Acetic acid versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A randomized controlled trial

PurposeThe purpose of this prospective study was to compare the efficacy of percutaneous acetic acid (PAAI) to that of radiofrequency ablation (RFA) in the treatment of small (≤ 5 cm) hepatocellular carcinoma (HCC) using a randomized trial.Material and methodsConsecutive patients with small HCC underwent clinical, biochemical, and imaging evaluation. Those fulfilling the inclusion criteria (Child's A/B cirrhosis, less than 5 HCC nodules, HCC nodules ≤ 5 cm diameter, no extrahepatic disease, patent portal vein, normal coagulation profile with informed consent) were randomly assigned to receive RFA or PAAI. Tumor response and survival rate were estimated. Non-inferiority margin of 10% difference was taken for effectivity of PAAI compared to RFA.ResultsOf the 86 patients screened, 55 patients with 67 HCC nodules were included. There were 40 men and 15 women with a mean age of 54.3 ± 10.5 (SD) years (range: 28–71 years). Of these, 26 patients had PAAI and 29 had RFA. The clinical, demographic and imaging profiles of the two groups were similar. Complete response was non-inferior to RFA [PAAI 75% and RFA 83.3%, difference 8.3% CI (−12.5% to 29.2%)]. Lower limit of this 95% CI (−12.5%) was lower than the 10% non-inferiority margin difference (8.3%). Survival rates were similar at 12 months (PAAI, 81.6% vs. RFA, 71.9%; P = 0.68) and at 30 months (PAAI, 54.4% vs. RFA, 52%; P = 0.50).ConclusionPAAI and RFA have similar efficacy in treating small HCC. PAAI could thus be a cost-effective alternative in situations where RFA is either unavailable or unaffordable.