Radiofrequency Ablation For Hepatocellular Carcinoma Research Articles

Safety margin after radiofrequency ablation of hepatocellular carcinoma: precise assessment with a three-dimensional reconstruction technique using CT imaging

Purpose: To analyse the precise ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and the correlation between AM and local tumour progression (LTP) with a three-dimension (3D) reconstruction technique.Methods: From March 2011 to May 2013, 134 patients who underwent RFA for 159 primary or recurrent HCCs within Milan criteria were enrolled. Contrast-enhanced computed tomography (CECT) scans were performed 1 week before and 1 month after treatment. The AM was measured in various directions using a 3D reconstruction technique that shows the index tumour and ablated zone on the same image. The average of all obtained AMs (average AM) and the smallest AM (min-AM) were calculated.Results: The min-AM after RFA ranged from 1 to 9.3 mm (median ± standard deviation, 4.8 ± 1.8 mm). LTP was observed in 19 tumours from 19 patients. The median min-AM was 3.1 ± 1.6 mm for patients with LTP, while the median min-AM of patients without LTP was 5.1 ± 1.8 mm (p = 0.023). After RFA, the 1-, 2- and 3-year LTP rates were 10.9, 25.9 and 35.1%, respectively, for patients with min-AM <5 mm, and 4.1, 4.1 and 4.1%, respectively, for patients with min-AM ≥5 mm (p = 0.016). Multivariate analysis showed that only min-AM <5 mm was an independent risk factor for LTP after RFA (p = 0.044, hazard ratio =4.587, 95% confidence interval, 1.045–22.296).Conclusions: The 3D reconstruction technique is a precise method for evaluating the post-ablation margin. Patients with min-AM less than 5 mm had a higher probability of developing LTP.

High Fever After Radiofrequency Ablation of Hepatocellular Carcinoma

High Fever After Radiofrequency Ablation of Hepatocellular Carcinoma

An unusual cause of right ventricular wall rupture during radiofrequency ablation of hepatocellular carcinoma.

An unusual cause of right ventricular wall rupture during radiofrequency ablation of hepatocellular carcinoma.

Liver Stiffness Measured by Two-Dimensional Shear-Wave Elastography: Prognostic Value after Radiofrequency Ablation for Hepatocellular Carcinoma

Purpose: To evaluate the prognostic value of liver stiffness (LS) measured using two-dimensional (2D) shear-wave elastography (SWE) in patients with hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA). Methods: The Institutional Review Board approved this retrospective study and informed consent was obtained from all patients. A total of 134 patients with up to 3 HCCs ≤5 cm who had undergone pre-procedural 2D-SWE prior to RFA treatment between January 2012 and December 2013 were enrolled. LS values were measured using real-time 2D-SWE before RFA on the procedural day. After a mean follow-up of 33.8 ± 9.9 months, we analyzed the overall survival after RFA using the Kaplan-Meier method and Cox proportional hazard regression model. The optimal cutoff LS value to predict overall survival was determined using the minimal p value approach. Results: During the follow-up period, 22 patients died, and the estimated 1- and 3-year overall survival rates were 96.4 and 85.8%, respectively. LS measured by 2D-SWE was found to be a significant predictive factor for overall survival after RFA of HCCs, as was the presence of extrahepatic metastases. As for the optimal cutoff LS value for the prediction of overall survival, it was determined to be 13.3 kPa. In our study, 71 patients had LS values ≥13.3 kPa, and the estimated 3-year overall survival was 76.8% compared to 96.3% in 63 patients with LS values <13.3 kPa. This difference was statistically significant (hazard ratio = 4.30 [1.26-14.7]; p = 0.020). Conclusion: LS values measured by 2D-SWE was a significant predictive factor for overall survival after RFA for HCC.

Incarcerated Diaphragmatic Hernia as a Late Complication of Radiofrequency Ablation for Hepatocellular Carcinoma

Incarcerated Diaphragmatic Hernia as a Late Complication of Radiofrequency Ablation for Hepatocellular Carcinoma

Predictive Value of Procalcitonin for Bacterial Infection after Transarterial Chemoembolization or Radiofrequency Ablation for Hepatocellular Carcinoma.

