EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY ‘Building a European Ultrasound Community’ Young Investigator’s Award EUROSON 2016 Leipzig, Germany 28 October 14.00 – 15.30
7 minutes each for presentation plus 2 minutes discussion
Primary liver tumors and percutaneous ablative treatment: an 18-year Bulgarian experience K.Pavlov1, J.Genov1*, R.Mitova1, N.Grigorov1, G.Taneva1, D.Dimitrov1, M.Spasov1, S.Stoychev1, D.Sotirov2, P.Getsov4, I.Terziev3, B.Vladimirov1, D.Damyanov2, B.Korukov2 1.Clinic of Gastroenterology 2.Clinic of Surgery 3.Pathology unit 4.Radiology unit University hospital “Tsaritsa Yoanna – ISUL”, Sofia, Bulgaria
ABSTRACT Introduction Prevalence of primary liver tumors (PLT), treatment options and agressive decisions for better results has grown for the last decades in Bulgaria. We introduce our experience in one-shotlarge-volume percutaneous ethanol (Shot-PEI), radiofrequency (RF) and microwave (MW) ablation of PLT. Purpose
To compare different techniques in terms of technical effectiveness, oncologic results and safety in the treatment of PLT. Methods
In 1997-2015 327 patients (80.4% male), aged 26-84 (mean 64.2), were diagnosed, using CEUS/CECT, histology/immunohistochemistry, with PLT (89.4% HCC, 9.9% cholangiocarcinoma, 0.7% mixed HCC/CC), and coexisted cirrhosis (Child A 59.7%; B 35.4%, 81.6% viral infection: HBV 53.3%; HCV 32.4%), solitary lesion 69.4%, 52.6%≥5 cm, BCLC: A21.7%; B-38.5%; C-32.2%, D-7.7%. RFA (monopolar/multipolar/expandable) was used in 40,1%, MWA-6,4%, shot-PEI-17,2%. 39% of RFA-treated-lesions were>5 cm; half of MWAtreated were large and/or difficult/risky located. Results
Follow-up was 1–72 months (mean 13), Complete destruction was achieved in 61.9%/59.5%/43% for MWA/RFA/Shot-PEI, in 94.4%/54.1%/48.6% - for BCLC-A/B/C. Major complications occurred in 13.1%/7.7%/4.4%/0%/0% after Shot-PEI/
monopolar/multipolar/expandable RFA/MWA reflecting learning curve. Local tumor progression (LTP) occurred after mean 12.2 months in 19.0%/13.7% following MWA/RFA; new lesions - in 19.0% and 22.1% respectively after mean 10.1 months. Median survival was 59 months. 12-, 24-, 36-months survival was 81%, 81%, 79%, similar for both thermal techniques. Conclusion
MWA is equal to RFA in terms of technical and oncologic effectiveness, offering advantage in difficult/risky locations. Expandable RFA ensures less LTP rates in medium-sized lesions. Patients with BCLC B-C could benefit from ablation-based treatment.