Trial Information

Radiofrequency Ablation Versus Liver Resection for Elderly Patients With Hepatocellular Carcinoma (HCC) Within the Milan Criteria

Hepatocellular carcinoma (HCC) is a common cancer, and it is the third commonest global
cause of cancer-related death. With an increase in life-expectancy of the general
population, the number of elderly with HCC is expected to increase. Current curative
treatment options for HCC include: liver transplantation, liver resection (LR) and local
ablation therapy. Liver transplantation is a good treatment for HCC within the Milan
criteria (single HCC ≤ 5 cm or up to 3 nodules each < 3 cm). As a consequence of the lack of
liver donors, one relative contraindication for liver transplantation is age over 65 years,
or the protocol requires elderly patients to have very good general health before they can
be put on a transplant list. Transcatheter arterial chemoembolization (TACE) is used more
commonly for the treatment of intermediate and advanced-staged HCC, while liver resection
and local ablation therapy are used for early-staged HCC. Amongst the local ablative
therapies, radiofrequency ablation (RFA) is most widely used. It has the advantage of
minimally invasiveness, making it the first-line treatment for small HCC in patients with
compromised liver function or associated severe medical conditions.

Elderly patients are more likely to have poor general conditions and associated medical
diseases. RFA has the advantage of being less invasive and it causes less pain, less blood
loss and earlier recovery than LR. On the other hand, incomplete ablation of HCC and tumor
track seeding may happen. Several studies have demonstrated the safety of LR for elderly
patients. There is no good evidence in the medical literature to support whether RFA or LR
is a better treatment for elderly patients with HCC.