RFS

Journal Primer Interventional Oncology SL

Quick Summary
BOTTOM LINE
HCC patients with Child-Pugh class A or B cirrhosis and HCC lesions 4cm
and no more than 2 lesions in total, percutaneous Cryoablation (CA) and
RFA are equally safe and effective ablations Rxs.
HCC size 3.1- 4.0cm percutaneous CA is associated with a lower rate of
Local tumor progression rate than RFA (P<0.041) and should be
considered one of the standard local ablation modalities in these
patients.

MAJOR POINTS
Largest prospective, multicenter RCT to compare RFA vs. CA for HCC.
Prior studies concludes RFA was signiDicantly superior to CA in terms of
complications and local tumor progression.
Newer and safer generation of CA devices ; Improved operator experience
and skill contributed to improved efDicacy and safety of CA for HCC Rx.

Quick Summary
CRITICISM
Follow up was only 25 months; Based on the overall survival

and LTP graphs from the study, given a larger period of F/O
there would be not be a signiDicant difference in survival
between the two Rx groups.
Did not analyze other factors like; Length of hospital stay,

operating time and cost between the two groups.

The study includes only HCC lesions 4cm.

Study design
*TYPE OF STUDY : Prospective multicentered randomized controlled
study.
2426 patients with a diagnosis of HCC, 621 met the inclusion criteria.
360 patients who choose to participate, were enrolled in the study.

Randomly assigned at 1:1 ratio to CA (n=180) and RFA (n=180)

Time range: February 2008 to October 2013
Primary endpoints: Locat tumor progression at 3yrs. after Tx. and

safety.

INCLUSION CRITERIA
HCC with lesion 4cm and no more than 2 lesions
No extrahepatic HCC metastatis or invasion of PV, HV or sec. branches
No Prior HCC Rx
Child-Pugh class A or B cirrhosis only
ECOG PS of 0-2
No evidence of severe coagulopathy (PT>5 sec)

Study design (contd.)

*EXCLUSION CRITERIA
Uncontrolled or refractory ascites with ongoing
variceal bleeding, severe hypersplenism or
enchepahlopathy.
Child-Pugh Class C cirrhosis
Patents who preferred to receive surgery or OLT Rx
HCC within 5mm of GB, colon, stomach or CBD

Purpose
Growing data demonstrated that Cryoablation represents a safe and effective

alternative therapy for HCC but no RCT have been reported to compare CA vs RFA
in HCC Rx.
Main goal is to compare the outcomes of percutaneous CA with RFA for Rx of HCC.

Interven'on

Interven'on

Outcome

Outcome

Outcome

Therapeutic efDicacy of percutaneous CA was compared with

RFA in cirrhosis patients with HCC measuring 4cm and no

more than 2 tumors.

Both cryoablation and RFA were equally safe and effective,
. survival rates.
with similar 5-year

No signiWicant difference were observed in the primary

technique effectiveness rate, Local tumor progression,

distant intrahepatic recurrence, complications, overall
survival and tumor free survival between the two groups.

Conclusion
Cryoa-abation resulted in a signiWicantly

lower local progression than RFA especially

with tumor size of 3.1 to 4cm although both
Cryoablation and RFA are equally safe and
effective with similar 5-year survival rates.

Credits

Insert Institution Logo

SUMMARY BY:

*Name: Srikanth Medarametla M.D. (PGY 4)
*Interventional Radiology
*UAMS

*FULL CITATION(S):
Huang YZ, Zhou SC, Zhou H, Tong M. Radiofrequency ablaHon versus cryosurgery
ablaHon for hepatocellular carcinoma: a meta-analysis.
Hepatogastroenterology 2013;60:1131-1135.

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