Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
TREATMENT BY RADIOFREQUENCY ABLATION FOLLOWED BY SALVAGE TRANSPLANTATION IN PATIENTS WITH CHILD PUGH A CIRRHOSIS AND HCC WITHIN MILAN CRITERIA
G. Nkontchou1*, O. Seror1, M. Aout2, A. Laurent3, N. Ganne Carrie1, V. Grando Lemaire1, J.-C. Trinchet1, D. Cherqui4, E. Vicaut2, M. Beaugrand1
Liver transplantation is the preferred option for HCC within Milan criteria in patients with Child Pugh B or C cirrhosis. In patients with Child Pugh A cirrhosis, local treatment, followed by liver transplantation in case of HCC recurrence or liver failure could help to optimize utilization of liver grafts. We report the results of a first line treatment by radiofrequency ablation (RFA) followed by salvage LT in case of recurrence or liver failure.Patients and methodsBetween 2000 and 2007, 203 patients with histologically proven cirrhosis Child -Pugh A and HCC within Milan criteria were treated by RFA in the same center. Among them, 67 patients were 65 years old or less and potentially eligible for liver transplantation. Their mean age was 58 years, 55male with cirrhosis related to alcohol (n= 25), HCV (n= 26), HBV (n= 12), hemochromatosis (n= 2) and NASH (n=2). The mean tumor size was 28 mm ;29 ≥ 30mm). Sixteen (23%) patients had a multifocal form , 22 were staged BCLC 0. Follow-up included US, triphasic CT or MRI and measurement of AFP every 3 months.Results A complete necrosis was obtained in 78/81 (96%) nodules with no mortality. During a median follow-up of 4 8 months, local (n=6) or distant recurrence (n=35) or both occurred in 37 patients. The 5-year recurrence rate was 68%. Recurrences were out of Milan in 14 patients (37%). Multifocality was the only independent factor of recurrence (HR= 2, 1.0-4.0; p= 0.049) .At the date of point, 24 patients were transplanted ( recurrence (n=20)or liver failure (n=4) ) . Sixteen deaths occurred, including 11 related to HCC progression, 2 after transplantation and 3 from complications of cirrhosis. Twenty nine patients are alive without transplantation including 25 without detectable tumor. Overall survival and survival rates without detectable tumor at 5 year was 74 % and 68% respectively.The 5- year survival rate was 80%. conclusion In patients with Child A cirrhosis and HCC within Milan criteria, RFA followed by salvage transplantation if necessary allows a 5-year survival rate of 74% and even 80% in patients BCLC0, while limiting the number of grafts used.