Local ablative treatments for hepatocellular carcinoma: An updated review

Table 1 Contraindications to thermal ablative treatments

Absolute contraindications

Extrahepatic disease

Altered mental status

Active infection

Tumor abutting a major hepatic duct

Liver decompensation (particularly in presence of ascites)

Relative contraindications

Lesions > 5 cm

More than four lesions

Severe pulmonary or cardiac disease

Refractory coagulopathy

Table 2 Randomized controlled trials comparing radiofrequency ablation and surgery in hepatocellular carcinoma patients

Ref.	Liver function	Tumor features	Treatment	3-yr SR	5-yr SR	3-yr DFS	5-yr DFS
Chen et al[47]	CP A	Single < 5 cm	HR 90	73.40%	NA	69.00%	NA
	ICG-R15 < 30%		RFA 71	71.40%	NA	64.10%	NA
	PLT > 40000/mm3
Huang et al[48]	CP A/B	Within MC	HR 115	92.20%	75.70%	60.90%	51.30%
	ICG-R15 < 20%		RFA 115	69.60%	54.80%	46.10%	28.70%
	PLT > 50000/mm3
		Single ≤ 3 cm	HR 45	95.60%	82.20%	NA	NA
			RFA 57	77.20%	61.40%	NA	NA
		Single 3-5 cm	HR 44	95.50%	72.30%	NA	NA
			RFA 27	66.70%	51.50%	NA	NA
		Multifocal < 3 cm	HR 26	80.80%	69.20%	NA	NA
			RFA 31	58.10%	45.20%	NA	NA
Feng et al[49]	CP A/B	Up to 2 nodules < 4 cm	HR 84	74.80%	NA	61.10%	NA
	ICG-R15 < 30%		RFA 84	67.20%	NA	49.60%	NA
	PLT > 50000 mm3
Fang et al[50]	CP A/B	Up to 3 nodules ≤ 3 cm	HR 60	77.50%	NA	41.30%	NA
	PLT > 50000 mm3		RFA 60	82.50%	NA	55.40%	NA

SR: Survival rate; DFS: Disease-free survival; CP: Child-Pugh; ICG-R15: Indocyanin green retention at 15 min; PLT: Platelets; HR: Hepatic resection; RFA: Radiofrequency ablation; NA: Not available; MC: Milan criteria.

Table 3 Randomized controlled trials comparing radiofrequency ablation and percutaneous ethanol injection in hepatocellular carcinoma patients

Ref.	Region	Patients (n)	Nodules n (1/>1)	Tumor size, cm	No. of sessions	Complete response (%)	3-yr survival (%)	3-yr recurrence (%)
Lin et al[65]	Taiwan	RFA (52)	38/14	2.9 ± 0.8	1.6 ± 0.4	96.0	74	18.0
		PEI (52)	40/12	2.8 ± 0.8	6.5 ± 1.6	88.0	50	45.0
Lin et al[66]	Taiwan	RFA (62)	49/13	2.5 ± 1.0	1.3 ± 0.3	96.1	74	14.0
		PEI (62)	49/13	2.3 ± 0.8	4.9 ± 1.3	88.1	51	34.0
Shiina et al[67]	Japan	RFA (118)	72/46	NA	2.1 ± 1.3	100.0	81	1.7
		PEI (114)	60/54	NA	6.4 ± 2.6	100.0	66	11.0
Wang et al[68]	China	RFA (49)	NA	2.4 ± 1.2	NA	93.8	NA	NA
		PEI (49)	NA	2.3 ± 1.4	NA	77.5	NA	NA
Azab et al[69]	Egypt	RFA (30)	NA	NA	1.45	85.0	NA	NA
		PEI (30)	NA	NA	7.68	75.0	NA	NA
Giorgio et al[70]	Italy	RFA (128)	128/0	2.3 ± 0.4	5.00	100.0	83	7.8
		PEI (143)	143/0	2.2 ± 0.5	8.00	100.0	78	9.4
Lencioni et al[71]	Italy	RFA (52)	40/12	2.8 ± 0.6	1.1 ± 0.5	91.0	NA	21.0
		PEI (50)	31/19	2.8 ± 0.8	5.4 ± 1.6	82.0	NA	59.0
Brunello et al[72]	Italy	RFA (70)	54/16	2.4 ± 0.5	NA	95.7	59	NA
		PEI (69)	54/15	2.2 ± 0.5	NA	65.6	56	NA

RFA: Radiofrequency ablation; PEI: Percutaneous ethanol injection; NA: Not available.

