Recent Advances in the Treatment of Hepatocellular Carcinoma

Amit G. Singal; Jorge A. Marrero

Disclosures

Curr Opin Gastroenterol. 2010;26(3):189-195. 

In This Article

Percutaneous Ablation

Percutaneous ablation therapy is the best alternative for patients with early HCC who are not eligible for resection or transplantation. The two most widely used techniques are percutaneous ethanol injection (PEI) and radio frequency ablation (RFA).

Several randomized controlled trials comparing these two techniques have demonstrated that RFA is able to achieve higher rates of complete tumor ablation using fewer sessions, with tumor necrosis rates of 90–95% in solitary HCC under 4 cm.[27–31] Furthermore, a recent meta-analysis showed that 3-year survival is significantly prolonged with RFA compared with PEI [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.34–0.67].[32•] Therefore, RFA has largely replaced PEI as the preferred local ablation technique in patients with early HCC. A notable exception is patients with tumors adjacent to large blood vessels. In these patients, the vessel acts as a 'heat sink' for the radio frequency energy and ethanol injection is more effective.

Three randomized controlled trials have demonstrated similar 3-year survival rates after percutaneous ablation and surgical resection in patients with early HCC, although there was a consistent trend in lower disease-free survival after percutaneous ablation in all three trials.[33–35] A Markov model using these data concluded that hepatic resection is the best therapeutic option except in cases where patients were older than 70 years of age, the perioperative mortality exceeded 30%, negative margins were achieved less than 60% of the time, or RFA could be performed at least 60% of the time for recurrent disease.[36]

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