Safety and tolerance of high intensive focused ultrasound ablation for hepatocellular carcinoma in 100 consecutive patients

Abstract

High intensive focused ultrasound ablation (HIFU) is a novo noninvasive ablation methods for hepatocellular carcinoma (HCC). Emerging evidence has shown that it is effective in the treatment of HCC particularly in patient with poor liver function. Unlike partial hepatectomy or RFA for HCC on patients with cirrhosis, there are no data on the safety limit of HIFU. However, information is vital for the selection of appropriate patients for the procedure. In this study, we analyzed the results of HIFU on HCC patients and determined the lower limit of liver function and other patient’s factors with which HCC patients can tolerate HIFU. METHOD: Preoperative variables of consecutive 100 patients who underwent HIFU for HCC were analyzed to identify the risk factors in HIFU intolerance in terms of morbidity associated with stress-induced complications. RESULTS: 15 patients were in Child Pugh grade B liver cirrhosis and 1 patient was in Pugh Child C liver cirrhosis. 15 patients presented with ascites before treatment. Thirteen (13%) patients developed intolerance to HIFU. Postoperative morbidity was mainly due to skin and subcutaneous injury (n = 9), five patients developed first degree skin burn, one patient developed second degree skin burn and three patients developed third degree skin burn. Two patients developed pneumothorax, one patient developed hyperbilirubinemia and six patients developed other complications. Univariated analysis only showed that age (p = 0.022) is the single independent factor that predict the development of intolerance. CONCLUSIONS: HIFU is generally well tolerated inpatients with cirrhosis. This is a safe method for patients even when TACE is considered risky as a treatment modality. This ablative treatment modality can be used in selected patients with Pugh Child C liver cirrhosis.