Radiofrequency ablation (RFA) has proven effective for treating HCC nodules, but its repeatability in managing recurrences and the impact of this approach on survival has not been evaluated. To this end, we retrospectively analyzed a Ceritinib prospective series of 706 patients with cirrhosis (Child-Pugh class ≤B7) who underwent RFA for 859 HCC ≤35 mm in diameter (1-2 per patient). The results of RFA were classified as complete responses (CRs) or treatment failures. CRs were obtained in 849 nodules (98.8%) and 696 patients (98.5%). During follow-up (median, 29 months), 465 (66.8%) of the 696 patients with CRs experienced a first recurrence at an incidence

rate of 41 per 100 person-years (local recurrence 6.2; nonlocal 35). Cumulative incidences check details of first recurrence at 3 and 5 years were 70.8% and 81.7%, respectively. RFA was repeated in 323 (69.4%) of the 465 patients with first recurrence, restoring disease-free status in 318 (98.4%) cases. Subsequently, RFA was repeated in 147 (65.9%) of the 223 patients who developed a second recurrence after CR of the first, restoring disease-free status in 145 (98.6%) cases. Overall, there were 877 episodes of recurrence (1-8 per patient); 577 (65.8%) of these underwent RFA that achieved CRs in 557 (96.5%) cases. No procedure-related deaths occurred in 1,921 RFA sessions. Estimated 3- and 5-year overall and disease-free

(after repeated RFAs) survival rates were 67.0% and 40.1% and 68.0 and 38.0%, respectively. Conclusion: RFA is safe and effective for managing HCC in patients with cirrhosis, and its high repeatability makes it particularly valuable for controlling intrahepatic recurrences. (HEPATOLOGY 2011) Hepatocellular carcinoma (HCC) is the third leading cause of death from cancer worldwide.1 Most HCC patients have underlying cirrhosis, which MCE complicates management of their cancer and is often the direct cause of death.2 Internationally endorsed guidelines currently recommend surgical resection for early-stage HCCs in patients with well-preserved liver function.3,

4 When surgery is not possible, there are several minimally invasive options for chemical or thermal tumor ablation.5-8 One of the most effective is radiofrequency ablation (RFA),9 which is now considered potentially curative for early-stage HCCs in patients with or without surgical prospects.3, 4, 10-12 Local tumor control and survival are the parameters most widely used to assess the efficacy of surgical and nonsurgical treatments for HCC.6-16 Data on local control are fairly easy to interpret: disease relapse at the treated tumor site is regarded as a treatment failure. Survival data are more difficult to interpret. The risk of death is influenced by the outcome of the first treatment,3, 4 but also by tumor characteristics (e.g., multifocal progression, vascular involvement, etc.) and by factors partially or wholly unrelated to tumor (e.g.