Radiofrequency ablation versus resection for the treatment of early stage hepatocellular carcinoma: a multicenter Australian study

Abstract

While SR is superior to RFA for the management of early stage BCLC A disease with ≤5 cm HCC, both appear effective as first-line treatment options for Western patients with small ≤3 cm tumors. Although safer than SR, RFA is associated with higher rates of tumor recurrence and local disease progression. Further prospective randomized controlled trials are warranted to compare these two modalities.

Comparative effectiveness of first‐line radiofrequency ablation versus surgical resection and transplantation for patients with early hepatocellular carcinoma

“…For tumors measuring <3 cm, no difference in the median survival was found between patients treated with RFA and those treated with RXN (3‐year survival rate of 66% vs 69%). However, when the patient cohort was extended to include individuals with tumors measuring >3 cm, a significant increase in local recurrence and lower recurrence‐free and disease‐free survival rates was observed in the RFA group . These findings are consistent with the results of the current study.…”

“…Thus, the current study results demonstrating that RFA is an effective first‐line option for patients with lesions measuring up to 30 mm is of clinical importance because HCC more and more often is diagnosed at this small size. This is due to increases in axial imaging in general, improved imaging technology, and the development of screening programs designed to detect small‐size HCC tumors (formerly available only in high‐incidence countries) …”

“…Studies with discrepant results regarding the efficacy of RFA for tumors of various sizes and the benefit of RFA compared with that of RXN or TXP have led to confusion. Tumors of patients undergoing RFA that are reported in the literature frequently measure >30 mm, and the results reported for these patients are conflicting . For example, a study from France that included 281 patients with HCC tumors measuring up to 50 mm demonstrated no difference in the 5‐year survival rate between patients who underwent RFA and those who underwent RXN or TXP .…”

“…For patients with HCC who are candidates for both RFA and RXN, there is significant controversy with regard to which modality provides the best outcomes. Recent studies comparing RFA with RXN have demonstrated comparable outcomes and similar survival rates for RFA in patients with early‐stage HCC (tumor size of 2‐5 cm) . Although RFA can be successful as first‐line therapy, the maximum HCC tumor size for which RFA is safe and effective remains highly controversial; size cutoff values of 20 mm, 30 mm, and 50 mm have been proposed .…”

Asia–Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update

“…In one study, RFA had better long-term survival than surgical resection after propensity score analysis [503]. RFA was associated with fewer major complications [494, 500] and shorter hospital stay [494]. RFA may be more cost-effective than surgical resection [504].…”