セッション情報 | JDDW International Debate Session(Featured Lecture)1(JDDW)JDDW International Debate Session 「Treatment of small HCC (Surgery vs RFA)」 |
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タイトル | IS1-1-2:Radiofrequency Ablation of Small Hepatocellular Carcinoma: Pros and Cons |
演者 | H.-C. Rhim(Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) |
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抄録 | Resection is the first-line treatment option for patient with solitary HCC and well-preserved liver function. Local ablation with radiofrequency or ethanol injection is considered the standard of care for the patients with very early and early HCC not suitable for surgery. Both techniques achieve complete responses in most of cases with good long-term outcomes especially for the patients with very early stage HCC. The advantages of local therapy are the followings: 1) Minimally invasiveness, 2) Excellent local tumor control for very small (<2cm) tumor, 3) Repeatable for recurrent tumors. However, the cons of local therapy is the limited tumor control for 1) larger (> 3cm) tumor, 2) peri-vascular tumor (heat-sink effect), 3) Inconspicuous tumor on guiding modality, 4) Inferior disease free survival due to intrahepatic recurrences compared to surgery. Although there are many comparative studies to elucidate whether RFA can compete with surgical resection as a first-line treatment for patients with early HCC, the results of even RCT studies are conflicting and there are many limitations in study design to draw any conclusion. An ongoing RCT with large series (SURF trial) can provide more robust evidence on which specific subgroup is ideal for each treatment option. Radiofrequency ablation has a great potential to provide an excellent local tumor control with almost zero-mortality for a patient with unresectable small HCC. Furthermore, using many novel techniques with fusion imaging or contrast enhanced US guidance, RFA will extend its role in the era of multidisciplinary strategy for managing HCC. |
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