This prospective observational study aimed at investigating the role of procalcitonin (PCT) in diagnosing bacterial infection and guiding antibiotic therapy for hepatocellular carcinoma (HCC) patients with fever after transarterial chemoembolization (TACE) and/or radiofrequency ablation (RFA). Ninety-seven cases (84 patients) were enrolled. Serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured on the day of fever onset (day 0) and days 1, 3, 5, and 7 of fever. Empirical antibiotics were initiated only if PCT was ≥0.5 ng/mL or specific infection foci were suspected. An infectious cause was found in nine cases. PCT on day 0 of fever was significantly higher in patients with bacterial infection than in those without infection (P = 0.035). The area under the receiver operating characteristic curve for PCT was 0.715 (95% confidence interval, 0.538–0.892) and was higher than that for CRP (0.598 (0.368–0.828)) or WBC counts (0.502 (0.307–0.697)). In patients undergoing TACE and/or RFA, a significantly lower number of antibiotics were prescribed during the study period than during the prestudy period (P < 0.001). In conclusion, PCT might be a biomarker for diagnosing infection and guiding antibiotic treatment to reduce unnecessary antibiotic use in patients with fever after TACE and/or RFA.

A Case of needle-tract implantation of hepatocellular carcinoma in the ovary after radiofrequency ablation

Radiofrequency ablation (RFA), a local ablative modality, is gaining acceptance for the treatment of liver malignancies. Despite a relatively low complication rate, tumor seeding resulting from RFA in hepatocellular carcinoma (HCC) treatment can occur. A 44-year-old woman was diagnosed with HCC. Spiral computed tomography (CT) revealed a 2.3 × 2.0-cm mass in the S5 segment, which was treated with RFA on May, 2005. Follow-up imaging, performed at 6-month intervals after RFA, showed complete tumor necrosis. In October 2009, CT revealed a heterogeneous mass, 5.7 cm in diameter, in the right ovary. Since the lesion was limited to the right ovary without evidence of spread, bilateral salpingo-oophorectomy was performed. Histopathology indicated that the metastatic spread from the HCC to the ovary was positive for hepatocyte-specific antigen on immunohistochemistry. The ovary is a rare site for HCC metastasis. Moreover, needle tract implantation of HCC in the ovary is very rare.

Surgically treated diaphragmatic perforation after radiofrequency ablation for hepatocellular carcinoma

We review 6 cases of diaphragmatic perforation, with and without herniation, treated in our institution. All patients with diaphragmatic perforation underwent radiofrequency ablation (RFA) treatments for hepatocellular carcinoma (HCC) performed at Kurume University Hospital and Tobata Kyoritsu Hospital. We investigated the clinical profiles of the 6 patients between January 2003 and December 2013. We further describe the clinical presentation, diagnosis, and treatment of diaphragmatic perforation. The change in the volume of liver and the change in the Child-Pugh score from just after the RFA to the onset of perforation was evaluated using a paired t-test. At the time of perforation, 4 patients had herniation of the viscera, while the other 2 patients had no herniation. The majority of ablated tumors were located adjacent to the diaphragm, in segments 4, 6, and 8. The average interval from RFA to the onset of perforation was 12.8 mo (range, 6-21 mo). The median Child-Pugh score at the onset of perforation (8.2) was significantly higher compared to the median Child-Pugh score just after RFA (6.5) (P = 0.031). All patients underwent laparotomy and direct suture of the diaphragm defect, with uneventful post-surgical recovery. Diaphragmatic perforation after RFA is not a matter that can be ignored. Clinicians should carefully address this complication by performing RFA for HCC adjacent to diaphragm.

