Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy

Hepatology. 2014 Jul;60(1):192-201. doi: 10.1002/hep.27057. Epub 2014 May 27.


Resection and radiofrequency ablation (RFA) are treatment options for hepatocellular carcinoma (HCC) <3 cm; there is interest in expanding the role of ablation to 3-5 cm. RFA is considered high-risk when the lesion is in close proximity to critical structures. Combining microcatheter technology and the localized emission properties of Y90, highly selective radioembolization is a possible alternative to RFA in such cases. We assessed the efficacy (response, radiology-pathology correlation, survival) of radiation segmentectomy in solitary HCC not amenable to RFA or resection. Patients with treatment-naïve, unresectable, solitary HCC ≤ 5 cm not amenable to RFA were included in this multicenter study. Administered dose, response rate, time-to-progression (modified Response Evaluation Criteria in Solid Tumors [mRECIST]), radiology-pathology correlation and long-term survival were assessed. In all, 102 patients were included in this study. mRECIST complete response (CR), partial response (PR), and stable disease (SD) were 47/99 (47%), 39/99 (39%), and 12/99 (12%), respectively. Median time-to-disease-progression was 33.1 months. In all, 33/102 (32%) patients were transplanted with a median (interquartile range [IQR]) time-to-transplantation of 6.3 months (3.6-9.7). Pathology revealed 100% and 50-99% necrosis in 17/33 (52%) and 16/33 (48%), respectively. Median overall survival was 53.4 months. Univariate analysis demonstrated a survival benefit for Eastern Cooperative Oncology Group (ECOG) 0 patients. In the multivariate model, age <65, ECOG 0, and Child-Pugh A were characteristics associated with longer survival.

Conclusion: Radiation segmentectomy is an effective technique with a favorable risk profile and radiology-pathology outcomes for solitary HCC ≤ 5 cm. This approach may allow for treatment of HCC in difficult locations. Since RFA and resection are not options given tumor location, there appears to be a strong rationale for this technique as second choice.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular* / mortality
  • Carcinoma, Hepatocellular* / radiotherapy
  • Carcinoma, Hepatocellular* / surgery
  • Catheter Ablation / methods*
  • Catheter Ablation / mortality
  • Databases, Factual
  • Disease Progression
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Liver / pathology
  • Liver / surgery
  • Liver Neoplasms* / diagnosis
  • Liver Neoplasms* / mortality
  • Liver Neoplasms* / surgery
  • Liver Transplantation
  • Male
  • Middle Aged
  • Radiotherapy / methods*
  • Radiotherapy / mortality
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome
  • Yttrium Radioisotopes / therapeutic use*


  • Yttrium Radioisotopes