|Opis:||Background and objectives: The incidence of primary liver cancer (PLC) is rising across the world. Hepatocellular carcinoma (HCC) is the most common (90%) and it and intrahepatic cholangiocarcinoma represent more than 98.5% of all primary liver tumors. Despite being one of the most common causes of cancer-related death around the world, fewer than 20%of patients with HCC are eligible for curative treatment—that is, surgical resection or liver transplantation. Only curative treatment offers the patient a chance for long-term survival, with 5-year survival rates of 70% for liver resection and liver transplantation. When radical or curative treatment is not indicated due to the patient’s condition, underlying liver disease, or tumor extent, other methods such as transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and local ablative treatments such as radiofrequency ablation (RFA), microwave ablation (MWA), cryotherapy, and other methods help in longer survival of those patients. Electrochemotherapy provides non-thermal ablation of cutaneous and deep-seated tumors. Based on positive results of the treatment of colorectal liver metastases, we conducted a prospective pilot study on hepatocellular carcinomas with the aim of testing the feasibility, safety, and effectiveness of electrochemotherapy.
Patients and methods: Electrochemotherapy with bleomycin was performed on 33 hepatocellular carcinomas in 25 patients using a previously established protocol. The procedure was performed during open laparotomy for 24/25 patients, and percutaneous electrochemotherapy with computed tomography control was performed for one patient. At the end of the observation period, the median follow-up was 23.5 months.
Results: Electrochemotherapy was feasible for all 33 lesions, and no treatment-related adverse events or major postoperative complications were observed. The complete response rate at 3 to 6 months was 92% per patient and 94% per treated lesion. At the end of the observation period, after a median follow-up time of 23.5 months, complete response was obtained in 31 out of 33 lesions.
Conclusions: Electrochemotherapy of hepatocellular carcinoma proved to be a feasible and safe treatment in all 25 patients. To evaluate the effectiveness of this method, a longer observation period is needed. Electrochemotherapy is predominantly applicable for patients with impaired liver function due to liver cirrhosis, in patients with mild to severe portal hypertension, and/or for lesions where a high-risk operation is needed to achieve curative intent because ECT offers the possibility for complete response of the lesion to treatment.|