Laparoscopic liver resection versus percutaneous radiofrequency ablation in patients with hepatocellular carcinoma and liver cirrhosis: a case-matched study

BackgroundHepatitis B-related liver cirrhosis and hepatocellular carcinoma is a serious problem in China. Radiofrequency ablation had been considered a good option because it is minimally invasive. The aim of this study was to compare the perioperative outcomes of laparoscopic liver resection (LLR) with percutaneous radiofrequency ablation (RFA) for patients with hepatocellular carcinoma patients. MethodsA retrospective analysis of a prospective database for liver tumours identified patients with liver cirrhosis who underwent LLR and RFA of hepatocellular carcinoma in the University of Hong Kong, Queen Mary Hospital, Hong Kong between March 18, 2002, and Nov 23, 2015. The complications and-long term outcome after the operations were compared. FindingsWe identified 217 patients who underwent laparoscopic treatment of hepatocellular carcinoma with liver cirrhosis in the University of Hong Kong, Queen Mary Hospital, between 2000 and 2015. 112 patients had undergone percutaneous RFA, and 105 patients who had undergone LLR with similar were selected for comparison. The patient baseline parameters, including age, sex, comorbidity, tumour size, number, and stage of hepatocellular carcinoma, did not differ between patients in the LLR and RFA groups. The median number of tumours was one tumour per patient in both treatment groups (range 1–3; p=0·517). Patients in the RFA group and LLR group had similar duration of hospital stay (2 days vs 4 days, p<0·0001), morbidity (4·5% vs 9·5%, p=0·142), and mortality (0% vs 0%). Intrahepatic recurrence was 70·5% in the RFA group versus 28·6% in the LLR group (p<0·0001). RFA was associated with the lowest overall survival (90·8 months in the RFA group vs >146·4 months in the LLR group, p=0·00019) and lowest disease-free survival (16·9 months vs 74·9 month; p<0·0001). InterpretationLLR and RFA are well tolerated in patients with liver cirrhosis. A better survival outcome has been observed in the LLR group. We suggest LLR be considered as an option in selected patients who are deemed poor candidates for open hepatectomy. FundingNone.

Clinical application of oxycodone combined with dexmedetomidine in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas

Objective: To explore the effects of oxycodone combined with dexmedetomidine in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas. Methods: Sixty patients who underwent percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas were randomly divided into fentanyl group (group A) and oxycodone group( group B), with 30 patients in each group. Patients in group A were injected with fentanyl (2 μg/kg), and patients in group B were injected with oxycodone (0.2 mg/kg). All the patients were injected with dexmedetomidine, with a loading dose of 0.5 μg/kg for 10 minutes and a continuous infusion rate of 0.2 μg·kg(-1)·h(-1) until the end of the operation. The changes of heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO(2)) and bispectral index (BIS) were monitored at different time points: time when patients entering the operating room (T0), the beginning of operation (T1), 10 minutes after operation (T2), the end of operation (T3), 15 minutes after the end of operation (T4). The incidence of side effects (nausea and vomiting, respiratory depression and body movements) was assessed. The visual analogue scale (VAS) scores were also recorded at T0, T3 and an hour postoperatively. Results: Five patients of Group A had the body movements during the operation, and it was improved after injecting with fentanyl 2 μg/kg. Compared with T0, HR in two groups decreased significantly at T2 (P<0.05). At each time point, the difference of MAP, HR, SPO(2) and BIS was not statistically significant in two groups. The incidence of Nausea and vomiting, body movements was lower in group B than that in group A(P<0.05). The VAS scores were lower in group B than that in group A at T3 and an hour postoperatively (P<0.05). Conclusion: The combination of oxycodone and dexmedetomidine can be used safely and effectively in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas, and it shows more effective analgesia and less side-effects.

Nomograms to Predict the Disease-free Survival and Overall Survival after Radiofrequency Ablation for Hepatocellular Carcinoma.

