Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma

  • Review
  • Intervention

Authors


Abstract

Background

Hepatocellular carcinoma is one of the most common malignant diseases worldwide. A potential curative option is surgical resection. Due to impaired liver function and/or anatomical reasons only few patients can be treated surgically. For the majority of patients, several interventions have been developed. Among these, local radiofrequency inducing heat production has been used to coagulate the cancer.

Objectives

To evaluate the effects of radiofrequency thermal ablation in hepatocellular carcinoma patients with respect to clinically relevant outcomes (mortality, rate of recurrences, adverse events, quality of life, and duration of hospital stay) versus sham intervention, no intervention, or other interventions.

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Controlled Trials Register on The Cochrane Library, MEDLINE, EMBASE, CancerLit, and Current Contents until October 2003. Handsearches were also conducted. Reference lists of the identified articles were checked for further trials.

Selection criteria

All randomised trials investigating radiofrequency thermal ablation versus placebo, no intervention, or any other therapeutic approach were considered for inclusion, regardless of blinding, language, and publication status.

Data collection and analysis

Trial inclusion, quality assessment, and data extraction were performed independently by two reviewers. Principal investigators were contacted for further information.

Main results

Only two randomised clinical trials were identified. One trial including 102 patients compared radiofrequency thermal ablation versus percutaneous ethanol injection for small hepatocellular carcinoma. Radiofrequency thermal ablation significantly increased recurrence-free survival (hazard ratio 0.48, 95% confidence interval (CI) 0.27 to 0.85) but did not significantly influence overall survival (hazard ratio 0.20, 95% CI 0.02 to 1.69). The rate of complications and side effects did not differ significantly between the two groups. Another trial with methodological flaws compared radiofrequency thermal ablation versus percutaneous microwave coagulation for 72 patients with 94 hepatocellular carcinoma lesions. The main outcome criterion was the rate of recurrences in both groups; no significant difference was detected. The rate of side effects did not differ significantly, but significantly more treatment sessions were needed with percutaneous microwave coagulation to achieve complete tumour ablation.

Authors' conclusions

Radiofrequency thermal ablation seems a potentially promising technique for the treatment of small hepatocellular carcinoma. However, more randomised clinical trials are needed.

摘要

背景

以射頻燒灼術對照其他干預法治療肝細胞癌的比較

肝細胞癌是世界上最常發生的惡性疾病之一。經由手術切除有可能治癒肝癌。由於肝臟功能受損和/或解剖學的原因,只有少數病人可以進行手術治療。 多數病人則已經發展出幾種干預療法。 在這些療法中,人們已使用局部射頻產生熱量的療法用來使癌細胞凝結。

目標

從臨床相關結果(死亡率。復發率、不良事件、生活品質、住院日)評估射頻燒灼術對照假治療,無干預法或其他干預法治療肝細胞癌病人的利弊。

搜尋策略

我們搜尋截至2003年10月的The Cochrane HepatoBiliary Group Controlled Trials Register, Cochrane Library的The Cochrane Controlled Trials Register on、MEDLINE、EMBASE、 CancerLit 和Current Contents。展開手動搜索。檢查已找出之的文章的參考文獻列表,以獲取進一步的試驗。

選擇標準

收錄所有研究射頻燒灼術對照安慰劑、無干預法或其他任意療法的隨機試驗。不受盲法、語言和發表狀態的限制。

資料收集與分析

兩位文獻回顧作者獨立收納試驗、評估品質、摘錄數據。 聯繫主要的研究者,以獲取額外資訊。

主要結論

一共找到兩個隨機臨床試驗。一個試驗比較射頻燒灼術和經皮乙醇注射治療 小肝細胞癌,共有102 病人參加。射頻燒灼術明顯增加了無復發存活率 (hazard ratio 0.48, 95% 信賴區間 (CI) 0.27 0.85) ,但是沒有顯著影響整體存活率 (hazard ratio 0.20, 95% CI 0.02 – 1.69)。2個小組在併發症比例和副作用比例上沒有顯示顯著差異。 另外一個存在方法學缺陷的試驗比較射頻燒灼術和經皮微波凝固術治療72位病人,存在94個肝細胞癌病灶。主要的結果標準是指兩組的復發率,但是沒有發現有顯著差異。副作用的比例沒有顯著差異,但是需要使用經皮微波組織凝固術治療的次數明顯較多,以達到徹底的腫瘤消融。

作者結論

射頻燒灼術看似是治療小肝細胞癌的一種潛在具有前景的技術。但是仍需要更多的隨機臨床試驗來證實。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

期待更多的有關射頻燒灼術治療肝細胞癌療效的證據。肝細胞癌是世界上最常發生的惡性疾病之一。只有少數病人可以進行手術治療。 人們已開發幾種微創治療技術用於治療肝細胞癌的病人。在這些技術中,通常使用由射頻誘發熱凝固(熱消融)的方法。目前,沒有充足的證據建議肝細胞癌病人使用射頻燒灼術治療。只有一個品質較好的試驗顯示,和經皮乙醇注射治療術比較,射頻燒灼術具有較高的無復發存活率。 根據一個小規模的試驗,肝細胞癌的射頻燒灼術和微波凝固療法不會在療效和安全性方面出現顯著差異。

Plain language summary

Still awaiting evidence on the effect of radiofrequency thermal ablation for the treatment of hepatocellular carcinoma

Hepatocellular carcinoma is one of the most common malignancies worldwide. Only a minority of the patients can be treated by surgery. Several minimally invasive treatment techniques have been developed to treat patients with hepatocellular carcinoma. Among these, heat coagulation (thermal ablation) induced by radiofrequency is commonly used. At present there is no sufficient evidence to recommend radiofrequency thermal ablation for patients with hepatocellular carcinoma. Only one trial of good quality shows higher rates of recurrence-free survival compared with percutaneous ethanol injection. According to one small trial, radiofrequency and microwave coagulation of hepatocellular carcinoma caused no significant differences regarding efficacy and safety.