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(Radiology. 1999;210:655-661.)
© RSNA, 1999

Vascular and Interventional Radiology

Small Hepatocellular Carcinoma: Treatment with Radio-frequency Ablation versus Ethanol Injection

Tito Livraghi, MD1, S. Nahum Goldberg, MD2, Sergio Lazzaroni, MD3, Franca Meloni, MD1, Luigi Solbiati, MD4 and G. Scott Gazelle, MD, MPH2

1 Department of Radiology, Ospedale Civile, Via C. Battisti 23, 20059 Vimercate, Italy (T.L., F.M.)
2 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (S.N.G., G.S.G.)
3 Department of Internal Medicine, Ospedale San Biagio, Clusone, Italy (S.L.)
4 Department of Radiology, Ospedale Generale, Busto Arsizio, Italy (L.S.).

PURPOSE: To compare the effectiveness of radio-frequency (RF) ablation with that of percutaneous ethanol injection in the treatment of small hepatocellular carcinoma (HCC).

MATERIALS AND METHODS: Eighty-six patients with 112 small (<=3-cm-diameter) HCCs underwent RF ablation (42 patients with 52 tumors) or percutaneous ethanol injection (44 patients with 60 tumors). Therapeutic efficacy was evaluated with dual-phase spiral computed tomography performed at least 4 months after treatment.

RESULTS: Complete necrosis was achieved in 47 of 52 tumors with RF ablation (90%) and in 48 of 60 tumors with percutaneous ethanol injection (80%). These results were obtained with an average of 1.2 sessions per tumor with RF ablation and 4.8 sessions per tumor with percutaneous ethanol injection. One major complication (hemothorax that required drainage) and four minor complications (intraperitoneal bleeding, hemobilia, pleural effusion, cholecystitis) occurred in patients treated with RF ablation; no complications occurred in patients treated with percutaneous ethanol injection.

CONCLUSION: RF ablation results in a higher rate of complete necrosis and requires fewer treatment sessions than percutaneous ethanol injection. However, the complication rate is higher with RF ablation than with percutaneous ethanol injection. RF ablation is the treatment of choice for most patients with HCC.

Index terms: Alcohol, 761.1269 • Liver, interventional procedure, 761.1269 • Liver neoplasms, therapy, 761.1269, 761.323, 761.47 • Radiofrequency (RF) ablation, 761.1269, 761.47




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S. H. Kim, H. K. Lim, D. Choi, W. J. Lee, S. H. Kim, M. J. Kim, S. J. Lee, and J. H. Lim
Changes in Bile Ducts after Radiofrequency Ablation of Hepatocellular Carcinoma: Frequency and Clinical Significance
Am. J. Roentgenol., December 1, 2004; 183(6): 1611 - 1617.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
D. Choi, H. K. Lim, M. J. Kim, S. H. Kim, W. J. Lee, S. H. Kim, J. H. Lim, S. W. Paik, K. C. Koh, and B. C. Yoo
Therapeutic Efficacy and Safety of Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma Abutting the Gastrointestinal Tract
Am. J. Roentgenol., November 1, 2004; 183(5): 1417 - 1424.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
S. Shankar, E. vanSonnenberg, P. R. Morrison, K. Tuncali, and S. G. Silverman
Combined Radiofrequency and Alcohol Injection for Percutaneous Hepatic Tumor Ablation
Am. J. Roentgenol., November 1, 2004; 183(5): 1425 - 1429.
[Abstract] [Full Text] [PDF]

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 Clin. Cancer Res.Home page
A. Hines-Peralta and S. N. Goldberg
Review of Radiofrequency Ablation for Renal Cell Carcinoma
Clin. Cancer Res., September 15, 2004; 10(18): 6328S - 6334S.
[Abstract] [Full Text] [PDF]

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 GutHome page
E Caturelli, L Solmi, M Anti, S Fusilli, P Roselli, A Andriulli, F Fornari, C Del Vecchio Blanco, and I de Sio
Ultrasound guided fine needle biopsy of early hepatocellular carcinoma complicating liver cirrhosis: a multicentre study
Gut, September 1, 2004; 53(9): 1356 - 1362.
[Abstract] [Full Text] [PDF]

