title: High-intensity focused ultrasound ablation: an effective bridging therapy for hepatocellular carcinoma patients.
abstract: OBJECTIVE
  To analyze whether high-intensity focused ultrasound (HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  From January 2007 to December 2010, 49 consecutive HCC patients were listed for liver transplantation (UCSF criteria). The median waiting time for transplantation was 9.5 mo. Twenty-nine patients received transarterial chemoembolization (TACE) as a bringing therapy and 16 patients received no treatment before transplantation. Five patients received HIFU ablation as a bridging therapy. Another five patients with the same tumor staging (within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison. Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores, tumor size and number, and cause of cirrhosis.
  
  
  RESULTS
  The HIFU group and TACE group showed no difference in terms of tumor size and tumor number. One patient in the HIFU group and no patient in the TACE group had gross ascites. The median hospital stay was 1 d (range, 1-21 d) in the TACE group and two days (range, 1-9 d) in the HIFU group (P < 0.000). No HIFU-related complication occurred. In the HIFU group, nine patients (90%) had complete response and one patient (10%) had partial response to the treatment. In the TACE group, only one patient (3%) had response to the treatment while 14 patients (48%) had stable disease and 14 patients (48%) had progressive disease (P = 0.00). Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list (P = 0.559).
  
  
  CONCLUSIONS
  HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis. It may reduce the drop-out rate of liver transplant candidate.
authors.affiliation: Tan To Cheung, Sheung Tat Fan, See Ching Chan, Kenneth SH Chok, Albert CY Chan, William W Sharr, Simon HY Tsang, Wing Chiu Dai, Ronnie TP Poon, Chung Mau Lo, Department of Surgery, the University of Hong Kong, Hong Kong, China.
authors.forename: Tan To
authors.initials: TT
authors.lastname: Cheung
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.forename: Ferdinand S K
authors.initials: FS
authors.lastname: Chu
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Jenkins
authors.forename: Regina C L
authors.initials: RC
authors.lastname: Lo
authors.forename: James Y Y
authors.initials: JY
authors.lastname: Fung
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.forename: William W
authors.initials: WW
authors.lastname: Sharr
authors.forename: Simon H Y
authors.initials: SH
authors.lastname: Tsang
authors.forename: Wing Chiu
authors.initials: WC
authors.lastname: Dai
authors.forename: Ronnie T P
authors.initials: RT
authors.lastname: Poon
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D016009:Chi-Square Distribution; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Ablation; Bridging therapy; Cirrhosis; Hepatocellular carcinoma; High-intensity focused ultrasound; Liver transplant; New technology