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Radiofrequency Ablation Reduces Local Recurrences Compared to Cryosurgery for Treatment of Inoperable Liver Cancer or Metastasis to the Liver According to a recent article published in the Archives of Surgery, radiofrequency ablation appears to be superior to cryosurgery for the treatment of inoperable liver cancer or metastasis to the liver.

The liver is the largest organ in the body and is responsible for over 500 functions, including 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 (HCC). Many types of cancer that start in different parts of the body spread to the liver in advanced stages. Treatment for cancer that has started in the liver or has spread to the liver (liver metastasis) depends on the size and number of tumors, condition of the liver, extent of disease and the patient’s age and general health. Treatment may include surgery, radiation therapy, immunotherapy, chemotherapy or a combination of therapies. Currently, the only treatment option that produces a cure for cancer in the liver is the surgical removal of the cancer. However, only a small percentage of these patients are eligible for surgery, as the majority of them have cancer that has spread too extensively throughout the liver or have other conditions involving the liver that make surgery too risky. Consequently, researchers are exploring new strategies for patients with either primary liver cancer or metastasis to the liver who are not eligible for surgery.

Percutaneous radiofrequency ablation and percutaneous cryosurgery are two therapeutic options for patients with inoperable primary liver cancer or metastasis to the liver. Radiofrequency ablation and cryosurgery both involve the placement of a probe through the skin and into the cancer, guided by imaging such as computed tomography (CT), magnetic resonance imaging (MRI) or ultrasound. Radiofrequency ablation involves electric current targeted directly at the cancer and cryosurgery involves extremely low temperatures which freeze the cancer cells. Although both of these therapeutic regimens have demonstrated safety and efficacy in the treatment of inoperable primary liver cancer or metastasis to the liver, there have been no clinical trials directly comparing radiofrequency ablation to cryosurgery in this group of patients.

Researchers from France recently analyzed data outcomes from patients with inoperable HCC or metastasis to the liver treated with either radiofrequency ablation or cryosurgery. This study involved 33 patients who were treated with radiofrequency ablation and 31 patients who were treated with cryosurgery. HCC was the diagnosis of 58% of patients treated with radiofrequency ablation and 55% of patients treated with cryosurgery. Metastasis to the liver from other sites of cancer was the diagnosis in 42% of patients treated with radiofrequency ablation and 45% of patients treated with cryosurgery. Initial treatment success (destruction of the sites of cancer in the liver) occurred in 83% of patients in both groups and rates of complications from the procedures were similar. However, 6 months following treatment, cancer recurrences within the liver occurred in only 18% of patients treated with radiofrequency ablation, compared to 53% of patients treated with cryosurgery.

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The researchers concluded that radiofrequency ablation appears to reduce the risk of local cancer recurrences compared to cryosurgery for patients with inoperable liver cancer or metastasis to the liver. However, a clinical trial directly comparing these two treatment regimens is needed to truly determine if one improves long-term outcomes over the other for these patients. Patients with inoperable liver cancer or metastasis to the liver may wish to discuss these results with their physician or the risks and benefits of participating in a clinical trial further evaluating novel therapeutic strategies.

Reference: Adam R, Hagopian E, Linhares M, et al. A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies.

Archives of Surgery. 2002;137:1332-1339.