Authors' objectives:

The aim of this review was to update the original ASERNIP-S systematic review on Radiofrequency Ablation for Liver Tumours, October 2002. This review was initiated in order to assess new studies examining the safety and efficacy of radiofrequency ablation (RFA) for primary hepatocellular carcinoma or metastatic colorectal liver carcinoma, in comparison to other surgical and non-surgical therapeutic techniques, on the basis of a systematic assessment of the literature. The surgical comparative techniques included resection or hepatic artery infusion chemotherapy. The non-surgical comparative interventions included local ablative therapies such as percutaneous ethanol injection (PEI); cryotherapy; or procedures that produce local heat such as microwave coagulation therapy (MCT) or laser-induced thermotherapy (LITT).

Authors' results and conclusions: As an update of a previous ASERNIP-S review which originally contained 12 studies, this systematic review has incorporated a further 12 studies bringing the total of included studies to 24. However, the limitations of the studies in the original systematic review are present in this update, ie; small sample sizes, short follow-up times and a lack of comparability between the reported outcome measures. Despite the limitations of the data, RFA generally resulted in larger and more complete areas of ablation and may also be associated with higher survival rates compared to the other ablative techniques assessed in this review. Surgical resection was associated with a lower rate of recurrence and an increased time interval to recurrence compared to RFA. However, these two procedures are usually performed on different patient groups, with RFA being performed on patients who are unable to undergo surgical resection. However, conclusions regarding safety and efficacy of RFA remain largely unchanged. At this time results are still inconclusive for the use of RFA in the treatment of hepatocellular carcinoma and colorectal metastases. Additionally, there is paucity of comparative evidence regarding the use of RFA for colorectal metastases. Further studies, on both forms of cancer, need to be produced which contain adequate patient numbers and a focus on long-term local and overall recurrence and safety outcomes. The standardisation of outcome measures across studies would also greatly benefit any analysis.

Authors' recommendations: On the basis of the evidence presented in this systematic review, the ASERNIP-S Review Group agreed on the following classifications and recommendations concerning the safety and efficacy of radiofrequency ablation for the treatment of liver tumours: Evidence rating The evidence-base in this review is rated as average. Safety The treatment of radiofrequency ablation for liver tumours is at least as safe as other treatments. Efficacy From the data included in this systematic review the efficacy of RFA cannot be determined in relation to other ablation techniques. Clinical and research recommendations More information is required to conclusively determine the advantages and disadvantages of radiofrequency ablation for primary hepatocellular carcinoma or metastatic colorectal liver carcinoma over other ablative treatment techniques. Further studies are also necessary to compare the safety and efficacy of percutaneous, laparoscopic and open approaches to radiofrequency ablation. The relationship of patient safety and efficacy outcomes and tumour size also requires additional research. Lastly, it is recommended that, through the increasing use of health informatics, cancer registries incorporate data items designed to gather information on treatment outcomes of ablative techniques for both hepatocellular carcinoma and metastatic colorectal liver carcinoma.

Authors' methods: Systematic Review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S)