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  • Publication # 14-RA001

Review finds insufficient evidence to compare effectiveness of most local therapies for unresectable primary liver cancer

Comparative Effectiveness Research

A new research review from AHRQ finds that there is not enough evidence in the available literature to draw conclusions about effectiveness outcomes (overall survival, quality of life, disease progression, local recurrence, length of hospital stay, and days of work missed) and adverse events across the majority of the local hepatic therapies that were studied for the treatment of unresectable primary liver cancer (hepatocellular carcinoma [HCC]). However, there is a moderate strength of evidence demonstrating that radiofrequency ablation (RFA) improves overall survival at 3 years and a low strength of evidence indicating that it lengthens the time to disease progression and results in better local disease control compared with percutaneous ethanol or acetic injections (PEI/PAI). 

In patients with larger tumors, there is a low strength of evidence demonstrating longer overall survival after RFA compared with PEI/PAI. However, this difference in survival was not found in patients with smaller tumors. A low strength of evidence also shows that patients treated with RFA remain in the hospital longer than patients treated with PEI/PAI.

HCC is the fifth most common cancer and the third leading cause of cancer death worldwide. Approximately 80 percent of patients with primary HCC–the most common type of liver cancer–are not candidates for surgery because of advanced-stage disease, tumors in unresectable locations, or other medical conditions that result in high surgical risk. Local therapies (e.g., ablation, embolization, and radiotherapy), which are used to prolong survival and/or palliate symptoms in these patients, are an important part of disease management. 

The review highlights the need for additional clinical studies to address the current gaps in research, especially considering that the incidence of and mortality rate due to HCC are projected to increase worldwide in the next 20 years. 

These findings are available in the research review Local Therapies for Unresectable Primary Hepatocellular Carcinoma, which can be accessed at

Page last reviewed October 2013
Internet Citation: Review finds insufficient evidence to compare effectiveness of most local therapies for unresectable primary liver cancer: Comparative Effectiveness Research. October 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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