Radiofrequency ablation in the management of primary hepatic and biliary tumors

Table 2 Utilization of Radiofrequency ablation for hepatocellular carcinoma

Ref.	Type	N	Technique	Survival	Recurrence	Adverse Events	Outcome
Zhang et al[89], 2013	Retrospective	155	RFA (78- 93 sessions) and MWA (77-91 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: 11/93 (11.8%) and MWA: 11/105 (10.5%)	RFA group: persistent jaundice (n = 1) and biliary fistula (n = 1). MWA group: hemothorax and intrahepatic hematoma (n = 1) and peritoneal hemorrhage (n = 1)	No significant differences LTP, DR, and overall survival
Karla et al[90], 2017	Prospective	50	RFA alone (25) and RFA + alcohol ablation (25)	RFA alone 84%; RFA + alcohol (80%) (at 6 month)	Local recurrence (11); Distant intrahepatic tumor recurrence (4)	Hemoperitoneum (1)	Combined use of RFA and alcohol did not improve the local tumor control and survival
Abdelaziz et al[91], 2017	Retrospective	67	TACE-RFA (22) and TACE-MWA (45)	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: 4 (18.2%); TACE-MWA: 8 (17.8%)	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%)	No significant difference in overall survival was observed
Gyori et al[92], 2017	Retrospective	150	54% (n = 81) received TACE-based LRT, 26% (n = 39) PEI/RFA regimen, and 17% (n = 26) had no treatment while on the waiting list	No difference in overall survival after liver transplantation when comparing TACE- and RFA-based regimens.			TACE- and RFA-based regimens showed equal outcomes in terms of transplantation rate, tumor response, and post-transplant survival. Lower survival in recipients of Multimodality LRT.
Hao et al[93], 2017	Retrospective	237	50 pathologically early HCCs, 187 typical HCCs		LTP observed in 1 Early HCC (2%); 46 Typical HCC (24.6%)	Fever, abdominal pain and elevated liver enzyme levels.	Rate of LTP for early HCCs after RFA was significantly lower than typical HCCs.
Liao et al[63], 2017	Prospective randomized	96	48 patients wide margin (WM) ablation (≥ 10 mm) and 48 normal margin (NM) ablation (≥ 5 mm but < 10 mm )	The 1-, 2-, and 3-year survival rates: WM: 95.8%, 91.6%, and 74.6%; NM: 95.8%, 78.4%, and 60.2%	3-year LTP: WM: 14.9%; NM: 30.2% Intrahepatic recurrence (IHR): WM: 15.0% NM: 32.7%	Perihepatic bile collection (1); intrahepatic hemorrhage(1); fever(1); liver infarction (1); thermal skin injury (1); pleural effusion (1)	WM-RFA may reduce the incidence of tumor recurrence among cirrhotic patients with small HCCs
Rajyaguru et al[64], 2018	Observational	3980	RFA (3,684) and SBRT (296)	5 yr overall survival: RFA: 29.8% (95%CI: 24.5-35.3%); SBRT: 19.3% (95%CI: 13.5-25.9%)			Treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC
Parick et al[65], 2018	Retrospective cohort	440	RFA (408) and SBRT (32)	RFA patients had better overall survival (P < 0.001)			SBRT (HR 1.80; 95%CI: 1.15-2.82) associated with worse survival
Santambrogio et al[94], 2018	Prospective controlled	264	Laparoscopic hepatic resection (LHR = 59) vs laparoscopic ablation therapy (LAT = 205)	Survival rates LHR at 1, 3, and 5 years were 93, 82, and 56%. In LAT = 91%, 62%, and 40%	LHR = 24/59 (41%); LAT = 135/205 (66%)		LAT found to be adequate alternative

OLT: Orthotopic liver transplantation; LRT: Locoregional treatment; LTP: Local Tumor Progression; TACE: Transarterial chemoembolization; PEI: Percutaneous ethanol injection; SBRT: Stereotactic body radiotherapy; MWA: Microwave ablation; DR: Distant recurrence.