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01-04-2020 | Hepatocellular Carcinoma | Original Paper

Ablation for hepatocellular carcinoma: beyond the standard indications

Authors: Matteo Renzulli, Francesco Tovoli, Alfredo Clemente, Anna Maria Ierardi, Irene Pettinari, Giuliano Peta, Giovanni Marasco, Davide Festi, Fabio Piscaglia, Salvatore Cappabianca, Gianpaolo Carrafiello, Rita Golfieri

Published in: Medical Oncology | Issue 4/2020

Abstract

Hepatocellular carcinoma (HCC), the most common primary liver neoplasia, represents the fifth most common malignant disease in men. Percutaneous ablation treatment is recommended among the treatments suggested for HCC patients in the very early/early stage. In the last decade, very important results in terms of survival benefits have been obtained with local ablative therapies, also outside the standard indications, thanks to many technical innovations. In particular, important results of ablation as a safe and effective technique have been obtained in the treatment of intermediate- or advanced-stage patients with HCC, and in the treatment of unfavourable tumour locations. Moreover, awareness is growing regarding the necessity of overcoming the rigidity of traditional guidelines in the treatment of HCC due to the complexity of patients with HCC, focusing on Precision Medicine. In this context, it is important to know the standard and non-standard indications of ablation in the treatment of HCC in order to offer the best therapeutic option tailored for each patient. The aim of this study was to analyse the possible clinical applications of ablative therapies for HCC patients, beyond the traditional indications recommended in the most widespread clinical practice guidelines for the management of HCC.

Himoto T, Kurokohchi K, Watanabe S, Masaki T. Recent advances in radiofrequency ablation for the management of hepatocellular carcinoma. Hepat Mon. 2012;12:e5945.PubMedPubMedCentral

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.PubMed

Bruix J, Sherman M, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.PubMedPubMedCentral

Llovet JM, Zucman-Rossi J, Pikarsky E, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016;2:16018.PubMed

Tiniakos DG, Maurício J, Reeves HL, et al. Fatty liver disease and hepatocellular carcinoma: the pathologist’s view. Adv Exp Med Biol. 2018;1032:55–69.PubMed

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.

Dimitroulis D, Damaskos C, Valsami S, et al. From diagnosis to treatment of hepatocellular carcinoma: an epidemic problem for both developed and developing world. World J Gastroenterol. 2017;23(29):5282–94.PubMedPubMedCentral

Nault JC, Sutter O, Nahon P, et al. Percutaneous treatment of hepatocellular carcinoma: state of the art and innovations. Hepatology. 2018;68(4):783–97.

Giannini EG, Bucci L, Garuti F, et al. Patients with advanced hepatocellular carcinoma need a personalized management: a lesson from clinical practice. Hepatology. 2018;67(5):1784–96.PubMed

10.

Putzer D, Schullian P, Braunwarth E, et al. Integrating interventional oncology in the treatment of liver tumors D. Eur Surg. 2018;50(3):117–24.PubMedPubMedCentral

11.

Poulou LS, Botsa E, Thanou I, et al. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;7(8):1054–63.PubMedPubMedCentral

12.

Facciorusso A, Serviddio G, Muscatiello N. Local ablative treatments for hepatocellular carcinoma: an updated review. World J Gastrointest Pharmacol Ther. 2016;7(4):477–89.PubMedPubMedCentral

13.

European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.

14.

Kokudo N, Hasegawa K, Akahane M, et al. Evidence-based clinical practice guidelines for hepatocellular carcinoma: the Japan Society of Hepatology 2013 update (3rd JSH-HCC Guidelines). Hepatol Res. 2015. https://doi.org/10.1111/hepr.12464.CrossRefPubMed

15.

Renzulli M, Golfieri R, Bologna Liver Oncology Group (BLOG) (2016) Proposal of a new diagnostic algorithm for hepatocellular carcinoma based on the Japanese guidelines but adapted to the Western world for patients under surveillance for chronic liver disease. J Gastroenterol Hepatol 31(1):69–80.

16.

Heimbach J, Kulik LM, Finn R, et al. AASLD Guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358–80.PubMed

17.

