Treatment of Recurrent Hepatocellular Carcinoma: Reinforcing the Role of the Interventional Oncologist

Abstract

This article written by Mikami et al is timely and extremely relevant to practicing interventional oncologists (1). Large series exist documenting the long-term efficacy of thermal ablation for treating small hepatocellular carcinomas (HCCs). However, in the presence of cirrhosis-driven field carcinogenesis, the development of new primary tumors is a concern. In another long-term follow-up study, Lencioni et al demonstrated control of 90% of ablated tumors, but separate tumors developed in 49% of patients over 3 years (2). The current work focuses on the latter patient subgroup. The authors identified new HCC in 25% of previously treated patients during the 2-year study period. Repeat ablation was feasible in 104 of 113 (92%) of the patients, with a median survival of 4.96 years from the second procedure. These outcomes provide a powerful example of the kind of durable outcomes possible using locoregional therapies in patients with HCC and reinforce the role of interventional oncologists as long-term care givers in this population. Mikami et al’s work also underscores the key role of imaging in these patients, with potential implications for all interventional radiologists regarding clinical trial structure and resource use. Overall survival is an appropriate gold standard measure for oncologic trials. However, given the length of time