Letter to the Editor: “Feasibility, safety, and long-term efficacy of stereotactic radiofrequency ablation for tumors adjacent to the diaphragm in the hepatic dome: a case-control study”
by Zhaonan Li, Dechao Jiao, Xinwei Han (email@example.com)Feasibility, safety, and long-term efficacy of stereotactic radiofrequency ablation for tumors adjacent to the diaphragm in the hepatic dome: a case-control study
We read with great interest the article by Dr. Schullian et al . In this retrospective single-center study, 177 patients (82 HCCs, 6 ICCs, and 89 metastatic tumors) underwent stereotactic RF ablation (SRFA) of 238 tumors abutting the diaphragm in the hepatic dome. And the authors point out that SRFA is a safe and feasible option in the management of difficult-to-treat tumors abutting the diaphragm in the hepatic dome, with a similar safety profile compared with matched controls. However, some deficiencies in the study deserve further attention.
First, it is inappropriate to include local tumor recurrence (LTR) in the current study. The term LTR implies the appearance of new tumor foci at the ablative margin after local eradication of all tumor cells with ablation. However, after most cases of the image-guided ablation procedure, the ” clear margin ” cannot be pathologically determined . Therefore, tumors that appear at the edge of the ablation zone during imaging may represent residual untreated microscopic tumors, so the term should be avoided. Additionally, The treatment of recurrent HCC is a comprehensive and individualized process [3, 4].
Therefore, the use of adjuvant therapies (such as the PD-1 or Sorafenib) is very important for the treatment of this disease, but the researchers failed to record the effects of immune-targeted drugs, which will cause the result of survival to be questioned.
In conclusion, we appreciate the authors’ efforts in exploration of the treatment with HCC. However, we suggest that appropriate modification would further confirm and greatly solidify the conclusions of the study.