Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma

Abstract

Radiofrequency ablation (RFA) is considered a curative treatment option for hepatocellular carcinoma (HCC). Growing data have demonstrated that cryoablation represents a safe and effective alternative therapy for HCC, but no randomized controlled trial (RCT) has been reported to compare cryoablation with RFA in HCC treatment. The present study was a multicenter RCT aimed to compare the outcomes of percutaneous cryoablation with RFA for the treatment of HCC. In all, 360 patients with Child-Pugh class A or B cirrhosis and one or two HCC lesions £ 4 cm, treatment-na€ ıve, without metastasis were randomly assigned to cryoablation (n 5 180) or RFA (n 5 180). The primary endpoints were local tumor progression at 3 years after treatment and safety. Local tumor progression rates at 1, 2, and 3 years were 3%, 7%, and 7% for cryoablation and 9%, 11%, and 11% for RFA, respectively (P 5 0.043). For lesions >3 cm in diameter, the local tumor progression rate was significantly lower in the cryoablation group versus the RFA group (7.7% versus 18.2%, P 5 0.041). The 1-, 3-, and 5-year overall survival rates were 97%, 67%, and 40% for cryoablation and 97%, 66%, and 38% for RFA, respectively (P 5 0.747). The 1-, 3-, and 5-year tumor-free survival rates were 89%, 54%, and 35% in the cryoablation group and 84%, 50%, and 34% in the RFA group, respectively (P 5 0.628). Multivariate analyses demonstrated that Child-Pugh class B and distant intrahepatic recurrence were significant negative predictors for overall survival. Major complications occurred in seven patients (3.9%) following cryoablation and in six patients (3.3%) following RFA (P 5 0.776). Conclusion: Cryoablation resulted in a significantly lower local tumor progression than RFA, although both cryoablation and RFA were equally safe and effective, with similar 5-year survival rates. (HEPATOLOGY 2015;61:1579-1590 See Editorial on Page 1465 H epatocellular carcinoma (HCC) is the sixth ranking cancer and the third leading cause of cancer-related mortality globally.1 The incidence of HCC in China accounts for 55% of all HCC cases worldwide.2 Although hepatic resection remains a first-line treatment for HCC and orthotopic liver transplantation (OLT) offers high rates of disease-free remission, only 10-15% of HCC patients are suitable for hepatic resection or OLT. Therefore, percutaneous local ablative techniques including percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), microwave (MV), and cryoablation (CRYO) have been the alternative options to unresectable HCC in cirrhosis patients.

Current Technique and Application of Percutaneous Cryotherapy

“…The 1-, 3-, and 5-year overall survival rates were almost identical at 97 %, 67 %, and 40 %, respectively, for cryoablation compared to 97 %, 66 %, and 38 %, respectively, after RFA (p = 0.747). As an important finding, the safety of hepatic cryoablation with a complication rate similar to RFA of 3.9 % versus 3.3 % could be shown (p = 0.776) [25].…”

“…Cryoablation of the liver was considered problematic for a long time following reports about fatal outcomes due to so-called cryoshock after ablation of large liver lesions [25]. More recent ▶ Fig.…”

Is cryoablation really more effective than radiofrequency ablation in hepatocellular carcinoma?

“…I read with interest the article by Wang et al (1) regarding the comparison between cryoablation and radiofrequency ablation (RFA) in the management of small hepatocellular carcinoma (HCC). The authors demonstrated that cryoablation had lower local tumor progression than RFA.…”

Randomized, controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma

“…We read the article by Wang et al 1 with great interest regarding percutaneous cryoablation (CRYO) and radiofrequency ablation (RFA) in early hepatocellular carcinoma (HCC) up to 4 cm in diameter. The researchers found that the 3-year tumor progression rate for CRYO is lower than that of RFA with comparable major complications rates.…”

“…With improvements in devices and techniques, many recent studies reported encouraging results, including complete ablation and survival rate of RFA for treating HCC greater than 3 cm. 1 …”