Table 3. List of studies utilizing radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).
| Study | Year | Type | N | Technique | # of sessions | Follow-up | Outcomes | Survival | Adverse events | Deaths | Recurrence |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Györi et al. (70) | 2017 | Retrospective | 150 | 61% (n=92) underwent OLT, 54% (n=81) received TACE-based locoregional therapy, 26% (n=39) PEI/RFA regimen, and 17% (n=26) had no treatment while on the waiting list | – | Multimodality LRT group showed a lower 1-, 3-, and 5-year post-transplant survival than single LRT (68%, 58%, and 58% vs. 82%, 75%, and 70%; (P=0.05) | TACE- and RFA-based regimens showed equal outcomes in terms of transplantation rate, tumor response, and post-transplant survival | No difference in overall survival after liver transplantation when comparing TACE- and RFA-based regimens. Patients receiving multimodality locoregional therapy had lower overall survival after transplantation (P=0.05) | – | 6 | – |
| Hao et al. (71) | 2017 | Retrospective | 237 | Fifty pathologically early HCCs, 187 typical HCCs | – | Early HCCs: 49 (98%) of the nodules did not exhibit local tumor progression (LTP) vs. 46 (24.6%) in typical HCCs | Rate of LTP for early HCCs after RFA was significantly lower than typical HCCs (P=0.002) | – | Fever, abdominal pain and elevated liver enzyme levels were observed after treatment, but no serious complications | – | Early HCC: 1 nodule (2%). Typical HCC: 46 (24.6%) |
| Liao et al. (72) | 2017 | Prospective randomized | 96 | 48 patients wide margin WM (10 mm ablation margin) and 48 normal margin NM (>5 mm but <10 mm ablation margin) | – | 3-year LTP: WM: 14.9%; NM: 30.2% | WM-RFA may reduce the incidence of tumor recurrence among cirrhotic patients with small HCCs | The 1-, 2-, and 3-year survival rates: WM: 95.8%, 91.6%, and 74.6%; NM: 95.8%, 78.4%, and 60.2% | Post-RFA complication = 8.3% (8/96); however, no significant differences between two groups | 32 (WM =13 and NM =19) | WM: 3, NM: 9 |
| Intrahepatic recurrence (IHR): WM: 15.0% NM: 32.7% | The 1-, 2-, and 3-year incidences of LTP: WM: 2.1%, 8.5%, and 15.0%; NM: 6.8%, 16.0%, and 30.2% | ||||||||||
| Recurrence-free survival (RFS): WM: 31.7±12.1 months; NM: 24.0±11.7 months | |||||||||||
| Rajyaguru et al. (73) | 2018 | Observational | 3980 | RFA [3,684] and SBRT [296] | – | 5-year overall survival: RFA: 29.8% (95% CI, 24.5–35.3%); SBRT: 19.3% (95% CI, 13.5–25.9%) (P=0.001) | Treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC | RFA was associated with a significant OS benefit [hazard ratio (HR), 0.67; 95% CI, 0.55–0.81; P<0.001]; the 5-year OS was 29.8% (95% CI, 24.5–35.3%) in the RFA group vs. 19.3% (95% CI, 13.5–25.9%) in the SBRT group (P<0.001) | – | – | – |
| Parikh et al. (74) | 2018 | Retrospective cohort | 440 | RFA [408] and SBRT [32] | – | RFA patients had better overall survival (P<0.001) | SBRT group received significantly less subsequent treatments | Multivariate analysis = advanced age, higher stage, decompensated cirrhosis, and treatment with SBRT (HR 1.80; 95% CI: 1.15–2.82) associated with worse survival | – | – | – |
| Praktiknjo et al. (75) | 2018 | Prospective | 14 | Used real-time 2D shear-wave elastography (RT 2D-SWE) to examine stiffness of HCC lesion before and 3, 30 and 90 days after local ablative therapy | – | Stiffness of HCC nodules and liver showed no significant difference prior to local ablative therapy. As early as three days after treatment, stiffness of responding HCC was significantly higher compared to non-responding | Nodule stiffness in general and RT 2D-SWE in particular could provide a useful tool for early prediction of HCC response to local ablative therapy | – | – | 1 (gallbladder perforation); 1 (progressive tumor disease) | 8 (non-target lesion) |
| Santambrogio et al. (76) | 2018 | Prospective controlled | 264 | Laparoscopic hepatic resection (LHR =59) vs. laparoscopic ablation therapy (LAT =205) | – | LHR (41.7±31.5 months) vs. LAT (38.7±32.3 months) | LAT found to be adequate alternative | Survival rates LHR at 1, 3, and 5 years were 93, 82, and 56%. In LAT =91%, 62%, and 40% (P=0.0053) | – | No operative deaths in either group at 30 days. 2 in LHR group | LHR =24/59 (41%); LAT =135/205 (66%) (P=0.0001) |
| Kalra et al. (77) | 2017 | Prospective | 50 | RFA alone [25] and RFA + alcohol ablation [25] | – | Survival at 6 months in patients who completed at least 6-month follow-up = RFA alone 84%; RFA + alcohol (80%) | Combined use of RFA and alcohol did not improve the local tumour control and survival | – | Hemoperitoneum [1] | 14 in RFA group. 6 in RFA + alcohol group | 11 and 4 patients treated with RFA alone showed local and distant intrahepatic tumour recurrence, respectively |
| Zhang et al. (78) | 2013 | Retrospective | 155 | RFA [78] and MWA [77] | RFA (93 sessions); MWA (91 sessions) | 1-, 3-, and 5-year overall survival rates: RFA: 91.0%, 64.1% and 41.3%; MWA: 92.2%, 51.7%, and 38.5% | RFA and MWA are both effective methods in treating HCC, with no significant differences in CA, LTP, DR, and overall survival | No significant difference between the two groups | RFA group: persistent jaundice (n = 1) and biliary fistula (n = 1). MWA group: hemothorax and intrahepatic hematoma (n = 1) and peritoneal hemorrhage (n = 1) | RFA [46] and MWA [51] | RFA: 11/93 (11.8%) and MWA: 11/105 (10.5%) |
| Abdelaziz (79) | 2017 | Retrospective | 67 | TACE-RFA [22] and TACE-MWA [45] | – | TACE-MWA showed a higher tendency to complete response than TACE-RFA (P=0.06), especially for lesions sized 3–5 cm (P=0.01) | No difference in survival rates | Survival at 1, 2 and 3 years: TACE-MWA: 83.3%, 64.7%, 64.7%; TACE-RFA: 73.1%, 40.6% and 16.2% (P=0.08) | TACE-RFA: bone metastases 1 (4.5%), Ascites 3 (13.6%), variceal bleeding 5 (22.7%); TACE-MWA: portal vein thrombosis: 1 (2.2%), ascites 6 (13.3%), variceal bleeding: 4 (8.9%) | 24 (35.8%) equally divided between both groups | TACE-RFA: 4 (18.2%); TACE-MWA: 8 (17.8%) |
OLT, orthotopic liver transplantation; LRT, locoregional treatment; TACE, transarterial chemoembolization; PEI, percutaneous ethanol injection; WM, wide margin ablation; NM, normal margin ablation; SBRT, stereotactic body radiotherapy; OS, overall survival; LAT, laparoscopic ablative therapy; MWA, microwave ablation; CA, complete ablation; DR, distant recurrence .