
authors.forename: J Robert
authors.initials: JR
authors.lastname: Beecroft
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
authors.forename: Anand
authors.initials: A
authors.lastname: Ghanekar
authors.forename: Markus
authors.initials: M
authors.lastname: Guba
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cattral
authors.forename: Ian D
authors.initials: ID
authors.lastname: McGilvray
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014850:Waiting Lists