Objective The purpose of this study was to construct nomograms for the disease-free survival (DFS) and overall survival (OS) of post-radiofrequency ablation (RFA) patients with hepatocellular carcinoma (HCC). Furthermore, we compared the prognostic predictive ability of these nomograms for estimating per-patient outcomes with that of traditional staging systems. Methods We retrospectively enrolled 298 patients in the training set and 272 patients in the validation set who underwent RFA for HCC. The nomograms for the DFS and OS were constructed from the training set using the multivariate Cox proportional hazards model. The discriminatory accuracy of the models was compared with traditional staging systems by analyzing the Harrell's C-index. Results The DFS nomogram was developed based on the tumor size, tumor number, aspartate aminotransferase (AST), albumin, age, and α-fetoprotein. The OS nomogram was developed based on the tumor size, the model for end-stage liver disease, AST, and albumin. Our DFS and OS nomograms had good calibration and discriminatory abilities in the training set, with C-indexes of 0.640 and 0.692, respectively, that were greater than those of traditional staging systems. The C-indexes of our DFS and OS nomograms were also greater than those of traditional staging systems in the validation set, with C-indexes of 0.614 and 0.657, respectively. RFA patients were stratified into low- and high-risk groups based on the median nomogram scores. High-risk patients receiving surgical resection (SR) were associated with a better DFS and OS than those undergoing RFA. However, the DFS and OS were similar between the low-risk RFA and SR groups. Conclusion We constructed reliable and useful nomograms that accurately predict the DFS and OS after RFA for early-stage HCC patients. These graphical tools are easy to use and will assist physicians during the therapeutic decision-making process.

Small Bowel Perforation after Percutaneous Ultrasound-guided Radiofrequency Ablation of Hepatocellular Carcinoma

Small Bowel Perforation after Percutaneous Ultrasound-guided Radiofrequency Ablation of Hepatocellular Carcinoma

Combination of the neutrophil to lymphocyte ratio and the platelet to lymphocyte ratio as a useful predictor for recurrence following radiofrequency ablation of hepatocellular carcinoma.

The aim of the present study was to investigate the prognostic potential of a novel inflammation-based system, the combination of the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) (CNP), for predicting the survival time of patients with hepatocellular carcinoma (HCC) who had received radiofrequency ablation (RFA). A total of 287 HCC patients treated with RFA were enrolled in the study. Patients with an elevated NLR (>2.58) and an elevated PLR (>131.78) were allocated a score of 2, and patients exhibiting one or neither of these characteristics were allocated a score of 1 or 0, respectively. The association between the CNP and various HCC clinicopathological factors, patterns of recurrence and prognoses were analyzed. The CNP was associated with liver cirrhosis (P=0.015), Child-Pugh class (P=0.024), total bilirubin level (P=0.028), neutrophil count (P<0.001), lymphocyte count (P<0.001) and platelet count (P<0.001). Compared with their low-CNP counterparts, patients with an elevated CNP were more likely to develop distant intrahepatic recurrence [52.3% (CNP 2) vs. 33.9% (CNP 0) and 34.6% (CNP 1), P=0.015; CNP 0 vs. CNP 1, P=0.922; CNP 1 vs. CNP 2, P=0.020] and extrahepatic metastasis [25.0% (CNP 2) vs. 7.6% (CNP 0) and 18.5% (CNP 1), P=0.003; CNP 0 vs. CNP 1, P=0.020; CNP 1 vs. CNP 2, P=0.309], and had shorter overall survival (OS) time (CNP 0 vs. CNP 1, P<0.001; CNP 1 vs. CNP 2, P<0.001) and recurrence-free survival (RFS; CNP 0 vs. CNP 1, P=0.012; CNP 1 vs. CNP 2, P=0.004). Moreover, multivariate analysis revealed that the CNP was superior to the NLR and the PLR as an independent prognostic marker of OS and RFS. Therefore, it was concluded that the CNP may represent a useful predictor for recurrence and prognosis in patients with HCC treated with RFA.

Non-Hypervascular Hypointense Hepatic Nodules during the Hepatobiliary Phase of Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI as a Risk Factor of Intrahepatic Distant Recurrence after Radiofrequency Ablation of Hepatocellular Carcinoma

