Surgical resection remains the first-line treatment for patients with single small liver cancers, although equivalent 3-year survival rates indicate that minimally invasive radiofrequency ablation might be an option, said Riccardo Lencioni, MD, professor of radiology, University of Pisa, Pisa, Italy.

The radiofrequency-ablation procedure costs about 1/10 of the surgical option, too, Dr. Lencioni added, with the major cost difference being the 7- to 10-day hospital stay required with open surgery. It may be a month or longer recovery with open surgery until a patient can return to a normal routine. With radiofrequency ablation, patients spend about 2 days in the hospital and can return to normal activities almost immediately.

There were significantly greater risks of local recurrence with the radiofrequency ablation procedure, although they did not affect survival. "If there is regrowth, however, you can repeat the procedure," explained Dr. Lencioni.

Using the Tumor Radiofrequency Ablation Italian Network (TRAIN), researchers identified 1,077 cases of hepatocellular carcinoma. They eventually found 38 patients with good liver function, uninodal cancers of 5 cm or less, no portal vein invasion, and no extra-hepatic spread, who had been surgically treated. These subjects were matched with 124 patients who had undergone radiofrequency ablation.

After 3 years, overall survival in the surgery patients was 65.1%, compared to 71.8% in the radiofrequency patients. That difference did not reach statistical significance.

Local tumor progression at 3 years was 0% in the surgery arm, compared to 19.3% in the radiofrequency patients (P =.0082).

New tumors occurred in 58.5% of surgery patients compared with 55.2% of radiofrequency patients, a non-significant difference.

"We were very impressed to see that ablation patients achieved the same [survival] result as surgery patients," Dr. Lencioni said.

Robert Vogelzang, MD, professor of radiology, Northwestern University School of Medicine, Chicago, Illinois, United States, said that minimally invasive techniques in liver cancer have progressed to the point where open surgery for cancer of the liver may be nearing its end.

"In this study from Italy we see, once again, that minimally invasive, image-guided therapy seems to be equal to or perhaps better than a classical surgical method," said Dr. Vogelzang.


[Presentation title: Comparing Resection and Radiofrequency Ablation in Cirrhotic Patients with a Single Small Hepatocellular Carcinoma. Abstract 1021]

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