Radiofrequency ablation <i>versus</i> laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: A randomized trial

Costanzo, Giovan Giuseppe Di; Tortora, Raffaella; D’Adamo, Giuseppe; Luca, Massimo De; Lampasi, F.; Addario, Luigi; Lanza, A; Picciotto, Francesco; Tartaglione, M.T.; Cordone, G; Imparato, Michele; Mattera, Silvana; Pacella, Claudio Maurizio

doi:10.1111/jgh.12791

Cited by 77 publications

(47 citation statements)

References 44 publications

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“…Three RCTs were included in this assessment [7, 34, 35]. A fixed-effect model revealed no significant difference in tumor diameter (mean difference 0.11, 95% CI −0.08 to 0.30) between the LSA and RFA groups.…”

Section: Resultsmentioning

confidence: 99%

Effects of radiofrequency ablation versus other ablating techniques on hepatocellular carcinomas: a systematic review and meta-analysis

Luo

Zhang

et al. 2017

World J Surg Onc

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BackgroundPercutaneous ablation has quickly arisen as one of the important alternative treatments for hepatocellular carcinoma (HCC). We aimed to compare the therapeutic effects of radiofrequency ablation (RFA) and other ablative techniques on HCCs.MethodsDatabases were searched to identify literature on complete tumor ablation (CTA), overall survival (OS), local tumor recurrence (LTR), and complications of RFA in the treatment of HCC, compared with those of microwave ablation (MWA), percutaneous ethanol injection (PEI), PEI plus RFA, cryoablation (CRA), laser ablation (LSA), and high-intensity focused ultrasound. Randomized controlled trials and high-quality cohort studies were included in the assessment.ResultsThe effects of MWA and CRA appeared to be similar to those of RFA, but lower rates of LTR and higher rates of CTA in large tumors compared with RFA were reported (P < 0.05). CTA rates were lower in patients treated with PEI (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.06–0.42), and higher in those treated with PEI plus RFA (OR 2.28, 95% CI 1.19–3.60), with an increased incidence of fever (P < 0.05). LSA resulted in lower CTA rates (OR 0.32, 95% CI 0.13–0.81) and OS (hazard ratio 1.47, 95% CI 1.01–2.15), with a lower incidence of complications.ConclusionsCompared with RFA, identical effects were found in MWA and CRA groups. Fewer complications were observed in PEI and LSA group. PEI plus RFA appeared more effective, with a higher rate of complications. Well-designed randomized controlled trials are further needed to confirm above results.

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Section: Resultsmentioning

confidence: 99%

Effects of radiofrequency ablation versus other ablating techniques on hepatocellular carcinomas: a systematic review and meta-analysis

Luo

Zhang

et al. 2017

World J Surg Onc

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“…In a recent RCT with 140 Milan-in patients, complete response was observed in 97.4% of patients treated with RFA and 95.7% with LA and mean time-to local progression and overall survival were comparable between the two study groups ( P = 0.129 and 0.693, respectively)[110]. The authors concluded that LA resulted non-inferior to RFA and therefore it should be considered as a valuable alternative for thermal ablation of small HCC in cirrhotic patients[110].…”

Section: Other Thermal Ablation Techniquesmentioning

confidence: 99%

“…The authors concluded that LA resulted non-inferior to RFA and therefore it should be considered as a valuable alternative for thermal ablation of small HCC in cirrhotic patients[110]. …”

Section: Other Thermal Ablation Techniquesmentioning

confidence: 99%

Local ablative treatments for hepatocellular carcinoma: An updated review

Facciorusso

Serviddio

Muscatiello

2016

WJGPT

108

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Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.

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“…The adventages of the small needle and precise thermal energy distribution theoretically could minimize the risk of off-target burning and decrease problems in treating lymph nodes and particularly in difficult anatomical location. Previous studies have focused on laser ablation in the prostate [14, 15], thyroid [16–19] and liver [20, 21] while the present study aimed to assess the safety and efficacy of ultrasonography (US)-guided local Nd:YAG laser ablation for metastatic lymph nodes in the retroperitoneal region. Additionally, we performed a systematic review of the literature.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous laser ablation: a new contribution to unresectable high-risk metastatic retroperitoneal lesions?

et al. 2016

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BACKGROUND & AIMSMetastasis in retroperitoneal lymph nodes is one of the signs of advanced stage or terminal stage of malignancy. We performed a trial to assess the safety and efficacy of ultrasonography (US)-guided local neodymium-doped yttrium aluminum garnet (Nd:YAG) laser ablation for metastatic lymph nodes in the retroperitoneal region.METHODSWe evaluated 4 cases of retroperitoneal metastatic lymph nodes treated using US-guided Nd:YAG laser ablation. Additionally, we reviewed the PubMed database for articles on thermal ablation of retroperitoneal lesions until March 2016, without language limitations.RESULTSIn our study, all lesions were nearly completely ablated with mild discomfort, including pain and fever at the 3-month follow-up. In the literature review, a total of 398 patients with 491 retroperitoneal tumors were identified, and complications after the procedure included enterovesical fistula, fecal incontinence, and hematoma.CONCLUSIONSPercutaneous laser ablation could be a theoretically promising approach for retroperitoneal metastatic lesions.ClinicalTrials.gov number: NCT02822053.

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Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: A randomized trial

Abstract: LA resulted not inferior to RFA in inducing the CTA of HCC nodules and therefore it should be considered as an evaluable alternative for thermal ablation of small HCC in cirrhotic patients.

Cited by 77 publications

References 44 publications

Effects of radiofrequency ablation versus other ablating techniques on hepatocellular carcinomas: a systematic review and meta-analysis

Effects of radiofrequency ablation versus other ablating techniques on hepatocellular carcinomas: a systematic review and meta-analysis

Local ablative treatments for hepatocellular carcinoma: An updated review

Percutaneous laser ablation: a new contribution to unresectable high-risk metastatic retroperitoneal lesions?

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