Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma ≤4 cm
ABSTRACT The aim of this study was to compare the clinical outcome of percutaneous radiofrequency (RF) ablation, conventional percutaneous ethanol injection (PEI), and higher-dose PEI in treating hepatocellular carcinoma (HCC) 4 cm or less.
A total of 157 patients with 186 HCCs 4 cm or less were randomly assigned to 3 groups (52 patients in the conventional PEI group, 53 in the higher-dose PEI group, and 52 in the RF group). Clinical outcomes in terms of complete tumor necrosis, overall survival, local tumor progression, additional new tumors, and cancer-free survival were compared across 3 groups.
The rate of complete tumor necrosis was 88% in the conventional PEI group, 92% in the higher-dose PEI group, and 96% in the RF group. Significantly fewer sessions were required to achieve complete tumor necrosis in the RF group than in the other 2 groups (P < .01). The local tumor progression rate was lowest in the RF group (vs the conventional PEI group, P = .012; vs the higher-dose PEI group, P = .037). The overall survival rate was highest in the RF group (vs the conventional PEI group, P = .014; vs the higher-dose PEI group, P = .023). The cancer-free survival rate was highest in the RF group (vs the conventional PEI group, P = .019; vs the higher-dose PEI group, P = .024). Multivariate analysis determined that tumor size, tumor differentiation, and the method of treatment (RF vs both methods of PEI) were significant factors in relation to local tumor progression, overall survival, and cancer-free survival.
The results show that RF ablation yielded better clinical outcomes than conventional and higher-dose PEI in treating HCC 4 cm or less.
- SourceAvailable from: Paolo De Simone
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- "Image-guided percutaneous ablation is currently accepted as a viable therapeutic choice for nonsurgical patients with early-stage HCC  . While ethanol injection has been the seminal percutaneous technique, radiofrequency (RF) ablation has emerged as the most effective method for local tumour destruction and is currently used as the primary ablative modality at most institutions   . Nevertheless, histologic data from liver specimens of patients who underwent percutaneous RF ablation as bridge treatment for transplantation showed that tumour size significantly affects the local effect of RF treatment . "
ABSTRACT: Experimental studies have shown synergy between radiofrequency (RF) ablation and adjuvant chemotherapy in animal tumour models. We aimed to assess safety and efficacy of doxorubicin-eluting bead (DEB)-enhanced RF ablation in the treatment of human hepatocellular carcinoma (HCC). Twenty patients with single HCC ranging 3.3-7.0 cm (mean, 5.0 cm+/-1.4) showing evidence of residual viable tumour after standard RF ablation underwent intraarterial DEB administration (50-125 mg doxorubicin; mean, 60.2 mg+/-21.8). Follow-up period ranged 6-20 months (mean, 12 months+/-5). No major complication occurred. No deterioration of liver function was observed. The volume of treatment-induced necrosis--as measured on imaging--increased from 48.1 cm3+/-35.7 after RF ablation to 75.5 cm3+/-52.4 after DEB administration, with an increase of 60.9%+/-39.0. The enhanced effect resulted in confirmed complete response (CR) of the target lesion in 12 (60%) of 20 patients. Incomplete response with persistence of <10% of initial tumour volume was observed in 6 (30%) of 20 patients, and local tumour progression in 2 (10%) of 20. Intraarterial DEB administration substantially enhances the effect of RF ablation. DEB-enhanced RF ablation is safe and results in a high rate of CR in patients refractory to standard RF treatment.Journal of Hepatology 08/2008; 49(2):217-22. DOI:10.1016/j.jhep.2008.03.021 · 10.40 Impact Factor
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- "The first trial, performed in European centres , failed to show a statistically significant difference in overall survival between patients who received RF ablation and those treated with PEI  . However, survival advantages were identified in a subgroup analysis of a trial coming from Taiwan  and in a Japanese study, although in the latter the survival benefit was not confirmed in the subgroup analysis of patients with solitary tumours  . All three investigations showed that RF ablation had a higher local anticancer effect than PEI, leading to better local control of the disease. "
ABSTRACT: Hepatocellular carcinoma (HCC) is the fifth most common cause of cancer, and its incidence is increasing worldwide because of the dissemination of hepatitis B and C virus infection. Patients with cirrhosis are at the highest risk of developing HCC and should be monitored every 6 months to diagnose the tumour at an early, asymptomatic stage. Patients with early-stage HCC should be considered for any of the available curative therapies, including surgical resection, liver transplantation and percutaneous image-guided ablation. Liver transplantation is the only option that provides cure of both the tumour and the underlying chronic liver disease. However, the lack of sufficient liver donation greatly limits its applicability. Resection is the treatment of choice for HCC in non-cirrhotic patients, who account for about 5% of the cases in western countries. However, in patients with cirrhosis, candidates for resection have to be carefully selected to reduce the risk of postoperative liver failure. It has been shown that a normal bilirubin concentration and the absence of clinically significant portal hypertension are the best predictors of excellent outcomes after surgery. However, less than 5% of cirrhotic patients with HCC fit these criteria. Image-guided percutaneous ablation is the best therapeutic choice for non-surgical patients with early-stage HCC. While ethanol injection has been the seminal percutaneous technique, radiofrequency ablation has emerged as the most effective method for local tumour destruction and is currently used as the primary ablative modality at most institutions.Cancer Imaging 02/2008; 8(1):19-26. DOI:10.1102/1470-7330.2008.0004 · 1.29 Impact Factor
The Cancer Handbook, 10/2007; , ISBN: 9780470025079
- "The best outcomes have been reported in solitary lesions less than 4 cm (Tanabe et al., 2004) and although usually well tolerated, possible side effects include pain at treatment site, fever, and cutaneous burns. When compared with PEI, local progression rate was lower for lesions up to 4 cm and the OS rate was higher with RFA (Lin et al., 2004). Some studies have reported needle-track seeding with RFA, which may be a significant negative factor with this approach. "