Efficacy and safety of ablative techniques in elderly HCC patients

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COD: 06_2011_457-464 Categorie: ,

Aldo Bove, Giuseppe Bongarzoni, Raffaella M. Di Renzo, Luca Marsili, Stella Chiarini, Luciano Corbellini.

Ann. Ital. Chir., 2011; 82: 457-463

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BACKGROUND: This study was conducted to evaluate the efficacy and safety of ablative techniques in elderly patients with
hepatocellular carcinoma (HCC).
METHODS: From February 2004 to February 2009, 80 elderly patients (age > 70 years) affected by non-resectable HCC
were treated with a regional palliative approach, trans-arterial-chemo-embolization and radio-frequency-thermal-ablation
(TACE, RFA). Our approach includes a first treatment of TACE and then a control CT plan after a month. A possible
following RFA can be performed to ensure a complete necrosis of the lesions, and then a further contrast enhanced
CT scan after 2 months. For 60 patients, the first TACE was sufficient to treat the disease at beginning. For 15 patients
TACE was followed by RFA, and for 5 patients an RFA was performed directly due to nodule localization.
Response to TACE is assessed every 2 to 3 months with serial AFP level and TC scan.
RESULTS: Two patients died for related method’s causes (2.5%): liver-renal syndrome (1 patients), and portal thrombosis
with irreversible postoperative liver failure (1 patients). A total of 15 patients were lost to follow-up (18.7%): 2
(2.5%) patients had died for non-tumor-related causes, 1 due to a liver transplantation, and 12 (15%) due to failure
to attend follow-up visits. All patients developed further localisation, medially after 4 months, and underwent TACE
treatment for a mean of another two times. A mean follow up is 36.7 months (1-60) with a mean survival rate of
35.1 months (1-60)
CONCLUSIONS: We conclude that, even in over 70-year-olds, TACE and RFA treatment should be employed to completely
cure HCC, if liver function and tumor stage are acceptable.

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