Background: Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI have been reported to be associated with intrahepatic distant recurrence (IDR) after hepatectomy or radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). IDR is categorized into hypervascular transformation of non-hypervascular hypointense hepatic nodules and new intrahepatic recurrence. The aim of this study was to evaluate the relationship between non-hypervascular hypointense hepatic nodules on Gd-EOB-DTPA-enhanced MRI and IDR after RFA, focusing on new intrahepatic recurrence. Methods: Ninety-one consecutive patients with 115 HCCs undergoing pretreatment Gd-EOB-DTPA-enhanced MRI and RFA for treatment of HCC were enrolled. Results: Of the 91 patients who underwent RFA for HCC, 24 had non-hypervascular hypointense hepatic nodules on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrences were observed in 15 and 19 patients with and without non-hypervascular hypointense hepatic nodules, respectively. Of the 15 recurrences in patients with non-hypervascular hypointense hepatic nodules, 10 patients had new intrahepatic recurrences. The cumulative incidence of new intrahepatic recurrence was significantly higher in patients with non-hypervascular hypointense hepatic nodules than in those without non-hypervascular hypointense hepatic nodules (p < 0.0001). Multivariate analysis revealed that the presence of non-hypervascular hypointense hepatic nodules and Child-Pugh score were independent risk factors for new intrahepatic recurrence. Conclusions: Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were a useful predictive factor for IDR, particularly for new intrahepatic recurrence, after RFA.

The Role of Diffusion Weighted MR Imaging in Assessment of Hepatocellular Carcinoma after Radiofrequency Ablation

Background: hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Surgical resection and local ablative therapies represent the most frequent first lines therapies adopted when liver transplantation cannot be offered. Aim of the work:this study aimedto evaluate the feasibility of DWI and the corresponding ADC values to detect tumor response after radiofrequency ablation for hepatocellular carcinoma. Patients and methods: MR examinations were done for 20 HCC patients post-RFA. Pre and post gadolinium enhanced images as well as DW sequences were performed. ADC values of ablation zones and liver parenchyma were assessed. ADC values of ablation zones and adjacent signal alterations identified in DWI were analyzed. Results:residual or recurrent lesions were detected in 4 patients (20%). The mean ADC value of ablated zones differed significantly from that of normal liver parenchyma. The corresponding ADC values were significantly lower in patients with residual lesion than in patients without residual lesion. Conclusion: it can be concluded that DWI is a feasible follow-up tool for post ablation liver contributing in detection of residual lesion.

Advantages of Laparoscopic Radiofrequency Ablation Over Percutaneous Radiofrequency Ablation in Hepatocellular Carcinoma

Inoperable hepatocellular carcinoma (HCC) can be treated with laparoscopic radiofrequency ablation (LRFA), which is generally a more accurate and accessible procedure than percutaneous RFA (PRFA). However, few studies have compared survival outcomes between LRFA and PRFA in patients with HCC. This study aimed to compare the efficacy of LRFA and PRFA for HCC treatment. Patients who underwent PRFA or LRFA as an initial treatment modality between April 2005 and April 2016 were enrolled in this study. The overall and recurrence-free survival rates were examined for each patient. Additionally, propensity score matching was performed for both groups. The baseline characteristics of patients in the PRFA and LRFA groups showed several minor differences. Multivariate analysis showed that the RFA method was not a critical determinant of recurrence-free or overall survival (p=0.069 and p=0.406). Among patients who underwent RFA as the initial treatment modality, there was no significant effect between either RFA procedures on survival. After propensity score matching, univariate analysis showed a significant difference in overall survival between PRFA and LRFA (p=0.031). Multivariate analysis showed that LRFA is a strong factor that contributed to an improved overall survival in HCC patients (hazard ratio 0.108, p=0.040). Furthermore, our data showed that LRFA was able to limit multiple intrahepatic recurrences, as well as prevent marginal recurrence. LRFA appears to be superior to PRFA in terms of survival. LRFA may help reduce mortality in HCC patients.

Enhanced efficacy of radiofrequency ablation for hepatocellular carcinoma using a novel vascular disrupting agent, CKD-516.

