Study Questions Value of CT-Guided RFA for OAs With Hepatocellular Carcinoma

Computed tomography (CT) is increasingly used for image guidance for radiofrequency ablation (RFA) in patients 65 years and older with hepatocellular carcinoma not eligible for surgical resection. But a new study suggests it offers no significant improvements in postprocedural complications or survival compared with less expensive ultrasound-guided RFA. Researchers published their findings in the journal Value in Health.

“Although CT-guided RFA has been shown to be a safe and efficacious treatment for patients with unresectable hepatocellular carcinoma, no comparative effectiveness studies to date have demonstrated CT-guided RFA to be superior to ultrasound-guided RFA in the United States,” researchers wrote. “If CT- and ultrasound-guided RFAs offer similar clinical benefits, then there will be a fast diffusion of the CT-guided RFA because the procedure is nearly twice as expensive as the ultrasound-guided procedure.”

To compare the effectiveness of CT-guided and ultrasound-guided RNA, researchers looked at a cohort of 463 Medicare patients age 65 and older with hepatocellular carcinoma from the Surveillance, Epidemiology, and End Results and Medicare-linked database.

The study identified a sharp rise in the use of CT to guide RNA, from 20.7% in 2002 to 75.9% in 2011. It also found the cost of CT-guided RFA to average $2847, compared with $1862 for ultrasound-guided RFA.

Despite the trend toward the more expensive guidance option, CT-guided RFA offered no statistically significant difference in overall survival or cancer-specific survival, researchers reported. Furthermore, the risk of postprocedural complications with CT-guided RFA was comparable to the risk with ultrasound-guided RFA.

“Echoing the American Board of Internal Medicine’s Choosing Wisely campaign and the American Society of Clinical Oncology’s Value of Cancer Care initiative, findings from our study call for critical evaluation of whether CT-guided RFA provides high-value care for patients with hepatocellular carcinoma,” researchers wrote.

—Jolynn Tumolo

Reference

Huo J, Aloia TA, Xu Y, Chung TH, Sheu T, Tina Shih YC. Comparative effectiveness of computed tomography- versus ultrasound-guided percutaneous radiofrequency ablation among Medicare patients 65 years of age or older with hepatocellular carcinoma. Value Health. 2019;22(3):284-292.