A Comparison of Percutaneous Cryosurgery and Percutaneous Radiofrequency for Unresectable Hepatic Malignancies

Abstract

The complication and success rates in patients treated with either percutaneous cryosurgery (PCS) or percutaneous radiofrequency (PRF) for unresectable hepatic malignancies are similar. Design: Retrospective study. Setting: University hospital. Patients and Methods: Sixty-four patients were treated with either PCS (n = 31) or PRF (n = 33). Patient treatment was based on the random availability of the probes. Tumors were evaluated by a blinded comparison of pretreatment and posttreatment helical computed tomographic scans. All living patients had at least a 6-month follow-up. Main Outcome Measures: Complication rate, initial treatment success (complete devascularization of the tumor), and local recurrence (tumor revascularization within or at its periphery). Results: The distribution of tumor types was similar in the 2 groups (P = .76). One patient with cirrhosis died of variceal hemorrhage on day 30 after PCS (mortality, 3.2%), while no mortality was observed after PRF (P=.48). Complications occurred in 9 (29%) of the patients following PCS and in 8 (24%) of the patients following PRF (P=.66). Initial treatment success was comparable in the 2 treatment groups (30 [83%] of 36 tumors following PCS vs 34 [83%] of 41 tumors following PRF). However, local recurrences occurred more frequently after PCS than after PRF (16 [53%] of 30 vs 6 [18%] of 34; P =.003). The higher rate of local recurrence was identified for metastases (10 [71%] of 14 after PCS vs 3 [19%] of 16 after PRF; P=.004), while the difference was not significant for hepatocellular carcinoma (6 [38%] of 16 after PCS vs 3 [17%] of 18 after PRF; P =.25). Multivariate analysis demonstrated that the use of PCS (P=.003) and more than 1 treatment (P=.05) were independent risk factors for local tumor recurrence. Conclusion: While similar initial treatment success and complication rates are observed following either PCS or PRF, local recurrences occur more frequently following PCS, particularly for metastases.

Serum cytokine levels in response to hepatic cryoablation

“…Cryotherapy has also gained acceptance as a local ablative treatment [5,6]. According to a recent comparative study of thermal and cryoablation therapies, while similar success and complication rates were found, local recurrence occurs more frequently in cryotherapy [7]. Then a device to keep local recurrence to be low should be argued.…”

Radiofrequency for the Treatment of Liver Tumours

“…However, despite many reports on the use of RFA in this patient category, it remains difficult to define the results of RFA in colorectal liver metastases [3,4,5,6,7,8,9,10,11,12,13,14]. First of all, RFA ablation is aiming for local tumour control, while the main issue in colorectal liver metastases is to control systemic disease and prolong overall survival.…”

“…In these cases, RFA was used in addition to resection in order to treat some unresectable lesions that are left over after resection of the main tumour mass. In addition, a laparoscopic route for RFA was introduced [3,4,5,6,7,8,9,10,11,12,13,14]. …”

Percutaneous ablation of hepatocellular carcinoma: State-of-the-art

“…Recently, Adam et al 39 compared the complication and success rates in patients treated with percutaneous cryosurgery (PCS) or percutaneous RF ablation for unresectable hepatic malignancies. Sixty-four patients were treated with either PCS (n ϭ 31) or PRF (n ϭ 33).…”