Ultraschall in Med 2007; 28 - V_1_32
DOI: 10.1055/s-2007-988871

Percutaneous laser ablation (PLA) in cirrhotic patients with hepatocellular carcinoma (HCC) submitted to liver transplantation (OLT): Assessment of effectiveness at explant analysis

G Francica 1, M Pompili 2, CM Pacella 3, E Nicolardi 2, A Pretolati 4, M Angelico 4, G Tisone 5, P Cabroledda 6, S Pacella 3, Z Rossi 7, GL Rapaccini 2
  • 1Presidio Ospedaliero Camilliani 'S. Maria della Pietà', Unità Operativa di Ecografia, Casoria, Italy
  • 2Università Cattolica del Sacro Cuore, Istituto di Medicina Interna e Geriatria, Roma, Italy
  • 3Ospedale Regina Apostolorum, Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, Albano Laziale, Italy
  • 4Università Tor Vergata, Unità di Epatologia, Roma, Italy
  • 5Università Tor Vergata, Unità di Trapianto di Fegato, Roma, Italy
  • 6Università Tor Vergata, Unità di Anatomia e Istologia Patologica, Roma, Italy
  • 7Ospedale Regina Apostolorum, Dipartimento di Epatologia, Albano Laziale, Italy

Purpose: To analyse the effectiveness of PLA in cirrhotic patients with HCC submitted to OLT.

Methods: Data of 10 cirrhotic patients (all males, mean age 52,8yrs; Child-Pugh class A/B/C=5/4/1; 6 cases with a single tumor nodule) undergoing OLT between 2002 and 2006 were reviewed. Twelve biopsy-proven HCC tumors (mean diameter 2cm, range 1,5–3cm) underwent PLA treatments carried out by inserting 300 nm optical fibers through 21-g needles (from two to four) positioned under US guidance into the target lesions. A continuous wave Nd:YAG laser operating at a wave length of 1,064 nm was used. Seven tumors underwent a single PLA session. A single session of Transarterial chemoembolization (TACE) prior to OLT was carried in three incompletely ablated nodules.

Results: The mean waiting time for OLT was 10,9 months (range 1–28 mo). Complete necrosis at histological examination of the explanted livers was found in 7 nodules (58%, all treated exclusively with PLA), partial necrosis >50% in 3 nodules (25%, 2 treated with a combination of PLA and TACE), partial necrosis <50% in 1 nodule, absent necrosis in 1 nodule (treated with both PLA and TACE). In the latter case the final histological diagnosis was that of a yolk sac tumor. Mean follow-up length was 22.2 months: 5 patients are alive without tumor recurrence whereas the remaining 5 were dead (only one with recurrent intrahepatic HCC).

Conclusions: Our preliminary data suggest that PLA is an effective bridge treatment in cirrhotic patients with HCC smaller than 3cm listed for OLT.