HCC treatment

[mh9301]

Dear Dr. Schiano,
Thank you for your assistance on this wonderful site.  I was hoping for some help/direction with my father.
My father ( dx with HCV about 6 years) was recently dx via CT w/ 1.6cm HCC segment 7 near a branch of the hepatic vein.  No vascular involvement noted. He will have a MRI next week.  He is 73 with no other medical problems, not even HTN.  All liver/blood tests normal no ascites/portal hypertension.  Recent AFP is 9.9.  Initially only offered TACE then I asked for sx consult.  Surgeon stated he was a candidate for surgical resection of the tumor (I believe approx removal 1/3 of the liver?). Then we were offered another  consult with an interventional radiologist.  He stated because of his age ,cirrhosis, size of the tumor his best option and least invasive option would be RFA but first TACE to improve results since next to vein.  He wouldn't recommend removing such a large portion of the liver as basically you don't know what will happen in the future (i.e. more tumors ).  He also stated at his age a LT is not indicated. Which is what his hepatologist has been saying as well.  I don't think he is that old. But maybe they are not as experienced with LT at that age.
My questions are:  Could RFA potentially "cure" (or just shrink) this tumor because it is small or would the only chance of cure be resection?  Would liver failure after resection be more of a concern because of his age (I believe he is CHILD  A)??  At this stage would liver failure occur?
Is there a chance that RFA could spread the tumor? And also should his age really be a factor to this extent? We live in  Milwaukee, Wisconsin and he is going to a hospital performing liver transplants (maybe 30 a year?).  
Any additional information, studies, recommendations, questions, (possibly second opinions?) to help us with this decision would be ever so much appreciated. We are in limbo there seems to be research supporting both techniques unless I am not looking in the best places.Thankyou

[Thomas D Schiano, MD]

larger liver transplant centers in your general egion would include northwestern, mayo clinic and university of indiana.  recurrence rates vary after RFA because it depends on technically how well it goes.  the bottom line is that its not curative.  i think you are asking all of the right questions. my sense is that resection is not an option ever.

[mh9301]

Thank you for your response. His platelet count is 114,000, but the surgeon did not mention this as a concern.  I will look into this further with his doctor.  Thank you.  Could you recommend  a few larger transplant centers for a second opinion?  Also, if RFA is attempted and is "successful", what is the best case scenario,  regarding recurrence of that tumor.  Then, would resection even be considered an option at that point?   Are there other questions I need to be asking his doctors?
Thank you again for all your insight! I so very much appreciate it all.
  

[Thomas D Schiano, MD]

resection is always the best option when it is possible, but it is infrequently possible.  surgeons will not consider resection if there is any degree of portal hypertension (i.e. platelet count less than 150,000 for example).  RFA is not curative but will slow the growth of the tumor.  if he is physiologically younger than his chronologic age then there is no reason he couldn't be transplanted if other treatments have been exhausted.  resection in the setting of portal hypertension can lead to liver failure.  there is always a very small risk of the tumor spreading in the RFA tract from the probe but it is very rare. i suspect only larger liver transplant centers would agree to transplant someone of his age so a second opinion should be sought.

i hope this is helpful.