An alternative treatment for hypervascular hepatocellular carcinoma

HCC is the fifth most common cancer in the world and the third most frequent cause of cancer-related death.

Only about 20% of HCC patients are eligible for surgical resection. Therefore, RFA has been used increasingly as a safe technique for treating hepatic tumors. However, for hypervascular HCC, RFA appears less effective because of its blood-flow-induced heat sink effect, which might cause incomplete ablation or recurrence. Transcatheter arterial chemoembolization (TACE) can reduce the blood supply of HCC by occlusion of tumor arteries. A difficulty remains for those patients who cannot tolerate or are ineligible for TACE because of liver cirrhosis or difficulty in manipulating vessels with abnormal curvature caused by surgical resection and liver transplantation. PAA of HCC may block or reduce the blood flow, thus increasing the ablation volume of coagulation necrosis of subsequent routine RFA. To the best of our knowledge, the application of PAA to the treatment of hypervascular HCC has not been reported in a large number of patients.

A research article to be published on June 7, 2009 in the World Journal of Gastroenterology addresses this question. The research team led by Professor Chen from Peking University School of Oncology, Beijing Cancer Hospital & Institute, studied a total of 154 HCC patients with 177 hypervascular lesions, to evaluate the feasibility and adjuvant value of PAA performed before routine RFA treatment of hypervascular HCC.

The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B (control group treated with conventional RFA) (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04).

For hypervascular HCC patients who are unsuitable for surgical resection or TACE, PAA is an alternative for effectively blocking the feeding artery of the tumor, and reducing heat loss during subsequent RFA. The combination of PAA and RFA may significantly decrease post-RFA recurrence and provide a safe and effective treatment for hypervascular HCC.

Reference: Hou YB, Chen MH, Yan K, Wu JY, Yang W. Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment. World J Gastroenterol 2009; 15(21): 2638-2643

Correspondence to: Min-Hua Chen, Ultrasound Department, Peking University School of Oncology, Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. [email protected]

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