Tovoli F, Negrini G, Bolondi L. Comparative analysis of current guidelines for the treatment of hepatocellular carcinoma. Hepatol Oncol. 2016;3(2):119–36.

18.

D’Avola D, Iñarrairaegui M, Pardo F, et al. Prognosis of hepatocellular carcinoma in relation to treatment across BCLC stages. Ann Surg Oncol. 2011;18(7):1964–71.PubMed

19.

Ho EY, Cozen ML, Shen H, et al. Expanded use of aggressive therapies improves survival in early and intermediate hepatocellular carcinoma. HPB (Oxf). 2014;16(8):758–67.

20.

Pecorelli A, Lenzi B, Gramenzi A, et al. Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma. Liver Int. 2016;37(3):423–33.PubMed

21.

Bolondi L, Burroughs A, Dufour JF, et al. Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis. 2012;32(4):348–59.PubMed

22.

Iezzi R, Pompili M, Posa A, Coppola G, Gasbarrini A, Bonomo L. Combined locoregional treatment of patients with hepatocellular carcinoma: state of the art. World J Gastroenterol. 2016;22(6):1935–42.PubMedPubMedCentral

23.

Di Costanzo GG, Tortora R. Intermediate hepatocellular carcinoma: how to choose the best treatment modality? World J Hepatol. 2015;7(9):1184–91.PubMedPubMedCentral

24.

Brace CL, Sampson LA, Hinshaw JL, Sandhu N, Lee FT Jr. Radiofrequency ablation: simultaneous application of multiple electrodes via switching creates larger, more confluent ablations than sequential application in a large animal model. J Vasc Interv Radiol. 2009;20(1):118–24.PubMed

25.

Livraghi T, Goldberg SN, Lazzaroni S, et al. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology. 2000;214(3):761–8.PubMed

26.

Sangiovanni A, Colombo M. Treatment of hepatocellular carcinoma: beyond international guidelines. Liver Int. 2016;36:124–9.PubMed

27.

Chen QW, Ying HF, Gao S, et al. Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2016;40(3):309–14.PubMed

28.

Wang Y, Deng T, Zeng L, Chen W. Efficacy and safety of radiofrequency ablation and transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma: a meta-analysis. Hepatol Res. 2016;46(1):58–71.PubMed

29.

Ni JY, Liu SS, Xu LF, Sun HL, Chen YT. Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol. 2013;19(24):3872–82.PubMedPubMedCentral

30.

Marelli L, Stigliano R, Triantos C, et al. Treatment outcomes for hepatocellular carcinoma using chemoembolization in combination with other therapies. Cancer Treat Rev. 2006;32(8):594–606.PubMed

31.

Lu Z, Wen F, Guo Q, Liang H, Mao X, Sun H. Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma: a meta-analysis of randomized-controlled trials. Eur J Gastroenterol Hepatol. 2013;25(2):187–94.PubMed

32.

Wang W, Shi J, Xie WF. Transarterial chemoembolization in combination with percutaneous ablation therapy in unresectable hepatocellular carcinoma: a meta-analysis. Liver Int. 2010;30(5):741–9.PubMed

33.

Wang N, Guan Q, Wang K, et al. TACE combined with PEI versus TACE alone in the treatment of HCC: a meta-analysis. Med Oncol. 2011;28(4):1038–43.PubMed

34.

Kudo M, Matsui O, Izumi N, et al. JSH Consensus-Based Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma: 2014 Update by the Liver Cancer Study Group of Japan. Liver Cancer. 2014;3(3–4):458–68.PubMedPubMedCentral

35.

Commissione “Epatocarcinoma” dell’Associazione Italiana per lo Studio del Fegato. Epatocarcinoma: Linee Guida per la Diagnosi e la Terapia. Bologna: TipografiaModerna; 1998.

36.

Benson AB III, Abrams TA, Ben-Josef E, et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Cancer Netw. 2009;7(4):350–91.

37.

Ahrar K, Newman RA, Pang J, Vijjeswarapu MK, Wallace MJ, Wright KC. Dr. Gary J. Becker Young Investigator Award: Relative thermosensitivity of cytotoxic drugs used in transcatheter arterial chemoembolization. J Vasc Interv Radiol. 2004;15(9):901–5.PubMed

38.

