***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND STUDY AIMS Hepatocellular carcinoma ( HCC ) is a major burden on health-care systems worldwide . Although radiofrequency ablation ( RFA ) is currently considered the best technique for coagulative necrosis , the superiority of concomitant use of RFA and percutaneous ethanol injection ( PEI ) needs to be determined . The study was design ed to compare efficacy , safety and rate of survival of patients with HCC assigned to receive combined PEI-RFA versus RFA alone and versus PEI alone . PATIENTS AND METHODS This 3-year study enrolled 90 cirrhotic patients with HCC ( Child 's class A or B , but not class C ) . They were r and omly assigned for either PEI-RFA ( group I ) , RFA alone ( group II ) or PEI alone ( group III ) . The primary end point was ablation of the tumour . The secondary end point was rate of survival and recurrence . RESULTS After the first session , complete ablation was significantly higher in the combination group ( 87.9 % ) compared with the RFA group ( 54.54 % ) . After the second session , complete ablation was achieved in 97.0 % of the combination group and in 84.8 % of the RFA group . Regarding the PEI group , 75 % had complete ablation , whereas 25 % had partial ablation after multiple sessions . The survival rate , 1.5 years later , was significantly higher in group I ( 86.7 % ) compared with group III ( 63.3 % ) . The overall incidence of serious adverse events was nil . CONCLUSION Combined treatment is superior to RFA alone and to PEI alone , in safety and efficacy in patients with HCC Aims : The aim of this study was to compare the outcomes of radiofrequency thermal ablation ( RFTA ) , percutaneous ethanol injection ( PEI ) , and percutaneous acetic acid injection ( PAI ) in the treatment of hepatocellular carcinoma ( HCC ) . Patients and methods : A total of 187 patients with HCCs of 3 cm or less were r and omly assigned to RFTA ( n = 62 ) , PEI ( n = 62 ) , or PAI ( n = 63 ) . Tumour recurrence and survival rates were assessed . Results : One , two , and three year local recurrence rates were 10 % , 14 % , and 14 % in the RFTA group , 16 % , 34 % , and 34 % in the PEI group , and 14 % , 31 % , and 31 % in the PAI group ( RFTA v PEI , p = 0.012 ; RFTA v PAI , p = 0.017 ) . One , two , and three year survival rates were 93 % , 81 % , and 74 % in the RFTA group , 88 % , 66 % , and 51 % in the PEI group , and 90 % , 67 % , and 53 % in the PAI group ( RFTA v PEI , p = 0.031 ; RFTA v PAI , p = 0.038 ) . One , two , and three year cancer free survival rates were 74 % , 60 % , and 43 % in the RFTA group , 70 % , 41 % , and 21 % in the PEI group , and 71 % , 43 % , and 23 % in the PAI group ( RFTA v PEI , p = 0.038 ; RFTA v PAI , p = 0.041 ) . Tumour size , tumour differentiation , and treatment methods ( RFTA v PEI and PAI ) were significant factors for local recurrence , overall survival , and cancer free survival . Major complications occurred in 4.8 % of patients ( two with haemothorax , one gastric perforation ) in the RFTA group and in none in two other groups ( RFTA v PEI and PAI , p = 0.035 ) . Conclusions : RFTA was superior to PEI and PAI with respect to local recurrence , overall survival , and cancer free survival rates , but RFTA also caused more major complications To assess whether ultrasound‐guided percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small hepatocellular carcinoma ( HCC ) , 60 patients with one to four HCCs smaller than 3 cm were entered onto a r and omized controlled trial . Thirty‐one and 29 patients , respectively , were treated by percutaneous acetic acid injection using 50 % acetic acid or by percutaneous ethanol injection using absolute ethanol . There were no significant differences in age , sex ratio , Child‐Pugh class , size of tumors , or number of tumors between the two groups . When there was no evidence of viable HCC from biopsy , plain and helical dynamic computed tomography , or angiography , the treatment was considered successful and was discontinued . All original tumors were treated successfully by either therapy . However , 8 % of 38 tumors treated with percutaneous acetic acid injection and 37 % of 35 tumors treated with percutaneous ethanol injection  developed a local recurrence ( P < .001 ) during the follow‐up periods of 29 ± 8 months and 23 ± 10 months , respectively . The 1‐ and 2‐year survival rates were 100 % and 92 % in percutaneous acetic acid injection and 83 % and 63 % in percutaneous ethanol injection ( P = .0017 ) . A multivariate analysis of prognostic factors revealed that treatment was an independent predictor of survival . The risk ratio of percutaneous acetic acid injection versus percutaneous ethanol injection was 0.120 ( range , 0.027‐0.528;P = .0050 ) . In conclusion , percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small HCC BACKGROUND & AIMS The aim of this study was to compare the clinical outcome of percutaneous radiofrequency ( RF ) ablation , conventional percutaneous ethanol injection ( PEI ) , and higher-dose PEI in treating hepatocellular carcinoma ( HCC ) 4 cm or less . METHODS A total of 157 patients with 186 HCCs 4 cm or less were r and omly assigned to 3 groups ( 52 patients in the conventional PEI group , 53 in the higher-dose PEI group , and 52 in the RF group ) . Clinical outcomes in terms of complete tumor necrosis , overall survival , local tumor progression , additional new tumors , and cancer-free survival were compared across 3 groups . RESULTS The rate of complete tumor necrosis was 88 % in the conventional PEI group , 92 % in the higher-dose PEI group , and 96 % in the RF group . Significantly fewer sessions were required to achieve complete tumor necrosis in the RF group than in the other 2 groups ( P < .01 ) . The local tumor progression rate was lowest in the RF group ( vs the conventional PEI group , P = .012 ; vs the higher-dose PEI group , P = .037 ) . The overall survival rate was highest in the RF group ( vs the conventional PEI group , P = .014 ; vs the higher-dose PEI group , P = .023 ) . The cancer-free survival rate was highest in the RF group ( vs the conventional PEI group , P = .019 ; vs the higher-dose PEI group , P = .024 ) . Multivariate analysis determined that tumor size , tumor differentiation , and the method of treatment ( RF vs both methods of PEI ) were significant factors in relation to local tumor progression , overall survival , and cancer-free survival . CONCLUSIONS The results show that RF ablation yielded better clinical outcomes than conventional and higher-dose PEI in treating HCC 4 cm or less AIM To compare 5-year survival of patients with a single hepatocellular carcinoma≤3 cm r and omly assigned to receive  percutaneous ethanol injection or radiofrequency ablation . PATIENTS AND METHODS A total of 285 patients ( 192 males , mean age 70 years ) , with a single hepatocellular carcinoma ( mean diameter 2.2 cm ) were r and omly assigned to receive percutaneous ethanol injection ( n=143 ) or radiofrequency ablation ( n=142 ) . The primary endpoint of the study was 5-year survival . RESULTS Overall 143 patients underwent percutaneous ethanol injection and 128 radiofrequency ablation . In consideration of segmental location , in fact , 14 patients with 14 hepatocellular carcinomas could not be treated with established radiofrequency and were treated with percutaneous ethanol injection ; these patients were not included in the survival evaluation . In the percutaneous ethanol injection and in the radiofrequency ablation groups , 3- and 5-year survival rates of 74 % and 68 % , and 78 % and 68 % , and 79 % and 70 % [ corrected ] respectively , were observed ( p = n.s ) . In the percutaneous ethanol injection group , 3- and 5-year local recurrence rates were 9.4 % and 12.8 % respectively ; in the radiofrequency group , the 3 and 5 years local recurrence rates were 7.8 % and 11.7 % , respectively ( p = n.s . ) . The overall costs  of percutaneous ethanol injection and radiofrequency ablation were 1359 Euros and 171.000 Euros , respectively ( p<0.0001 ) CONCLUSION Percutaneous ethanol injection and radiofrequency ablation conferred similar 5-year survival . Feasibility is not the same for both procedures . Percutaneous ethanol injection is much cheaper than radiofrequency ablation and should be considered whether in poor and rich countries BACKGROUND Ninety percent of patients with hepatocellular carcinoma ( HCC ) have cirrhosis . Bleeding esophageal varices ( BEV ) is a frequent complication of cirrhosis . Detection of HCC in cirrhotic patients with BEV has not been studied . METHODS Two hundred eleven unselected patients with cirrhosis and BEV were r and omized to endoscopic sclerotherapy ( n = 106 ) or emergency portacaval shunt ( n = 105 ) . Diagnostic workup and treatment were initiated within 8 hours . Ninety-six percent had > 10 years of follow-up . HCC screening involved serum α-fetoprotein ( AFP ) every 3 months , ultrasonography every 6 months , and selective computed tomography ( CT ) . RESULTS  HCC occurred in 15 patients , all incurable , a mean of 2.94 years after entry . They died a mean 1.33 years after discovery . Serial AFP and ultrasound examinations were unrevealing over a mean of 2.3 years . The mean model of end-stage liver disease score was 12.7 at entry and 17.4 at HCC diagnosis . CONCLUSIONS Long-term screening by AFP and ultrasound plus selective CT failed to detect HCC at a curable stage . The detection of HCC in cirrhotic patients with BEV remains a serious , unsolved problem . The use of CT for routine screening warrants consideration despite increased costs Objective . To compare percutaneous ethanol injection ( PEI ) , the st and ard approach which has been used for many years to treat early non-surgical hepatocellular carcinoma ( HCC ) in cirrhotic patients , and radiofrequency ablation ( RFA ) , which has become an interesting alternative . Material and methods . A r and omized trial was carried out on 139 cirrhotic patients in Child-Pugh classes A/B with 1–3 nodes of HCC ( diameter 15–30 mm ) , for a total of 177 lesions . Patients were r and omized to receive RFA ( n=70 ) or PEI ( n=69 ) . The primary end-point was complete response ( CR ) 1 year after the percutaneous ablation of all HCC nodes identified at baseline . Secondary end-points were : early ( 30–50 days ) CR , complications , survival and costs . Results . In an intention-to-treat analysis , 1-year CR was achieved in 46/70 ( 65.7 % ) and in 25/69 ( 36.2 % ) patients treated by RFA and PEI , respectively ( p=0.0005 ) . For lesions > 20 mm in diameter , there was a larger CR rate in the RFA group ( 68.1 % versus 26.3 % ) . An early CR was obtained in 67/70 ( 95.7 % ) patients treated by RFA compared with 42/64 ( 65.6 % ) patients treated by PEI ( p=0.0001 ) . Complications occurred in 10 and 12 patients treated by RFA and PEI , respectively . The overall survival rate was not significantly different in the RFA versus PEI arm ( adjusted hazard ratio=0.88 , 95 % CI : 0.50–1.53 ) . There was an incremental health-care cost of 8286 € for each additional patient successfully treated by RFA . Conclusions . The 1-year CR rate after percutaneous treatment of early HCC was significantly better with RFA than with PEI but did not provide a clear survival advantage in cirrhotic patients PURPOSE To compare the effectiveness of radio-frequency ( RF ) thermal ablation with that of percutaneous ethanol injection ( PEI ) for the treatment of small hepatocellular carcinoma ( HCC 
    Output:
    
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 .
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 Child-Pugh A liver function