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A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies
René Adam1, Ellen J Hagopian, Marcelo Linhares
1Department of Hepatobiliary Surgery and Liver Transplantation, Centre Hepato-Biliaire, Hôpital Paul Brousse, Université Paris Sud, Villejuif, France. rene.adam@pbr.ap-hop-paris.fr
Hypothesis:
The complication and success rates in patients treated with either percutaneous cryosurgery (PCS) or percutaneous radiofrequency (PRF) for unresectable hepatic malignancies are similar.
Design:
Retrospective study.
Setting:
University hospital.
Patients And Methods:
Sixty-four patients were treated with either PCS (n = 31) or PRF (n = 33). Patient treatment was based on the random availability of the probes. Tumors were evaluated by a blinded comparison of pretreatment and posttreatment helical computed tomographic scans. All living patients had at least a 6-month follow-up.
Main Outcome Measures:
Complication rate, initial treatment success (complete devascularization of the tumor), and local recurrence (tumor revascularization within or at its periphery).
Results:
The distribution of tumor types was similar in the 2 groups (P =.76). One patient with cirrhosis died of variceal hemorrhage on day 30 after PCS (mortality, 3.2%), while no mortality was observed after PRF (P =.48). Complications occurred in 9 (29%) of the patients following PCS and in 8 (24%) of the patients following PRF (P =.66). Initial treatment success was comparable in the 2 treatment groups (30 [83%] of 36 tumors following PCS vs 34 [83%] of 41 tumors following PRF). However, local recurrences occurred more frequently after PCS than after PRF (16 [53%] of 30 vs 6 [18%] of 34; P =.003). The higher rate of local recurrence was identified for metastases (10 [71%] of 14 after PCS vs 3 [19%] of 16 after PRF; P =.004), while the difference was not significant for hepatocellular carcinoma (6 [38%] of 16 after PCS vs 3 [17%] of 18 after PRF; P =.25). Multivariate analysis demonstrated that the use of PCS (P =.003) and more than 1 treatment (P =.05) were independent risk factors for local tumor recurrence.
Conclusion:
While similar initial treatment success and complication rates are observed following either PCS or PRF, local recurrences occur more frequently following PCS, particularly for metastases.