Treatment of recurrent hepatocellular carcinoma by radiofrequency thermal ablation

The treatment of choice for hepatocellular carcinoma is surgical resection. Recurrence occurs in most patients. Aggressive treatment of liver recurrence increases patients' survival, but most frequently, these patients are not suitable for surgery. The aim of this study was to analyze the indications for and results of radiofrequency thermal ablation (RFTA) in the treatment of intrahepatic recurrences of hepatocellular carcinoma after surgical resection or after RFTA.

Seventy-nine patients with HCC were treated by RFTA (17 during laparotomy, 1 in video-laparoscopic surgery, and 61 percutaneously). Five (5/79) of these patients had recurrences after surgical resection and 1 patient had a recurrence (new lesion) after percutaneous RFTA. Fifteen of the 79 patients were treated for recurrence after transarterial chemoembolization (TACE) and, for the remaining 58 patients, RFTA was the first treatment. We used a radiofrequency generator with an expandable needle with four, seven, or nine hooks at its end. We followed up all patients with enhanced computed tomography (CT) scans and alpha-fetoprotein sampling 1 month after RFTA, and then every 4 months.

All 5 patients treated for recurrence after resection are alive, after a mean period of 43 months from liver resection. One patient is disease-free, 1 patient has controlled disease, and 3 patients are in progression. The patient treated for recurrence after RFTA is disease-free after 4 months.

We treated all our patients with intrahepatic recurrence after surgical resection by a multimodal approach. We regard RFTA as the treatment of first choice in the management of intrahepatic recurrence. For superficial tumors, surgical resection is still the best treatment. For multifocal recurrence, TACE is needed. RFTA can be useful as a complementary technique for lesions not completely treated by TACE.