Efficacy and safety of ablative techniques in elderly HCC patients

This study was conducted to evaluate the efficacy and safety of ablative techniques in elderly patients with hepatocellular carcinoma (HCC).

From February 2004 to February 2009, 80 elderly patients (age > or = 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.

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).

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.