Value of radiofrequency ablation in the treatment of hepatocellular carcinoma

Table 1 Characteristics of studies using radiofrequency ablation as a pretransplantation bridge therapy

Ref.	n	Tumor size (cm)	RFA→LT interval (mo)	Dropout	Radiologic response necrosis	Pathologic response necrosis	Satellites found in explants	Follow-up after LT (mo)	Survival
									1-yr	3-yr
Pulvirenti et al[34]	14	3.50	8.0	0.0%	90.7%	86.4%	57.0%	16.0	100.0%	100.0%
Fontana et al[35]	33	3.60	7.9	21.7%	66.0%	-	-	26.9	85.0%	85.0%
Mazzaferro et al[36]	50	2.75	9.5	0.0%	70.0%	55.0%	28.0%	22.0	95.0%	83.0%
Pompili et al[37]	40	2.80	8.6	0.0%	75.0%	46.7%	14.0%	34.4	91.9%	85.4%
Lu et al[38]	52	2.50	8.7	5.8%	89.6%	70.3%	24.0%	14.9	85.0%	76.0%
Brillet et al[39]	21	2.40	11.9	24.0%	76.0%	75.0%	44.0%	25.0	-	-
DuBay et al[40]	77	2.50	9.5	21.0%	83.0%	-	-	30.0	-1	-1

¹No significant difference compared with untreated groups. LT: Liver transplantation; RFA: Radiofrequency ablation.

Table 2 Recommended treatment strategies with curative intent for patients with early-stage hepatocellular carcinoma

Tumors (n)	Tumor size (cm)	Child-Pugh class	Tumor characteristics	Recommended strategy
1	≤ 2	A	M0, subcapsular, adjacent to intrahepatic vessel trunk or extrahepatic organs	LR
		B	M0, central location	RFA
	> 2 to ≤ 4	A	M0	LR or RFA
			M0, subcapsular, adjacent to intrahepatic vessel trunk or extrahepatic organs	LR
		B	M0, central location	RFA
	> 4	A	M0	LR
2-3	≤ 3	A	M0, bilobar disease	LR and/or RFA
			M0, unilobar disease	LR
		B	M0	RFA

HCC: Hepatocellular carcinoma; LR: Liver resection; M: Metastasis classification; RFA: Radiofrequency ablation.

Table 3 Characteristics of studies involving treatment of recurrent hepatocellular carcinoma by radiofrequency ablation

Ref.	n	Tumors (n)	Tumor size (cm)	Radiologic response necrosis	PLR→RFA interval (mo)	Follow-up after RFA (mo)	Overall survival			Disease-free survival			Main findings
							1-yr	3-yr	5-yr	1-yr	3-yr	5-yr
Nicoli et al[100]	5	-	-	-	43 (31.0-61.0)	25.5 (-)	-	60.0%	-	-	20.0%	-	RFTA is the first-choice treatment in the management of intrahepatic recurrence
Choi et al[101]	45	53	2.1 (0.8-4.0)	87.0% (46.0/53.0)	23 (10.0-40.0)	18.0 (2.0-47.0)	82.0%	54.0%	-	57.0%	34.0%	-	Percutaneous RFA is effective and safe for intrahepatic recurrent HCC after hepatectomy. Serum alpha-fetoprotein level before RFA and resected tumor size were significant prognostic predictors of long-term survival
Lu et al[102]	72	124	2.4 (0.9-7.0)	96.0% (119.0/124.0)	27.9 (2.0-75.9)	21.0 (1.0-215.2)	70.0%	55.0%	28.0%	22.0%	95.0%	83.0%	Percutaneous thermal ablative therapies were particularly suitable for recurrent HCC and improved long-term survival
Schindera et al[103]	35	61	1.7 (0.5-5.3)	85.5% (54.0/61.0)	18 (1.0-65.0)	-	76.0%	45.0%	-	-	-	-	Percutaneous RFA is effective and safe for recurrent HCC after hepatectomy, with a good overall patient survival rate
Yang et al[104]	41	76	3.8 (2.0-6.6)	93.4% (71.0/76.0)	-	24.5 (1.0-96.0)	73.0%	41.0%	-	46.0%	24.0%	-	Percutaneous RFA is effective and safe for recurrent hepatic tumors after previous partial hepatectomy
Choi et al[105]	102	119	2.0 (0.8-5.0)	93.3% (111.0/119.0)	35.6 (7.0-83.0)	22.3 (1.3-125.7)	93.9%	65.7%	51.6%	52.2%	21.3%	7.2%	RFA is effective and safe for recurrent HCC after hepatectomy and is more effective in late than in early recurrence
Liang et al[106]	66	88	-	93.9% (62.0/66.0)	21.1 (2.4-69.4)	-	76.6%	48.6%	39.9%	-	-	-	Percutaneous RFA is as effective as repeat hepatectomy for recurrent small HCC. Percutaneous RFA has an advantage over repeat hepatectomy in terms of being less invasive
Chan et al[107]	45	-	2.2 (0.8-6.0)	87.0% (46.0/53.0)	35.6 (7.0-83.0)	-	83.7%	43.1%	29.1%	32.2%	12.4%	9.3%	Repeat resection and RFA attained similar survival benefits in the management of recurrent HCC after hepatectomy. The high repeatability of RFA and its ability to be delivered percutaneously render it a preferred treatment option for selected patients
Eisele et al[108]	27	-	2.8 (-)	-	-	21.0 (-)	96.0%	62.0%	32.0%	51.0%	30.0%	11.0%	Overall survival and disease-free survival were not significantly different between patients treated by RFA and repeat resection. There was, however, a tendency toward longer tumor-free survival in the resected patients

HCC: Hepatocellular carcinoma; PLR: Previous liver resection; RFA: Radiofrequency ablation; RFTA: Radiofrequency thermal ablation.