A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma.
OBJECTIVE
Percutaneous radiofrequency ablation is a recently introduced treatment for hepatocellular carcinoma, whereas ethanol injection is now a standard therapy. We compared their long-term outcomes.


METHODS
Two hundred thirty-two patients with hepatocellular carcinoma who had 3 or fewer lesions, each 3 cm or less in diameter, and liver function of Child-Pugh class A or B were entered onto a randomized controlled trial. The primary end point was survival, and the secondary end points were overall recurrence and local tumor progression.


RESULTS
One hundred eighteen patients were assigned to radiofrequency ablation and 114 to ethanol injection. The number of treatment sessions was smaller (2.1 times vs 6.4 times, respectively, P < .0001) and the length of hospitalization was shorter (10.8 days vs 26.1 days, respectively, P < .0001) in radiofrequency ablation than in ethanol injection. Four-year survival rate was 74% (95% CI: 65%-84%) in radiofrequency ablation and 57% (95% CI: 45%-71%) in ethanol injection. Radiofrequency ablation had a 46% smaller risk of death (adjusted relative risk, 0.54 [95% CI: 0.33-0.89], P = .02), a 43% smaller risk of overall recurrence (adjusted relative risk 0.57 [95% CI: 0.41-0.80], P = .0009), and an 88% smaller risk of local tumor progression (relative risk, 0.12 [95% CI: 0.03-0.55], P = .006) than ethanol injection. The incidence of adverse events was not different between the 2 therapies.


CONCLUSIONS
Judging from higher survival but similar adverse events, radiofrequency ablation is superior to ethanol injection for small hepatocellular carcinoma.
Shiina
Shuichiro
S
Department of Gastroenterology, University of Tokyo, Japan. sshiina-tky@umin.ac.jp
Teratani
Takuma
T
Obi
Shuntaro
S
Sato
Shinpei
S
Tateishi
Ryosuke
R
Fujishima
Tomonori
T
Ishikawa
Takashi
T
Koike
Yukihiro
Y
Yoshida
Haruhiko
H
Kawabe
Takao
T
Omata
Masao
M
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D012306:Risk; D012997:Solvents / Q000008:administration & dosage*; D016019:Survival Analysis
D012997:Solvents; D000431:Ethanol