PERCUTANEOUS ABLATION TREATMENTS IN HCC PATIENTS AS A BRIDGE TO LIVER TRANSPLANTATION

Purpose: The aim of this study is to evaluate the degree of response of ablative percutaneous treatment in waiting list for liver transplantation. The treatment were under us guidance and repeated on the basis of AFP level and Abdomen CT scan after the procedure. All the livers treated were submitted to a meticolous hystologic examination for analysis of response. It was considered Partial vs. Complete tumour ablation

Methods and Materials: From January 1999 to june 2004, 373 adult patients with chronic liver diseases were enrolled for primary OLTx. Considering exlusion criteria (groß vascular invasion, extra-hepatic metastasis, poorly differentiated tumor at percutaneous biopsy)64 patients affected by HCC were eligible for the study. Only 54 were transplanted and liver examined for histological analysis. 4 were exluded from waiting list for tumour progression and 6 are still awaiting for oltx. The mean aethiology was viral (HCV-HBV).

All the patients were treated by one or more PAT performed as PEIT or RFTA alone or mixed and controlled by AFP level and superior abdomen CT scan.

Results: Mean interval between first treatment and OLTx was 9.1 months. The mean number of treatments for each patient was 2.4. The histological response of liver transplanted was: CR 5 patients (9.2%), PR 34 patients (62,9); NR 15 patients(27,7%). No major complications occurred as haemorrhage or pnx; no mortality. The survival was of 72% at five years and it was not statistically different from analogous in liver benign disease.

Conclusions: Ablative terapies must be considered a safe and effective procedure moreover in patients waiting for liver transplantation. Persistance, rate and histological characteristic exclude the role of PEIT and RFTA as definitive treatment. We concluded that ablation therapies are a “bridge“ to transplantation.