Defying conventional wisdom, Italian researchers are saying that radio-frequency ablation should be offered as first-line treatment for patients with liver tumors. They will present data to support this breakthrough at the upcoming RSNA meeting in Chicago.
?I?m not crazy. This is a conclusion after 16 years of percutaneous ablation of hepatocellular carcinomas in cirrhotic patients,? said Dr. Riccardo Lencioni, an interventional radiologist at the University of Pisa.
The current standard of care is surgical resection, reserving RFA for cases not suitable for surgery. That paradigm needs to be turned on its head, according to Lencioni and colleagues.
They assessed long-term survival rates of 187 cirrhotic patients with HCC treated with RFA. They found five-year survival rates that were similar -- and in some cases superior -- to those for surgery.
The prospective study included 240 liver carcinomas that were 5 cm and smaller. These lesions underwent ultrasound-guided RFA with 50- or 150-watt generators using expandable multiprobe needles. A subgroup of 116 patients with stable liver function and solitary lesions achieved three- and five-year survival rates of 89% and 61%, respectively.
The study broke down overall survival rates: · one year: 97%, with 18% recurrence · two years: 89%, with 37% recurrence · three years: 71%, with 55% recurrence · four years: 57%, with 71% recurrence · five years: 48%, with 83% recurrence
Recent findings should prelude a fundamental shift in the way physicians approach unresectable cancers, Lencioni said. After years of RFA research, the evolution of this technology, along with the increased clinical experience, has opened new frontiers in treating other tumor types, including lung, bone, and kidney.
?The positive long-term data being gathered in Europe and the U.S. are powerful indicators that RFA should become an early priority in the treatment continuum for many cancer patients,? he said.
Lencioni will present his data on Monday, at 3:10 p.m., in room E450A.
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