PERCUTANEOUS US-GUIDED LASER THERMOABLATION IN THE TREATMENT OF “NAIVE“ HEPATOCELLULAR CARCINOMA NODULES </=4 CM

Purpose: Ultrasound (US)-guided Laser Thermoablation (LTA) of liver tumors is a newly introduced technique for percutaneous ablation of Hepatocellular Carcinoma (HCC). Aim of the present work was to evaluate effectiveness and safety of the technique in a series of newly diagnosed nodules of HCC in cirrhotic patients

Methods and Materials: 51 HCC nodules (mean diameter 23.9mm; range 10–40mm) in 40 cirrhotic patients (mean age 67.3 yr; 27 males; all HCV+; 33 Child A and 7 Child B) were selected for LTA between January 2001 and August 2004. All nodules were newly diagnosed and none had received any form of treatment before. One to four 300µm optic fiber(s) advanced in 21-g needle(s) were positioned into the target lesions under US guide. LTA was performed with a continuous wave Nd:YAG laser operating at a wavelength of 1,064 nm (DEKA MELA, Florence, Italy). A single optimal laser illumination was considered when 1,800 Joules x fiber were delivered in 6min. at 5 W. The interventional procedure was performed under conscious sedation, on an inpatient basis. Spiral bi- or triphasic CT was used to verify treatment effectiveness 3–4 weeks after LTA completion. More recently, contrast enhanced US with 2nd generation medium contrast (Sonovue, Bracco, Italy) was introduced to evaluate the completeness of necrosis quickly after an LTA session (24–48 hours)

Results: A mean energy of 9,615J (range 2,000–38,900) was delivered in 65 sessions (mean 1.3, range 1–3). Complete necrosis was obtained in 43 nodules (84%). Incomplete necrosis was observed in the remaining 9 nodules, 7 of which underwent a combined therapy with TACE. Over a mean follow-up time of 14 months (range 4–42), local recurrence rate was 13.7% (7 out of 51 nodules); extranodular recurrence was observed in 25% of cases (10 out of 40 patients). Neither death nor major complications were recorded. Fever (>38.0°C) and pain needing analgesics occurred in 15% of patients. Minor complications were recorded in 7 patients (17.5%): transient partial portal thrombosis (1), self-limiting colecystitis (1), paralytic ileum spontaneously resolved (1), a 3-cm hepatic abscess treated with antibiotics (1), ascites (1), small pleural effusion (2).

Conclusions: Our experience suggests that US-guided LTA may be an effective and safe treatment modality for nave HCC nodules </=4cm in cirrhotic patients