Treatment of unresectable large HCC by high intensity focused ultrasound therapy in patients with cirrhosis

Abstract

Introduction: High-intensity focused ultrasound (HIFU) ablation is a relatively new non-invasive treatment for unresectable HCC but long term survival analysis is lacking. In this study we aim to analysis the outcome for patients receiving this treatment compared to TACE. Methods: From Oct 2003 to Sept 2010, 112 patients received HIFU as a treatment of HCC in Department of Surgery Queen Mary Hospital. 27 patients has HCC larger than 3cm. 54 patient with matched tumour characteristic receiving TACE as primary treatment were selected for comparison. Short term outcome and long term survival outcome were analysed. Results: In the HIFU group (n=27) 46 tumours were ablated. The median age of the patients was 69 (range 49years-84 years). The median tumour size was 4.2cm (range 3-8cm). There were 30.8% of patients presented with ascites in the HIFU group. In TACE group (n=54), the median age for the patients was 67 (range 44years-84 years). The median tumour size was 4.8cm (range 3-8cm). (p=0.119) None of the patient had ascites. There was no hospital mortality in both groups. In the HIFU group, the complete tumour response (CR) , partial tumour response (PR), stable disease (SD) and progressive disease (PD) rate was 50%,7.7%,25.6% and 7.7% respectively versus 0%, 21.2%, 63.5% and 15.4% patients had progressive respectively in TACE group according to RECIST criteria. (p<0.0001) The 1-year, 3 year and 5-year survival was 84.6%, 49.2% and 32.3% respectively in the HIFU group versus 69.2%, 29.8% and 2.3% respectively in the TACE group. (p=0.001) Conclusion: High intensity focused ultrasound ablation is a safe and effective method for large unresectable HCC. The survival benefit is observed over TACE alone in selected patient. References: [1] Lo CM et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35: 1164-71. [2]Cheung TT, Ng KK, Poon RT, Fan ST. Tolerance of radiofrequency ablation by patients of hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 2009; 16: 655-60. [3] Bruix J et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol 2012; 57: 821-9. [4] Cheung TT et al. Tolerance of high-intensity focused ultrasound ablation in patients with hepatocellular carcinoma. World J Surg 2012; 36: 2420-7. [5]Cheung TT et al. Survival analysis of high-intensity focused ultrasound ablation in patients with small hepatocellular carcinoma. HPB (Oxford) 2012. [6]Cheung TT et al. High-intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients awaiting liver transplantation. Hepatobiliary Pancreat Dis Int 2012; 11: 542-4.