Management of Hepatocellular Carcinoma in Patients with Cirrhosis by High Intensity Focused Ultrasound Ablation

Abstract

Hepatocellular carcinoma (HCC) is one of the commonest cancers in Asia. However, only a small amount of patients is eligible for surgical intervention upon diagnosis. Treatment planning for patients with HCC remains a great challenge to most clinician. In Asia, most of the HCC patients are hepatitis B carrier. The bad combination of liver cancer and hepatitis B related cirrhosis make liver resection impossible in most of the patients.1 Radiofrequency ablation (RFA) is one of the very effective and simple treatment methods for HCC which can achieve survival similar to liver resesction for HCC smaller than 2cm. However, RFA may not be well tolerated in patients with cirrhosis and severe complication may follow after prolonged ablation.2 Transarterial choemoembolization (TACE) is a widely used treatment option for unresectable HCC and its effect has been shown to be better by best symptomatic treatment by randomised controlled studies.3 However, the survival outcome of TACE is not very appealing as the 2 year survival is around 30%. High intensity focused ultrasound (HIFU) is a totally non invasive ablation treatment modality. 4. Our center started offering HIFU treatment in 2006 as a non-invasive mode of surgical ablation for patients who could not tolerate liver resection because of poor liver reserve.5. Our initial results showed that the complete ablation rate with single ablation was 89.2%.6. Up to date, we have performed more than 200 cases of HIFU ablation to treat HCC and no postoperative liver failure has been recorded. HIFU ablation was safely performed in the present case even though the patient had thrombocytopenia. The unique needleless design of the HIFU system makes HIFU ablation superior to RFA, for needle penetration may induce hemorrhage from a hypervascular tumor in a patient with coagulopathy and low platelet count. Furthermore, without needle puncture, there is no risk of direct tumor seeding to the surrounding major vessels. 4,7 In conclusion, HIFU ablation is a potentially curative measure which seems to be safe and effective for patients with unresectable HCC.

References

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4. Cheung TT, Chok KS, Lo RC, Sharr WW, Chan SC, Poon RT, Fan ST, Lo CM. High-intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients awaiting liver transplantation. Hepatobiliary Pancreat Dis Int 2012;11:542-544.

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7. Cheung TT, Poon RT, Yau T, Tsang OS, Lo CM, Fan ST. High-intensity focused ultrasound as a treatment for colorectal liver metastasis in difficult position. Int J Colorectal Dis 2012; 27:987-988.