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 Br. J. Radiol.Home page
A R Gillams
Liver ablation therapy
Br. J. Radiol., September 1, 2004; 77(921): 713 - 723.
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 Am. J. Roentgenol.Home page
M. Koda, M. Ueki, Y. Maeda, K.-i. Mimura, K. Okamoto, Y. Matsunaga, M. Kawakami, K. Hosho, and Y. Murawaki
Percutaneous Sonographically Guided Radiofrequency Ablation with Artificial Pleural Effusion for Hepatocellular Carcinoma Located Under the Diaphragm
Am. J. Roentgenol., September 1, 2004; 183(3): 583 - 588.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
Y. Minami, M. Kudo, T. Kawasaki, H. Chung, C. Ogawa, and H. Shiozaki
Treatment of Hepatocellular Carcinoma with Percutaneous Radiofrequency Ablation: Usefulness of Contrast Harmonic Sonography for Lesions Poorly Defined with B-Mode Sonography
Am. J. Roentgenol., July 1, 2004; 183(1): 153 - 156.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
S. S. Raman, D. Aziz, X. Chang, M. Ye, J. Sayre, C. Lassman, and D. S. K. Lu
Minimizing Central Bile Duct Injury during Radiofrequency Ablation: Use of Intraductal Chilled Saline Perfusion--Initial Observations from a Study in Pigs
Radiology, July 1, 2004; 232(1): 154 - 159.
[Abstract] [Full Text] [PDF]

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 Ann OncolHome page
T.-I. Huo, Y.-H. Huang, J.-C. Wu, P.-C. Lee, F.-Y. Chang, and S.-D. Lee
Induction of complete tumor necrosis may reduce intrahepatic metastasis and prolong survival in patients with hepatocellular carcinoma undergoing locoregional therapy: a prospective study
Ann. Onc., May 1, 2004; 15(5): 775 - 780.
[Abstract] [Full Text] [PDF]

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 Ann. Surg. Oncol.Home page
R. T.-P. Poon, K. K.-C. Ng, C.-M. Lam, V. Ai, J. Yuen, and S.-T. Fan
Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma
Ann. Surg. Oncol., March 1, 2004; 11(3): 281 - 289.
[Abstract] [Full Text] [PDF]

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 Arch SurgHome page
R. T. P. Poon, K. K. C. Ng, C.-M. Lam, V. Ai, J. Yuen, and S.-T. Fan
Effectiveness of Radiofrequency Ablation for Hepatocellular Carcinomas Larger Than 3 cm in Diameter
Arch Surg, March 1, 2004; 139(3): 281 - 287.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
M. Ahmed, Z. Liu, K. S. Afzal, D. Weeks, S. M. Lobo, J. B. Kruskal, R. E. Lenkinski, and S. N. Goldberg
Radiofrequency Ablation: Effect of Surrounding Tissue Composition on Coagulation Necrosis in a Canine Tumor Model
Radiology, March 1, 2004; 230(3): 761 - 767.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
T. J. Vogl, R. Straub, K. Eichler, O. Sollner, and M. G. Mack
Colorectal Carcinoma Metastases in Liver: Laser-induced Interstitial Thermotherapy--Local Tumor Control Rate and Survival Data
Radiology, February 1, 2004; 230(2): 450 - 458.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
S. M. Lobo, K. S. Afzal, M. Ahmed, J. B. Kruskal, R. E. Lenkinski, and S. N. Goldberg
Radiofrequency Ablation: Modeling the Enhanced Temperature Response to Adjuvant NaCl Pretreatment
Radiology, January 1, 2004; 230(1): 175 - 182.
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 RadioGraphicsHome page
H. Rhim, G. D. Dodd III, K. N. Chintapalli, B. J. Wood, D. E. Dupuy, J. L. Hvizda, P. E. Sewell, and S. N. Goldberg
Radiofrequency Thermal Ablation of Abdominal Tumors: Lessons Learned from Complications
RadioGraphics, January 1, 2004; 24(1): 41 - 52.
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 RadiologyHome page
D. Choi, H. K. Lim, M. J. Kim, S. H. Lee, S. H. Kim, W. J. Lee, J. H. Lim, J.-W. Joh, and Y. I. Kim
Recurrent Hepatocellular Carcinoma: Percutaneous Radiofrequency Ablation after Hepatectomy
Radiology, January 1, 2004; 230(1): 135 - 141.
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 J Ultrasound MedHome page
D. Choi, H. K. Lim, W. J. Lee, S. H. Kim, Y. H. Kim, S. H. Kim, and J. H. Lim
Early Assessment of the Therapeutic Response to Radio Frequency Ablation for Hepatocellular Carcinoma: Utility of Gray Scale Harmonic Ultrasonography With a Microbubble Contrast Agent
J. Ultrasound Med., November 1, 2003; 22(11): 1163 - 1172.
[Abstract] [Full Text] [PDF]

