A systematic review of radiofrequency ablation versus percutaneous ethanol injection for small hepatocellular carcinoma up to 3 cm

Background and Aim Radiofrequency ablation ( RFA ) and percutaneous ethanol injection ( PEI ) have been used for patients with hepatocellular carcinomas ( HCCs ) < 3 cm, but there is controversy which of the two methods is superior. Therefore, we aimed to conduct a systematic review to assess survival, complete tumor necrosis, recurrence and metastasis, major complications, costs, hospital stays, and posttreatment survival quality of RFA versus PEI for treating small HCCs < 3 cm. Methods We conducted a search for published articles in P ubMed, E mbase, and the C ochrane Library until M arch 2012. Only randomized controlled trials ( RCT s) and quasi‐randomized clinical trials were included. Results Four RCT s with 766 patients were included in this review. We found that RFA is significantly better than PEI with respect to a 3‐year overall survival for small HCCs ( RFA   vs   PEI , hazard ratios [ HR]  = 0.66, 95% confidence interval [ CI] : 0.48–0.90, P  = 0.009), especially for HCCs > 2 cm ( HR  = 0.56, 95% CI : 0.31–0.99, P  = 0.045). RFA had a lower risk of local recurrence ( HR  = 0.38, 95% CI : 0.15–0.96, P  = 0.040), but no difference is seen for distant intrahepatic recurrence. RFA had higher rates of complete tumor necrosis, but RFA also caused more major complications and was more costly than PEI . B egg's and E gger's tests detected no significant publication bias among the four RCT s. Conclusions RFA appears superior to PEI with respect to local tumor control and 3‐year survival for small HCCs < 3 cm. RFA was more feasible in patients with HCCs > 2 cm or C hild– P ugh A liver function.