Radiofrequency thermal ablation vs percutaneous ethanol injection for small hcc in cirrhosis:metanalysis of randomized controlled trials

1. Am J Gastroenterol. 2009 Feb;104(2):514-24. Epub 2009 Jan 13.Radiofrequency thermal ablation vs. percutaneous ethanol injection for smallhepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlledtrials.Orlando A, Leandro G, Olivo M, Andriulli A, Cottone M.Department of Medicine, Pneumology and Nutrition Clinic, V. Cervello Hospital,University of Palermo, Piazza Mameli 1, Palermo, Italy. ambrogiorlando@tiscali.itOBJECTIVES: Radiofrequency thermal ablation (RF) and percutaneous ethanolinjection (PEI) have been employed in the treatment of small hepatocellularcarcinoma (HCC) as curative treatments. The aim of the study was to review theavailable evidence comparing RF to PEI for small HCC.METHODS: Search strategy: Cochrane, MEDLINE, CANCERLIT, and ENBASE databases wereused. Selection criteria: randomized clinical trials evaluating RF vs. PEI. Data were extracted from each randomized controlled trial (RCT). Primary outcomes wereoverall survival and local recurrence. Meta-analysis software was used and riskdifferences (RDs) and their 95% confidence intervals and Q-test for heterogeneitywere calculated.RESULTS: Five RCTs were identified including 701 patients. The overall survivalwas significantly higher in patients treated with RF than in those treated withPEI (RD 0.116, 95% CI 0.173/0.060; heterogeneity not present). Local recurrencerate is significantly higher in patients treated with PEI than in those treatedwith RF. In the RF group the 1, 2, and 3 years cancer-free survival rates weresignificantly better than in the PEI-treated patients (respectively: RD 0.098-95%CI 0.006/0.189; heterogeneity P=0.57; RD 0.187, 95% CI 0.082/0.293; heterogeneityP=0.98; RD 0.210, 95% CI 0.095/0.325; heterogeneity P = 0.78). A small number of adverse events were reported in the two treatments.CONCLUSIONS: RF ablation is superior to PEI in the treatment of small HCC withrespect to overall survival, 1, 2, and 3 years survival rates, 1, 2, and 3cancer-free survival rates, and tumor response. RF shows a significantly smaller risk of local recurrence.