title: [Percutaneous ablation of hepatocellular carcinoma in older patients in clinical practice].
abstract: BACKGROUND
  A high percentage of older patients with early-stage hepatocellular carcinoma (HCC) are potential candidates for percutaneous ablation.
  
  
  METHODS
  We prospectively assessed data from patients older than 70 years with HCC. We determined their demographic and clinical characteristics, the treatment provided and the response, complications and survival among those treated with radiofrequency ablation (RFA) and/or percutaneous ethanol injection (PEI).
  
  
  RESULTS
  Of 194 patients with HCC, 84 were older than 70 years (43.3%). The mean age was 76.8 ± 4.5 years. Seventy-five percent were male and 91.7% had cirrhosis. Cancer was initially identified by a surveillance program in 61.9%. According to the Barcelona Clinic Liver Cancer staging system, 60.7% were classified as having early stage cancer (0-A), 19% as stage B, 12% as stage C, and 8.3% as stage D. Potentially curative initial treatment was provided in 38.2% (surgical resection in 4.8%, PEI in 22.6%, RFA in 4.8%, PEI+RFA in 6%), transarterial chemoembolization in 20.2%, and sorafenib in 3.6%. Twenty-five percent of patients were not treatment candidates and 13% refused the recommended treatment. The median follow-up after percutaneous ablation was 23 months (IQR 14.2-40.6). The mean number of sessions was 3.5 ± 2.2 for PEI and 1.8 ± 1.6 for RFA. The complications rate per session was 4%. Remission was achieved in 35.7%. The overall median survival was 45.7 months (95% CI 20.8-70.6).
  
  
  CONCLUSIONS
  Almost half of the patients with HCC in our sample were elderly and more than half were diagnosed at an early stage. Percutaneous ablation was performed in one-third of the sample, achieving remission in 37.5%. There were few complications. Therefore, these patients should be assessed for percutaneous ablation.
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España. Electronic address: m.romero.gutierrez@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Romero Gutiérrez
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Lucía
authors.initials: L
authors.lastname: Ruano Díaz
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Diego
authors.initials: D
authors.lastname: Muñoz López
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Tomás
authors.initials: T
authors.lastname: Artaza Varasa
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Concepción
authors.initials: C
authors.lastname: González de Frutos
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Sánchez Ruano
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Gema
authors.initials: G
authors.lastname: de la Cruz Pérez
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Gómez Rodríguez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery* / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D048909:Diabetes Complications; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery* / Q000628:therapy*; D008297:Male; D016609:Neoplasms, Second Primary / Q000601:surgery / Q000628:therapy; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D011446:Prospective Studies; D012074:Remission Induction; D000077157:Sorafenib
chemical_list: D010671:Phenylurea Compounds; D009536:Niacinamide; D000431:Ethanol; D000077157:Sorafenib
keywords: Carcinoma hepatocelular; Elderly patients; Etanolización; Hepatocellular carcinoma; Pacientes de edad avanzada; Percutaneous ethanol injection; Percutaneous techniques; Radiofrecuencia; Radiofrequency ablation; Tratamiento percutáneo