Cha CH, Saif MW, Yamane BH, Weber SM. Hepatocellular carcinoma: current management. Curr Probl Surg. 2010;47:10–67.PubMed

39.

Lee MW, Kim YJ, Park SW, et al. Biplane fluoroscopy-guided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience. Br J Radiol. 2011;84:691–7.PubMedPubMedCentral

40.

Iezzi R, Cesario V, Siciliani L, et al. Single-step multimodal locoregional treatment for unresectable hepatocellular carcinoma: balloon-occluded percutaneous radiofrequency thermal ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE). Radiol Med. 2013;118(4):555–69.PubMed

41.

Nouso K, Kariyama K, Nakamura S, et al. Application of radiofrequency ablation for the treatment of intermediate-stage hepatocellular carcinoma. J Gastroenterol Hepatol. 2017;32(3):695–700.PubMed

42.

Lin CC, Cheng YT, Chen M WT, Lin SM. The effectiveness of multiple electrode radiofrequency ablation in patients with hepatocellular carcinoma with lesions more than 3 cm in size and Barcelona Clinic Liver Cancer Stage A to B2. Liver Cancer. 2016;5(1):8–20.PubMed

43.

Kariyama K, Wakuta A, Nishimura M, et al. Percutaneous radiofrequency ablation for intermediate-stage hepatocellular carcinoma. Oncology. 2015;89:19–26.PubMed

44.

Hou YF, Wei YG, Yang JY, et al. Combined hepatectomy and radiofrequency ablation versus TACE in improving survival of patients with unresectable BCLC stage B HCC. Hepatobiliary Pancreat Dis Int. 2016;15(4):378–85.PubMed

45.

Azuma S, Asahina Y, Nishimura-Sakurai Y, et al. Efficacy of additional radiofrequency ablation after transcatheter arterial chemoembolization for intermediate hepatocellular carcinoma. Hepatol Res. 2016;46(4):312–9.PubMed

46.

Xu RC, Liu HC, Li JL, et al. Long-term outcome of transcatheter arterial chemoembolization after radiofrequency ablation as a combined therapy for Chinese patients with hepatocellular carcinoma. Curr Med Res Opin. 2015;31(8):1553–600.PubMed

47.

Yin X, Zhang L, Wang YH, et al. Transcatheter arterial chemoembolization combined with radiofrequency ablation delays tumor progression and prolongs overall survival in patients with intermediate (BCLC B) hepatocellular carcinoma. BMC Cancer. 2014;14:849.PubMedPubMedCentral

48.

Hoffmann R, Rempp H, Syha R, et al. Transarterial chemoembolization using drug eluting beads and subsequent percutaneous MR-guided radiofrequency ablation in the therapy of intermediate sized hepatocellular carcinoma. Eur J Radiol. 2014;83(10):1793–8.PubMed

49.

Min JH, Lee MW, Cha DI, et al. Radiofrequency ablation combined with chemoembolization for intermediate-sized (3–5 cm) hepatocellular carcinomas under dual guidance of biplane fluoroscopy and ultrasonography. Korean J Radiol. 2013;14(2):248–58.PubMedPubMedCentral

50.

Ashoori N, Paprottka P, Trumm C, et al. Multimodality treatment with conventional transcatheter arterial chemoembolization and radiofrequency ablation for unresectable hepatocellular carcinoma. Digestion. 2012;85(1):18–26.PubMed

51.

Morimoto M, Numata K, Kondou M, Nozaki A, Morita S, Tanaka K. Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer. 2010;116(23):5452–60.PubMed

52.

Zhao M, Wang JP, Pan CC, et al. CT-guided radiofrequency ablation after with transarterial chemoembolization in treating unresectable hepatocellular carcinoma with long overall survival improvement. Eur J Radiol. 2012;81(10):2717–25.PubMed

53.

Raza A, Sood GK. Hepatocellular carcinoma review: current treatment, and evidence-based medicine. World J Gastroenterol. 2014;20(15):4115–277.PubMedPubMedCentral

54.

Cerrito L, Annicchiarico BE, Iezzi R, Gasbarrini A, Pompili M, Ponziani FR. Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: beyond the known frontiers. World J Gastroenterol. 2019;25(31):4360–82.PubMedPubMedCentral

55.

