Radiofrequency (thermal) ablation versus no intervention or other interventions for hepatocellular carcinoma

• Published in: Cochrane database of systematic reviews 2013-12 (12), p.CD003046-CD003046
• Main Authors: Weis, Sebastian, Franke, Annegret, Mössner, Joachim, Jakobsen, Janus C, Schoppmeyer, Konrad
• Format: Article
• Language: English
• Subjects: Acetic Acid - administration & dosage; Administration, Cutaneous; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Catheter Ablation - methods; Catheter Ablation - mortality; Ethanol - administration & dosage; Hepatectomy - mortality; Humans; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Microwaves - therapeutic use; Randomized Controlled Trials as Topic; Treatment Outcome
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD003046.pub3

Hepatocellular carcinoma is the fifth most common cancer worldwide. Percutaneous interventional therapies, such as radiofrequency (thermal) ablation (RFA), have been developed for early hepatocellular carcinoma. RFA competes with other interventional techniques such as percutaneous ethanol injection, surgical resection, and liver transplantation. The potential benefits and harms of RFA compared with placebo, no intervention, chemotherapy, hepatic resection, liver transplantation, or other interventions are unclear. To assess the beneficial and harmful effects of RFA versus placebo, no intervention, or any other therapeutic approach in patients with hepatocellular carcinoma. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ISI Web of Science to September 2012. We handsearched meeting abstracts from ASCO, ESMO, AASLD, EASL, APASL, and references of articles. We also contacted researchers in the field (last search September 2012). We considered for inclusion randomised clinical trials investigating the effects of RFA versus placebo, no intervention, or any other therapeutic approach on hepatocellular carcinoma patients regardless of blinding, language, and publication status. Two review authors independently performed the selection of trials, assessment of risk of bias, and data extraction. We contacted principal investigators for missing information. We analysed hazard ratios (HR) as relevant effect measures for overall survival, two-year survival, event-free survival, and local recurrences with 95% confidence intervals (CI). In addition, we analysed dichotomous survival outcomes using risk ratios (RR). We used trial sequential analysis to control the risk of random errors ('play of chance'). We identified no trials comparing RFA versus placebo, no intervention, or liver transplantation. We identified and included 11 randomised clinical trials with 1819 participants that included four comparisons: RFA versus hepatic resection (three trials, 578 participants); RFA versus percutaneous ethanol injection (six trials, 1088 participants) including one three-armed trial that also investigated RFA versus acetic acid injection; RFA versus microwave ablation (one trial, 72 participants); and RFA versus laser ablation (one trial, 81 participants). Ten of the eleven included trials reported on the primary outcome of this review, overall survival. Rates of major co