| セッション情報 |
International Forum 2(Liver) 4.Treatment Strategy
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| タイトル |
IF2-4-I (Keynote lecture) Image-guided percutaneous ablation therapies for hepatocellular carcinoma
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| 演者 |
Shuichiro Shiina（University of TokyoTokyoJapan） |
| 共同演者 |
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| 抄録 |
Image-guided percutaneous ablation therapies have been playing important roles in the treatment of he-patocellular carcinoma （HCC）since they are potentially curativeminimally invasiveand easily re-per-fbrmed for recurrence． At our departmentwe have treated 90%of previously untreated patients with ab-lation therapies． We have performed ethanol injection on a total of 2000 cases since 1985microwave co-agulation on a total of 200 cases since 1995with satisfactory long-term results． Howeversince the intro-duction of radiofrequency ablation （RFA） into clinical practice in 1999there has been a drastic shift fromethanol injection and microwave coagulation to RFA． Our randomized controlled trials and other’ sproved that RFA is superior to ethanol injection． We have recommended the following general require-ments for RFA． 1） Lesions are unresectable or the patient refuses surgery ； 2） three or fewer lesionseach3 cm or less in diameter ； 3） no extrahepatic metastasis or vascular invasion ； 4） no excessive bleeding ten-dency （platelet count of above 50xlO9／L and prothrombin activity of above 50%） ； 5） no refractory ascites．6） total bilirubin of less than 3．0 mg／dlThe rate of complete tumor necrosis has been reported to rangefrom 80% to 100%． We performed RFA on a total of 3011 cases （1430 patients） of HCC． Although we haveput no restriction on lesion locationthe final CT after RFA showed no residual cancer in 99．4% of thecases． Using artificial pleural effusionartificial ascites and guide-needle methodwe could ablate lesionson the surface of the liverbeneath the diaphragmnear large vesselsadj acent to other organsand thosethat were detected by CT but that was unable to be identified by ultrasound． Among the 1430 patients777 received RFA for initially diagnosed lesions and the remaining 653 had RFA for recurrence． The 12345and 7-year survival rates of the 777 patients were 96%89%81%70%59%and 46%respec-tively． ln 367 patients who had three or fewer lesionseach 3 cm or less in diameter and who were inChild-Pugh Athey were 99%96%91%83%73%and 59%respectively． Ageencephalopathyalbu-mintotal bilirubintumor sizetumor numberAFP and DCP were significant predictive factors for sur-vival． The 12345and 7-year distant recurrence rates from the primary site were 21%48%61%69%75%and 78%respectivelywhile the local tumor progression rates were 1．9%3．1%3．3%3．3%3．3%and 3．3%respectively． 89% of the recurrences were re-treated with RFA． Complications were en-countered in 3．2% of the cases． A randomized controlled trial showed that survival was not different be-tween RFA and resection and that adverse events were less frequent and Iess severe in RFA． Further tri-als would be necessaryhoweverto determine whether RFA can be a replacer of surgery for operableHCC． ln those trialsthe primary endpoint must be overall survival． Recurrence-free survival cannot be asurrogate endpoint ln HCCunlike other solid tumorsthere are sti11 effective therapies after recurrenceand the first recurrence does not cause death in most cases． Furthermoresurgery has theoretically betterdisease-free survival than RFA since it removes larger liver tissue． Better curability of hepatectomy canbe cancelledhoweverby deterioration of liver function． |
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