Better Survival but More Complications After Radiofrequency Thermal Ablation

Better Survival but More Complications After Radiofrequency Thermal Ablation of Small Liver Cancers

According to an article in the journal Gut, treatment of small liver cancers with radiofrequency thermal ablation resulted in fewer recurrences and longer survival, but also more complications, than treatment with ethanol or acetic acid injections.

The liver is the largest organ in the body and is responsible for over 500 functions. These include the secretion of glucose, proteins, vitamins, and fats; the production of bile; the processing of hemoglobin; and detoxification of numerous substances. Primary liver cancer starts in the cells of the liver and can spread through blood or lymph vessels to different parts of the body. Approximately 85% of all liver cancers that start in the liver (primary liver cancer) are classified as hepatocellular carcinoma.

Surgical removal of the cancer is the treatment of choice for small liver cancers, but others options may be considered for patients who decline surgery or who have inoperable cancer. This study compared three alternative approaches to destroying small liver cancers: radiofrequency thermal ablation (use of electric current to destroy cancer cells); ethanol injection (injection of alcohol into the tumor to kill cancer cells); and acetic acid injection (injection of acetic acid, the primary acid in vinegar, into the tumor to kill cancer cells). Each of these approaches involves the placement of a probe through the skin and into the cancer. The prone is guided by imaging such as computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound.

Investigators from Taiwan conducted a randomized clinical trial to compare these three approaches among a total of 187 adult patients with hepatocellular carcinomas measuring three centimeters or less. Sixty-two patients were treated with radiofrequency ablation, 62 were treated with ethanol injection, and 63 were treated with acetic acid injection. After three years of follow-up, cancer recurred in 14% of those treated with radiofrequency ablation, 34% of those treated with ethanol, and 31% of those treated with acetic acid. Survival was also better in the radiofrequency ablation group: 74% survived for at least three years after treatment, compared to 51% of the ethanol group and 53% of the acetic acid group. However, major complications were also more common in the patients receiving radiofrequency ablation. Two of these patients developed a hemothorax (blood in between the chest wall and the lung), and one had a perforation of the stomach (a hole through the wall of the stomach). There were no major complications among patients receiving ethanol or acetic acid injections.

The researchers conclude that among adults with small liver cancers, radiofrequency ablation results in better survival and fewer recurrences than ethanol or acetic acid injections, but it also results in more complications.

Patients with liver cancer may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating novel therapeutic approaches.

Reference: Lin SM, Lin CJ, Hsu CW et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut. 2005;54:1151-1156.

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