Small Hepatocellular Carcinoma in Cirrhosis: Randomized Comparison of Radio-frequency Thermal Ablation versus Percutaneous Ethanol Injection

TLDR

The study compared radio‑frequency thermal ablation with percutaneous ethanol injection for treating small hepatocellular carcinoma in cirrhotic patients. 102 cirrhotic patients with ≤3 lesions ≤5 cm were randomized to RF (n = 52) or PEI (n = 50) and followed for ~23 months, with outcomes evaluated by Cox regression. RF ablation yielded higher 1‑ and 2‑year local recurrence‑free survival (98 %/96 % vs 83 %/62 %) and event‑free survival (86 %/64 % vs 77 %/43 %) and was an independent prognostic factor, indicating superiority over PEI. © RSNA, 2003.

Abstract

PURPOSE: To compare the effectiveness of radio-frequency (RF) thermal ablation with that of percutaneous ethanol injection (PEI) for the treatment of small hepatocellular carcinoma (HCC) in patients with cirrhosis. MATERIALS AND METHODS: A series of 102 patients with hepatic cirrhosis and either single HCC 5 cm in diameter or smaller or as many as three HCCs each 3 cm or smaller (overall number of lesions, 142) randomly received either RF ablation (n = 52) or PEI (n = 50) as the sole first-line anticancer treatment. Mean follow-up was 22.9 months ± 9.4 (SD) in the RF group and 22.4 months ± 8.6 in the PEI group. Prognostic value of treatment techniques was assessed with univariate and multivariate Cox proportional hazards regression models. RESULTS: One- and 2-year survival rates were 100% and 98% in the RF group and 96% and 88% in the PEI group, respectively (univariate relative risk [RR] = 0.20; 95% CI: 0.02, 1.69; P = .138). One- and 2-year local recurrence-free survival rates were 98% and 96% in the RF group and 83% and 62% in the PEI group, respectively (univariate RR = 0.17; 95% CI: 0.06, 0.51; P = .002). One- and 2-year event-free survival rates were 86% and 64% for the RF group and 77% and 43% for the PEI group, respectively (univariate RR = 0.48; 95% CI: 0.27, 0.85; P = .012). RF treatment was confirmed as an independent prognostic factor for local recurrence-free survival rates with multivariate analysis (adjusted RR = 0.20; 95% CI: 0.05, 0.73; P = .015). CONCLUSION: RF ablation is superior to PEI with respect to local recurrence-free survival rates. © RSNA, 2003