Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 28, 2013; 19(20): 3083-3089
Published online May 28, 2013. doi: 10.3748/wjg.v19.i20.3083
High-intensity focused ultrasound ablation: An effective bridging therapy for hepatocellular carcinoma patients
Tan To Cheung, Sheung Tat Fan, See Ching Chan, Kenneth SH Chok, Ferdinand SK Chu, Caroline R Jenkins, Regina CL Lo, James YY Fung, Albert CY Chan, William W Sharr, Simon HY Tsang, Wing Chiu Dai, Ronnie TP Poon, Chung Mau Lo
Tan To Cheung, Sheung Tat Fan, See Ching Chan, Kenneth SH Chok, Albert CY Chan, William W Sharr, Simon HY Tsang, Wing Chiu Dai, Ronnie TP Poon, Chung Mau Lo, Department of Surgery, the University of Hong Kong, Hong Kong, China
Sheung Tat Fan, See Ching Chan, James YY Fung, Ronnie TP Poon, Chung Mau Lo, State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
Ferdinand SK Chu, Department of Diagnostic Radiology, the University of Hong Kong, Hong Kong, China
Caroline R Jenkins, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
Regina CL Lo, Department of Pathology, the University of Hong Kong, Hong Kong, China
James YY Fung, Department of Medicine, the University of Hong Kong, Hong Kong, China
Author contributions: Cheung TT designed the study, collected data and drafted the manuscript; Fan ST and Lo CM supervised the research and revised the manuscript; Chan SC and Poon RTP supervised the research; Chok KSH, Chu FSK, Jenkins CR, Lo RCL, Fung JYY, Chan ACY, Sharr WW, Tsang SHY and Dai WC collected the data.
Correspondence to: Sheung Tat Fan, Professor, State Key Laboratory for Liver Research, the University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. stfan@hku.hk
Telephone: +86-852-22554703 Fax: +86-852-29865262
Received: September 29, 2012
Revised: October 29, 2012
Accepted: January 11, 2013
Published online: May 28, 2013
Processing time: 41 Days and 0.6 Hours
Abstract

AIM: To analyze whether high-intensity focused ultrasound (HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma (HCC).

METHODS: From January 2007 to December 2010, 49 consecutive HCC patients were listed for liver transplantation (UCSF criteria). The median waiting time for transplantation was 9.5 mo. Twenty-nine patients received transarterial chemoembolization (TACE) as a bringing therapy and 16 patients received no treatment before transplantation. Five patients received HIFU ablation as a bridging therapy. Another five patients with the same tumor staging (within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison. Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores, tumor size and number, and cause of cirrhosis.

RESULTS: The HIFU group and TACE group showed no difference in terms of tumor size and tumor number. One patient in the HIFU group and no patient in the TACE group had gross ascites. The median hospital stay was 1 d (range, 1-21 d) in the TACE group and two days (range, 1-9 d) in the HIFU group (P < 0.000). No HIFU-related complication occurred. In the HIFU group, nine patients (90%) had complete response and one patient (10%) had partial response to the treatment. In the TACE group, only one patient (3%) had response to the treatment while 14 patients (48%) had stable disease and 14 patients (48%) had progressive disease (P = 0.00). Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list (P = 0.559).

CONCLUSION: HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis. It may reduce the drop-out rate of liver transplant candidate.

Keywords: Ablation; Bridging therapy; Cirrhosis; Hepatocellular carcinoma; High-intensity focused ultrasound; Liver transplant; New technology