Ricke J, Klümpen HJ, Amthauer H, et al. Impact of combined selective internal radiation therapy and sorafenib on survival in advanced hepatocellular carcinoma. J Hepatol. 2019;71(6):1164–74.PubMed

56.

Chow PKH, Gandhi M, Tan SB, et al. SIRveNIB: selective internal radiation therapy versus sorafenib in Asia-Pacific patients with hepatocellular carcinoma. J Clin Oncol. 2018;36(19):1913–21.PubMed

57.

Vilgrain V, Pereira H, Assenat E, et al. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet Oncol. 2017;18(12):1624–36.PubMed

58.

Giorgio A, Merola MG, Montesarchio L, et al. Sorafenib combined with radio-frequency ablation compared with sorafenib alone in treatment of hepatocellular carcinoma invading portal vein: a Western Randomized Controlled Trial. Anticancer Res. 2016;36:6179–83.PubMed

59.

Lu ZH, Shen F, Yan ZL, et al. Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation. J Cancer Res Clin Oncol. 2009;135:783–9.PubMed

60.

Zheng JS, Long J, Sun B, et al. Transcatheter arterial chemoembolization combined with radiofrequency ablation can improve survival of patients with hepatocellular carcinoma with portal vein tumour thrombosis: extending the indication for ablation? Clin Radiol. 2014;69:e253–e263263.PubMed

61.

Tovoli F, Casadei-Gardini A, Benevento F, Piscaglia F. Immunotherapy for hepatocellular carcinoma: a review of potential new drugs based on ongoing clinical studies as of 2019. Dig Liver Dis. 2019;51(8):1067–73.PubMed

62.

Roche’s Group. In: Roche’s Tecentriq in combination with Avastin increased overall survival and progression-free survival in people with unresectable hepatocellular carcinoma. https://www.roche.com/media/releases/med-cor-2019-10-21.htm. 2019. Accessed 15 Nov 2019.

63.

Kang TW, Lim HK, Lee MW, et al. Long-term therapeutic outcomes of radiofrequency ablation for subcapsular vs. nonsubcapsular hepatocellular carcinoma: a propensity score matched study. Radiology. 2016;280:300–12.PubMed

64.

Francica G, Meloni MF, de Sio I, et al. Radiofrequency and microwave ablation of subcapsular hepatocellular carcinoma accessed by direct puncture: safety and efficacy. Eur J Radiol. 2016;85:739–43.PubMed

65.

66.

Fukuda H, Numata K, Moriya S, et al. Hepatocellular carcinoma: concomitant sorafenib promotes necrosis after radiofrequency ablation—propensity score matching analysis. Radiology. 2014;272:598–604.PubMed

67.

Renzulli M, Buonfiglioli F, Conti F, et al. Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis. Eur Radiol. 2018;28:506–13.PubMed

68.

Tovoli F, Renzulli M, Negrini G, et al. Inter-operator variability and source of errors in tumour response assessment for hepatocellular carcinoma treated with sorafenib. Eur Radiol. 2018;28(9):3611–20.PubMed

69.

Renzulli M, Clemente A, Brocchi S, et al. LI-RADS: a great opportunity not to be missed. Eur J Gastroenterol Hepatol. 2019;31(3):283–8.PubMed

70.

Golfieri R, Garzillo G, Ascanio S, Renzulli M. Focal lesions in the cirrhotic liver: their pivotal role in gadoxetic acid-enhanced MRI and recognition by the Western guidelines. Dig Dis. 2014;32:696–704.PubMed

Title: Ablation for hepatocellular carcinoma: beyond the standard indications
Authors: Matteo Renzulli
Francesco Tovoli
Alfredo Clemente
Anna Maria Ierardi
Irene Pettinari
Giuliano Peta
Giovanni Marasco
Davide Festi
Fabio Piscaglia
Salvatore Cappabianca
Gianpaolo Carrafiello
Rita Golfieri
Publication date: 01-04-2020
Publisher: Springer US
Keywords: Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: Medical Oncology / Issue 4/2020
Print ISSN: 1357-0560
Electronic ISSN: 1559-131X
DOI: https://doi.org/10.1007/s12032-020-01348-y

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