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 J Ultrasound MedHome page
H.-X. Xu, X.-Y. Yin, M.-D. Lu, X.-Y. Xie, Z.-F. Xu, and G.-J. Liu
Usefulness of Three-dimensional Sonography in Procedures of Ablation for Liver Cancers: Initial Experience
J. Ultrasound Med., November 1, 2003; 22(11): 1239 - 1247.
[Abstract] [Full Text] [PDF]

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 Ann OncolHome page
T.-I. Huo, Y.-H. Huang, J.-C. Wu, J.-H. Chiang, P.-C. Lee, F.-Y. Chang, and S.-D. Lee
Sequential transarterial chemoembolization and percutaneous acetic acid injection therapy versus repeated percutaneous acetic acid injection for unresectable hepatocellular carcinoma: a prospective study
Ann. Onc., November 1, 2003; 14(11): 1648 - 1653.
[Abstract] [Full Text] [PDF]

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 Arch SurgHome page
B. H.-H. Lang, R. T.-P. Poon, S.-T. Fan, and J. Wong
Perioperative and Long-term Outcome of Major Hepatic Resection for Small Solitary Hepatocellular Carcinoma in Patients With Cirrhosis
Arch Surg, November 1, 2003; 138(11): 1207 - 1213.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
F. Burdio, A. Guemes, J. M. Burdio, A. Navarro, R. Sousa, T. Castiella, I. Cruz, O. Burzaco, and R. Lozano
Bipolar Saline-enhanced Electrode for Radiofrequency Ablation: Results of Experimental Study of in Vivo Porcine Liver
Radiology, November 1, 2003; 229(2): 447 - 456.
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 Am. J. Roentgenol.Home page
M. Kitamoto, M. Imagawa, H. Yamada, C. Watanabe, M. Sumioka, O. Satoh, M. Shimamoto, M. Kodama, S. Kimura, K. Kishimoto, et al.
Radiofrequency Ablation in the Treatment of Small Hepatocellular Carcinomas: Comparison of the Radiofrequency Effect With and Without Chemoembolization
Am. J. Roentgenol., October 1, 2003; 181(4): 997 - 1003.
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 Am. J. Roentgenol.Home page
T. de Baere, O. Risse, V. Kuoch, C. Dromain, C. Sengel, T. Smayra, M. G. E. Din, C. Letoublon, and D. Elias
Adverse Events During Radiofrequency Treatment of 582 Hepatic Tumors
Am. J. Roentgenol., September 1, 2003; 181(3): 695 - 700.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
T. S. Kim, H. K. Lim, K. S. Lee, Y. C. Yoon, C. A Yi, and D. Han
Imaging-Guided Percutaneous Radiofrequency Ablation of Pulmonary Metastatic Nodules Caused by Hepatocellular Carcinoma: Preliminary Experience
Am. J. Roentgenol., August 1, 2003; 181(2): 491 - 494.
[Abstract] [Full Text] [PDF]

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 Clin. Cancer Res.Home page
N. Waguri, T. Suda, M. Nomoto, H. Kawai, Y. Mita, T. Kuroiwa, M. Igarashi, M. Kobayashi, Y. Fukuhara, and Y. Aoyagi
Sensitive and Specific Detection of Circulating Cancer Cells in Patients with Hepatocellular Carcinoma; Detection of Human Telomerase Reverse Transcriptase Messenger RNA after Immunomagnetic Separation
Clin. Cancer Res., August 1, 2003; 9(8): 3004 - 3011.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
Y. L. Wen, M. Kudo, R. Q. Zheng, Y. Minami, H. Chung, Y. Suetomi, H. Onda, M. Kitano, T. Kawasaki, and K. Maekawa
Radiofrequency Ablation of Hepatocellular Carcinoma: Therapeutic Response Using Contrast-Enhanced Coded Phase-Inversion Harmonic Sonography
Am. J. Roentgenol., July 1, 2003; 181(1): 57 - 63.
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 RadiologyHome page
R. A. Lencioni, H.-P. Allgaier, D. Cioni, M. Olschewski, P. Deibert, L. Crocetti, H. Frings, J. Laubenberger, I. Zuber, H. E. Blum, et al.
Small Hepatocellular Carcinoma in Cirrhosis: Randomized Comparison of Radio-frequency Thermal Ablation versus Percutaneous Ethanol Injection
Radiology, July 1, 2003; 228(1): 235 - 240.
[Abstract] [Full Text] [PDF]