Lectures

Role of image-guided therapies in hepatocellular carcinoma

Small HCC  

Although it is understood that partial resection assures the higher possibility to completely ablate the tumor, different comparative studies based on historical results (table 1).

Table 1
Survival curve of patients with cirrhosis with HCC less than 5 cm. Survival curve of patients with Stage I disease having tumors ≤ 30 mm in size and ≤ 3 in number.

and two prospective trials comparing surgery and PAT demonstrated roughly equivalent results (table 2).

Table 2 - PROSPECTIVE TRIALS

 

SURGERY
3 – 5 y
PAT
3 – 5 y
1) Single or 
multiple < 3 cm
82% - 59% 84% - 61%
(PEI)
2) Single < 5 cm 85% - 67% 82% - 64%
(RFA)

In the second study the results were better with RFA when the size was < 3 cm, and better with surgery when the size was between 3 and 5 cm.
The explanation is probably due to a balance among advantages and disadvantages of the two therapies, the most important advantages of surgery being the higher ablation rate (using anatomical resection), and of PAT being repeatability, no loss or damage of nonneoplastic tissue and lower complication rate. Furthermore, the overall results of both therapies were partially flattened by the natural course of those aggressive tumors unresponsive to whatever treatment.
Currently, in our center, the selection for partial resection includes the following candidates (table 3).

Table 3 - HCC: candidates for resection according to prognostic factors
CLINICAL TUMORAL TECHNICAL
Child A Single (with
segmental IM)
Feasibility of
anatomical res
Normal bilirubin Grade I – II Peroperative
mortality < 2%
No portal
hypertension
> 2 cm Accurate
stadiation
< x 3 n.v.
transaminases
2 - 3 cm? Salvage
Site dependent