Radiofrequency Treatment for Liver Tumors

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A new review of four randomized controlled trials that directly compared two different therapys for small inoperable liver tumors has observed that radiofrequency ablation (RFA) significantly improves patient survival in comparison to the standard treatment of percutaneous ethanol injection (PEI). These findings are in the recent issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD). The article is also available online at Wiley Interscience (www.interscience.wiley.com).

AASLD guidelines recommend PEI as a safe and highly effective therapy for small hepatocellular carcinomas and say it is the standard against which new therapies should be compared. RFA is one of a handful of alternative nonsurgical therapys for small liver tumors. It has a higher rate of adverse events and is not always usable depending on the location of the tumor, however, some studies have suggested it offers a greater survival benefit in comparison to PEI.

To determine the benefit of RFA in comparison to PEI, scientists led by Yun Ku Cho of Seoul conducted a systematic review and meta-analysis of randomized controlled trials that compared the two therapies. Using databases and manual searches, they identified all relevant, peer-evaluated studies published from 1978 through July 2008. Ultimately, only four studies, which included a total of 652 patients, contained enough information for a meta-analysis of three-year overall survival.

"Most randomized controlled trials identified definite survival benefit favoring RFA in comparison to PEI except the latest trial published in 2008," the authors note. Their meta-analysis also detected a significant improvement in three-year survival for patients who'd undergone RFA.

"The additional survival benefit of RFA can be attributed to improved local tumor response of RFA, which in turn can be explained by the fact that more predictable tumor ablation was possible," the authors suggest. While injected ethanol might be stopped by the liver's fibrous septum or by satellite nodules, the heat from the radiofrequency electrode tip is distributed more homogenously.


Posted by: Janet    Source