Zhang YJ et al. (2007) Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: a prospective randomized trial. Radiology 244: 599–607

Local ablation for hepatocellular carcinoma (HCC) is recommended for patients who cannot undergo lesion resection and as a palliative treatment before liver transplantation. Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) are two ablative therapies that have been widely used in patients with HCC; however, the complete tumor necrosis rate achieved with these therapies in tumors larger than 5 cm is unsatisfactory. To test the hypothesis that the combined use of RFA and PEI might result in greater patient survival than the use of RFA alone, Zhang and colleagues conducted a prospective randomized trial.

In this trial, 133 patients were randomized to receive RFA and PEI (n = 66; 86% male), or RFA alone (n = 67; 87% male). Overall survival rates for the RFA + PEI group were significantly higher than those for the RFA-only group at both 3 and 5 years (P = 0.01 and P = 0.03, respectively). Stratification by tumor size revealed that patients with 3.1–5.0 cm tumors had a significantly higher 3-year overall survival rate when treated with RFA and PEI than when treated with RFA alone (P = 0.04); rates of 3-year overall survival did not differ between the two treatment groups in patients with tumors 5.1–7 cm or <3.0 cm in size. Local recurrence was significantly lower in the RFA + PEI group than in the RFA-alone group (P = 0.01).

Taken together, these results indicate that a treatment regimen that combines RFA and PEI produces better local tumor control and long-term survival in HCC than does RFA alone.