The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review.
OBJECTIVE
To review the current status of radiofrequency ablation (RFA) in the management of hepatocellular carcinoma (HCC).


BACKGROUND
The development of local ablative therapy has been 1 of the major advances in the treatment of HCC. Its role in the management of HCC is still rapidly evolving.


METHODS
Studies were identified by searching Medline, and PubMed databases for articles from January 1997 to April 2008 using the keywords "radiofrequency ablation," "hepatocellular carcinoma" and "ablation of HCC." Additional papers were identified by a manual search of the references from the key articles. Randomized controlled trials, nonrandomized comparative studies, cohort studies, were reviewed. Cohort studies with follow-up of less than 12 months and case reports were excluded.


RESULTS
Five aspects of RFA were analyzed: (1) RFA in comparison with other local ablative therapies; (2) RFA for unresectable HCC; (3) RFA as bridging therapy before liver transplantation; (4) RFA as primary treatment for resectable HCC; and (5) RFA for recurrent HCC after partial hepatectomy. Ten RCTs, 8 nonrandomized controlled trials and 26 cohort studies were included in this analysis.


CONCLUSIONS
The evidence in the medical literature showed RFA was more effective than other local ablative therapies, and supported its use in the treatment of unresectable small HCC, recurrent small HCC, and as bridging therapy before liver transplantation, and as a primary treatment in competition with partial hepatectomy for resectable small HCC.
Lau
Wan Yee
WY
Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. josephlau@cuhk.edu.hk
Lai
Eric C H
EC
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*