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To the Editor:

We read with interest the article by N'Kontchou et al.1 concerning hepatocellular carcinoma treatment by radiofrequency ablation (RFA). They report an excellent series with impressive results in terms of both very low major complication and tract seeding rates as well as a considerable long-term survival. Their complete response rate is 94.7%. However, this was assessed by radiological methods (magnetic resonance imaging and computed tomography) and not by pathological examination. As a result, the true response rate could be lower.

Our modest experience with 30 hepatocellular carcinoma nodules treated by RFA before liver transplant was recently published.2 We performed a pathological analysis of the explanted liver and found that only 14 nodules (46.7%) showed complete tumor destruction. In our study, the detection of RFA incomplete response by means of computed tomography scan had a 50% sensitivity and 100% specificity. The reported rates of complete pathological response in other works were variable but lower than those reported by N'Kontchou et al.: 20%,3 34.2%,4 37.5%,5 46.7%,6 55%,7 70.3%,8 and 75%.9 In these studies, as in ours, pathological examination was performed using hematoxylin-eosin stains.

Although RFA cannot be considered as a radical or curative treatment, and the ideal situation would be complete tumor destruction, partial destruction is probably enough to increase long-term survival and, especially, to avoid patient drop-out from liver transplant waiting lists.

References

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  • 1
    N'Kontchou G, Mahamoudi A, Aout M, Ganne-Carrié N, Grando V, Coderc E, et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 western patients with cirrhosis. HEPATOLOGY 2009; 50: 14751483.
  • 2
    Rodríguez-Sanjuán JC, González F, Juanco C, Herrera L, López-Bautista M, González-Noriega M, et al. Radiological and pathological assessment of hepatocellular carcinoma response to radiofrequency. A study on removed liver after transplantation. World J Surg 2008; 32: 14891494.
  • 3
    Fontana RJ, Hamidullah H, Nghiem H, Greenson JK, Hussain H, Marrero J, et al. Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: a safe and effective bridge to liver transplantation. Liver Transpl 2002; 12: 11651174.
  • 4
    Martin AP, Goldstein RM, Dempster J, Netto GJ, Katabi N, Derrick HC, et al. Radiofrequency thermal ablation of hepatocellular carcinoma before liver transplantation–a clinical and histological examination. Clin Transplant 2006; 20: 695705.
  • 5
    Wong LL, Tanaka K, Lau L, Komura S. Pre-transplant treatment of hepatocellular carcinoma: assessment of tumor necrosis in explanted livers. Clin Transplant 2004; 18: 227234.
  • 6
    Pompili M, Mirante VG, Rondinara, Fassati LR, Piscaglia F, Agnes S, et al. Percutaneous ablation procedures in cirrhotic patients with hepatocellular carcinoma submitted to liver transplantation: assessment of efficacy at explant analysis and of safety for tumor recurrence. Liver Transpl 2005; 11: 11171126.
  • 7
    Mazzaferro V, Battiston C, Perrone S, Pulvirenti A, Regalia E, Romito R, et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotics awaiting liver transplantation. Ann Surg 2004; 240: 900909.
  • 8
    Lu DS, Yu N, Raman SS, Lassman C, Tong MJ, Britten C, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. HEPATOLOGY 2005; 41: 11301137.
  • 9
    Brillet PY, Paradis V, Brancatelli G, Rangheard AS, Consigny Y, Plessier A, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma before liver transplantation: a prospective study with histopathological comparison. AJR Am J Roentgenol 2006; 186 ( 5 Suppl. ): S296S305.

Juan C. Rodríguez-Sanjuán M.D., Ph.D.*, Francisco González M.D.*, Manuel Gómez-Fleitas M.D., Ph.D.*, * Departments of General Surgery and Radiology, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.