title: Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  RF ablation is superior to PEI with respect to local recurrence-free survival rates.
authors.affiliation: Division of Diagnostic and Interventional Radiology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Via Roma 67, I-56125 Pisa, Italy. lencioni@do.med.unipi.it
authors.forename: Riccardo A
authors.initials: RA
authors.lastname: Lencioni
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Allgaier
authors.forename: Dania
authors.initials: D
authors.lastname: Cioni
authors.forename: Manfred
authors.initials: M
authors.lastname: Olschewski
authors.forename: Peter
authors.initials: P
authors.lastname: Deibert
authors.forename: Laura
authors.initials: L
authors.lastname: Crocetti
authors.forename: Holger
authors.initials: H
authors.lastname: Frings
authors.forename: Joerg
authors.initials: J
authors.lastname: Laubenberger
authors.forename: Ina
authors.initials: I
authors.lastname: Zuber
authors.forename: Hubert E
authors.initials: HE
authors.lastname: Blum
authors.forename: Carlo
authors.initials: C
authors.lastname: Bartolozzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D017115:Catheter Ablation; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D015996:Survival Rate
chemical_list: D000431:Ethanol