Authors' objectives:

This review aims to assess the effectiveness of radiofrequency ablation in the treatment of non-resectable primary hepatocellular carcinoma (HCC) or metastatic colorectal liver metastases (CLM) or neuroendocrine liver metastases (NLM).

Authors' results and conclusions: Safety: Hepatocellular carcinoma (HCC) In two RCTs, no significant differences in complications between RFA and PEI were found. Metastatic colorectal liver tumours (CLM) Patients with more tumours (and therefore more RFA sessions) may have a higher complication rate (based on case series data). Metastatic neuroendocrine liver tumours (NLM) In five case series, complication rates varied from 0% to 11%. Effectiveness: Hepatocellular carcinoma (HCC) Local recurrence free survival (and local recurrence rate) at one and two years did showed a statistically significant benefit for RFA over PEI in one RCT. In two other RCTs, local recurrence rates were less for RFA than for PEI, but this result was not statistically significant in either study. Metastatic colorectal liver tumours (CLM) While most of the case series reported high levels of ablation with RFA (90% and above), this surrogate outcome may not reflect long term effectiveness. Local recurrence rates varied from 4% to 55% and may depend on the method of access used for RFA. The single comparative study suggested that survival from the time of diagnosis was less for patients treated with RFA than surgical resection. Metastatic neuroendocrine liver tumours (NLM) A comparative study of only two patients was inconclusive. In five case series, local recurrence varied from 0% to 20%.

Authors' recommendations: MSAC recommended that, on the strength of evidence pertaining to radiofrequency ablation (RFA), public funding should be supported for the percutaneous treatment of non-resectable hepatocellular carcinoma not being considered for surgical resection. MSAC recommended that, as there is not yet enough evidence on the use of RFA for colorectal metastases (CLM), public funding should not be supported at this time for RFA treatment of CLM. Since there is currently insufficient evidence pertaining to RFA for neuroendocrine liver metastases (NLM), MSAC recommended that public funding should not be supported at this time for RFA treatment of NLM.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.msac.gov.au/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medicare Services Advisory Committee (MSAC)