Table 4 Randomized controlled trials comparing transarterial chemoembolization combined to radiofrequency ablation vs radiofrequency ablation alone in hepatocellular carcinoma patients

Ref.	Region	Patients (n)	Tumor size, cm	CP A/B/C	3-yr survival (%)	3-yr recurrence (%)
Peng et al[75]	China	TACE + RFA (69)	≤ 5.01	60/9/0	69.0	45.0
		RFA (70)	-	59/11/0	47.0	18.0
Cheng et al[76]	China	TACE + RFA (96)	≤ 7.5	NA	55.0	NA
		RFA (100)	-	NA	32.0	NA
Yang et al[77]	China	TACE + RFA (24)	6.6 ± 0.6	NA	NA	NA
		RFA (12)	5.2 ± 0.4	NA	NA	NA
Shibata et al[78]	Japan	TACE + RFA (46)	1.7 ± 0.6	32/14/0	84.8	48.8
		RFA (43)	1.6 ± 0.5	33/10/0	84.5	29.7
Morimoto et al[79]	Japan	TACE + RFA (19)	3.6 ± 0.7	12/7/0	93.0	NA
		RFA (18)	3.7 ± 0.6	16/2/0	80.0	28.0
Kang et al[80]	China	TACE + RFA (19)	6.7 ± 1.1	12/7/0	36.8	NA
		RFA (18)	6.2 ± 1.2	12/6/0	16.7	NA
Shen et al[81]	China	TACE + RFA (18)	5.6 (2.2-15.8)	4/14/0	73.3	50.0
		RFA (16)	5.0 (2.3-12.3)	6/10/0	20.4	18.7
Zhang et al[82]	China	TACE + RFA (15)	4.6 (2.3-7.1)	NA	NA	NA
		RFA (15)	4.1 (2.4-6.0)	NA	NA	NA

CP: Child-Pugh; TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation; NA: Not available.

Table 5 Studies comparing radiofrequency ablation and microwave ablation in hepatocellular carcinoma patients

Ref.	Arm (n)	Study design	Region	CP (A/B/C)	Tumor size (cm)	Number nodules	3-yr survival (%)	Local tumor recurrence (%)
Shibata et al[92]	RFA (36)	RCT	Japan	21/15/0	1.6 (0.7-2)	1.08	NA	8.3
	MWA (36)			19/17/0	1.7 (0.8-2)	1.14	NA	17.4
Lu et al[93]	RFA (53)	R	China	49/4/0	2.6 (1-6.1)	1.35	37.6	20.9
	MWA (49)			39/10/0	2.5 (0.9-7.2)	2.00	50.5	11.8
Ohmoto et al[94]	RFA (34)	R	Japan	20/11/3	1.6 (0.7-2)	1.08	49.0	9.0
	MWA (49)			31/14/4	1.7 (0.8-2)	1.14	70.0	19.0
Ding et al[95]	RFA (85)	R	China	49/36/0	2.38 (1-4.8)	1.15	77.6	5.2
	MWA (113)			75/38/0	2.55 (0.8-5)	1.15	82.7	10.9
Zhang et al[96]	RFA (78)	R	China	78/0/0	NA	1.24	64.1	11.8
	MWA (77)			77/0/0	NA	1.36	51.7	10.5
Abdelaziz et al[97]	RFA (45)	R	Egypt	24/21/0	2.95 ± 1.03+	1.00	NA	13.5
	MWA (66)			25/41/0	2.9 ± 0.97	1.00	NA	3.9
Vogl et al[98]	RFA (25)	R	Germany	NA	NA	1.28	72.0	9.4
	MWA (28)			NA	NA	1.28	79.0	8.3

CP: Child-Pugh; RFA: Radiofrequency ablation; MWA: Microwave ablation; RCT: Randomized controlled trial; R: Retrospective.