CKD-516 is a novel vascular disrupting agent that shuts down intratumoral blood flow. We therefore hypothesized that concomitant administration of CKD-516 would enhance the therapeutic efficacy of radiofrequency ablation (RFA) by reducing heat sink effects. We assessed the effects of the combination of CKD-516 and RFA in a rat orthotopic hepatocellular carcinoma (HCC) model. Rat HCC cells (N1-S1) were engrafted into the hepatic lobe of Sprague-Dawley (SD) rats. Mice were randomly divided into two groups: RFA-only and CKD-RFA. In the CKD-RFA group, CKD-516 was administered by intraperitoneal injection 2h before RFA. Ablation zone size was measured on triphenyltetrazolium chloride-stained specimens. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed to evaluate the area of apoptosis/necrosis in the ablation zone. Immunohistochemistry with anti-CD31 antibody was performed to evaluate the effect of CKD-516 on tumor vessels. Ablation zone size was significantly larger in the CKD-RFA group than in the RFA-only group (243.10±74.39 versus 123.30±28.17mm2, p<0.001). On TUNEL staining, the area of apoptosis/necrosis was also significantly larger in the CKD-RFA group than in the RFA-only group (274.44±140.78 versus 143.74±90.13mm2; p=0.006). Immunohistochemistry with anti-CD31 antibody revealed patent tumor vessels in the RFA-only group, while collapsed vessels were seen in the CKD-RFA group, indicating a vascular shutdown effect of CKD-516. Concomitant administration of CKD-516 during RFA can increase the ablation zone of tumors due to its vascular disrupting effect.

The Role of Diffusion Weighted MR Imaging in Assessment of Hepatocellular Carcinoma after Radiofrequency Ablation

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Surgical resection and local ablative therapies represent the most frequent first lines therapies adopted when liver transplantation cannot be offered. Aim of the work: was to evaluate the feasibility of DWI and the corresponding ADC values to detect tumor response after radiofrequency ablation for hepatocellular carcinoma. Materials and methods: MR examinations were done for 20 HCC patients post-RFA. Pre and postgadolinium enhanced images as well as DW sequences were performed. ADC values of ablation zones and liver parenchyma were assessed. ADC values of ablation zones and adjacent signal alterations identified in DWI were analyzed. Results: Residual or recurrent lesions were detected in 4 patients (20%). The mean ADC value of ablated zones differed significantly from that of normal liver parenchyma. The corresponding ADC values were significantly lower in patients with residual lesion than in patients without residual lesion. Conclusion: It could be concluded thatDWI is a feasible follow-up tool for postablation liver contributing in detection of residual lesion.

Percutaneous radiofrequency ablation of hepatocellular carcinoma in cirrhosis: analysis of complications in a single centre over 20 years.

To report on our 20 years' experience on complications after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in patients with cirrhosis. From 1994 to 2014, 1787 RFA procedures were performed percutaneously in 1162 patients with cirrhosis (852 Child A and 310 Child B) with HCC nodules (1.2-7 cm), prothrombin time >50%, platelet count of 50.000 mm3 and total bilirubin ranging from 0.80 to 4.5 mg dl-1. In 67 patients, RFA was performed on both intraparenchymal HCC nodule and tumour thrombus extended in the main portal vein and/or its branches. Four patients (0.3%) died after RFA. 39 patients (3.2%) changed in Child's class: 26 out of 28 Child A patients with cirrhosis changed to Child B and 2 changed to Child C class; 11 Child B patients changed to Child C class. On multivariate analysis, the total bilirubin pre-RFA was the only independent risk factor for impairment of liver function and death. Complications were hemoperitoneum, abscess and intrahepatic haematoma. RFA of HCC in patients with cirrhosis is safe, even in case of invasion of the portal venous system. Functional liver reserve should be strictly monitored, mainly when pre-RFA total bilirubin value is >2.5 mg dl-1. The study was approved by our institutional review board. Advances in knowledge: The total bilirubin value >2.5 mg dl-1 represents the main marker of functional liver reserve that predicts decompensation of liver cirrhosis in patients undergoing RFA for HCC.

Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation: A 10-year intention-to-treat analysis.

RFA as a first-line stand-alone bridge therapy to LT achieves excellent long-term overall and tumor-specific survivals, with a low dropout rate from tumor progression despite long wait list times and a sustained low tumor recurrence rate upon post-LT follow-up of up to 10 years. (Hepatology 2017;65:1979-1990).