Gastroenterology

Gastroenterology

Volume 127, Issue 6, December 2004, Pages 1714-1723
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma ≤4 cm

https://doi.org/10.1053/j.gastro.2004.09.003Get rights and content

Background & Aims: 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. Methods: 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. Results: 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. Conclusions: The results show that RF ablation yielded better clinical outcomes than conventional and higher-dose PEI in treating HCC 4 cm or less.

Section snippets

Study design and characteristics of patients

The study was conducted with the approval of the institutional ethics board. Written informed consent was obtained from each patient and family member.

At the time this study was designed, only a LeVeen RF needle 3.5 cm in diameter was available in our institute. In addition, successful ablation of an HCC tumor >3 cm was assumed to be difficult by conventional PEI alone,11, 12 but successful ablation has been achieved in up to 69 (95%) of 73 HCC ≤5 cm.9 RF ablation also was less satisfactory for

Complete tumor necrosis

The rate of failure to achieve complete tumor necrosis was 12% (6 of 52) in the conventional PEI group, 8% (3 of 53) in the higher-dose PEI group, and 4% (2 of 52) in the RF group. These 11 patients underwent additional transcatheter arterial chemoembolization because complete ablation was considered to be difficult using local ablation therapies alone owing to the following reasons. The reasons for treatment failure included (1) the depth of the tumor in the 3 groups and (2) a tumor close to

Discussion

For the treatment of small HCC, surgical resection or conventional PEI is still accepted as a standard option.2, 3, 4, 5, 6, 7 To establish the efficacy of a newer ablation modality such as RF ablation, it should be compared with conventional PEI by using a randomized controlled trial. To our knowledge, there is only one randomized controlled trial reporting a higher local recurrence-free survival and event-free survival with HCC ≤5 cm after RF than after conventional PEI.9 Although identifying

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    Copyright © 2004 American Gastroenterological Association. Published by Elsevier Inc. All rights reserved.