***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: This document , on the diagnosis and treatment of patients with hepatocellular carcinoma ( HCC ) , was commissioned by the British Society of Gastroenterology as part of a wider initiative to develop guidelines for clinicians in several areas of clinical practice . Cancer care has been the subject of increased scrutiny , with the development of care guidelines forming a major part of the strategy to reduce cancer related mortality in the UK . There is a strong suggestion that HCC is a disease which will be seen more frequently over the next few years , mainly as a result of the hepatitis C virus ( HCV ) epidemic . Previously , HCC has been a relatively rare tumour in the UK and much of the data pertaining to its diagnosis and therapy are derived from studies outside of the UK . Because of the lack of screening programmes and the fact that a significant proportion of HCC presents as symptomatic disease in individuals not known to have liver disease , most non-surgical therapies have been used in patients with advanced disease . There are a significant number of variables known to influence prognosis , with stage of underlying liver disease and tumour size at presentation being the most important . Controlling for these variables is difficult and these factors have contributed to a dearth of r and omised controlled trials of treatment for this tumour . There is however a substantial amount of evidence available which can form the basis of a framework for diagnosis and management . Guidelines are not rigid protocol s and they should not be construed as interfering with local clinical judgement . Hence they do not represent a directive of proscribed routes but a basis on which clinicians can consider the options available more clearly . These guidelines cover two areas of clinical practice relating to HCC : firstly , its diagnosis , including surveillance of high risk individuals ; and Abstract Background Hepatocellular carcinoma ( HCC ) is a primary tumor of the liver with poor prognosis . For early stage HCC , treatment options include surgical resection , liver transplantation , and percutaneous ablation . Percutaneous ablative techniques ( radiofrequency and microwave techniques ) emerged as best therapeutic options for nonsurgical patients . Aims We aim ed to determine the safety and efficacy of radiofrequency and microwave procedures for ablation of early stage HCC lesions and prospect ively follow up our patients for survival analysis . Patients and methods One Hundred and 11 patients with early HCC are managed in our multidisciplinary clinic using either radiofrequency or microwave ablation . Patients are assessed for efficacy and safety . Complete ablation rate , local recurrence , and overall survival analysis are compared between both procedures . Results Radiofrequency ablation group ( n = 45 ) and microwave ablation group ( n = 66 ) were nearly comparable as regards the tumor and patients characteristics . Complete ablation was achieved in 94.2 and 96.1 % of patients managed by radiofrequency and microwave ablation techniques , respectively ( p value 0.6 ) with a low rate of minor complications ( 11.1 and 3.2 , respectively ) including subcapsular hematoma , thigh burn , abdominal wall skin burn , and pleural effusion . Ablation rates did not differ between ablated lesions ≤3 and 3–5 cm . A lower incidence of local recurrence was observed in microwave group ( 3.9 vs. 13.5 % in radiofrequency group , p value 0.04 ) . No difference between both groups as regards de novo lesions , portal vein thrombosis , and abdominal lymphadenopathy . The overall actuarial probability of survival was 91.6 % at 1 year and 86.1 % at 2 years with a higher survival rates noticed in microwave group but still without significant difference ( p value 0.49 ) . Conclusion Radiofrequency and microwave ablations led to safe and equivalent ablation and survival rates ( with superiority for microwave ablation as regards the incidence of local recurrence ) 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 BACKGROUND The majority of patients with primary or metastatic malignancies confined to the liver are not c and i date s for resection because of tumor size , location , multifocality , or inadequate functional hepatic reserve . Cryoablation has become a common treatment in select groups of these patients with unresectable liver tumors . However , hepatic cryoablation is associated with significant morbidity . Radiofrequency ablation ( RFA ) is a technique that destroys liver tumors in situ by localized application of heat to produce coagulative necrosis . In this study , we compared the complication and early local recurrence rates in patients with unresectable malignant liver tumors treated with either cryoablation or RFA . PATIENTS AND METHODS Patients with hepatic malignancies were entered into two consecutive prospect i ve , nonr and omized trials . The liver tumors were treated intraoperatively with cryoablation or RFA ; intraoperative ultrasonography was used to guide placement of cryoprobes or RFA needles . All patients were followed up postoperatively to assess complications , treatment response , and local recurrence of malignant disease . RESULTS Cryoablation was performed on 88 tumors in 54 patients , and RFA was used to treat 138 tumors in 92 patients . Treatment-related complications , including 1 postoperative death , occurred in 22 of the 54 patients treated with cryoablation ( 40.7 % complication rate ) . In contrast , there were no treatment-related deaths and only 3 complications after RFA ( 3.3 % complication rate , P<0.001 ) . With a median follow-up of 15 months in both patient groups , tumor has recurred in 3 of 138 lesions treated with RFA ( 2.2 % ) , versus 12 of 88 tumors treated with cryoablation ( 13.6 % , P<0.01 ) . CONCLUSIONS RFA is a safe , well-tolerated treatment for patients with unresectable hepatic malignancies . This study indicates that ( 1 ) complications occur much less frequently following RFA of liver tumors compared with cryoablation of liver tumors , and ( 2 ) early local tumor recurrence is infrequent following RFA HYPOTHESIS The complication and success rates in patients treated with either percutaneous cryosurgery ( PCS ) or percutaneous radiofrequency ( PRF ) for unresectable hepatic malignancies are similar . DESIGN Retrospective study . SETTING University hospital . PATIENTS AND METHODS Sixty-four patients were treated with either PCS  ( n = 31 ) or PRF ( n = 33 ) . Patient treatment was based on the r and om availability of the probes . Tumors were evaluated by a blinded comparison of pretreatment and posttreatment helical computed tomographic scans . All living patients had at least a 6-month follow-up . MAIN OUTCOME MEASURES Complication rate , initial treatment success ( complete devascularization of the tumor ) , and local recurrence ( tumor revascularization within or at its periphery ) . RESULTS The distribution of tumor types was similar in the 2 groups ( P = .76 ) . One patient with cirrhosis died of variceal hemorrhage on day 30 after PCS ( mortality , 3.2 % ) , while no mortality was observed after PRF ( P = .48 ) . Complications occurred in 9 ( 29 % ) of the patients following PCS and in 8 ( 24 % ) of the patients following PRF ( P = .66 ) . Initial treatment success was comparable in the 2 treatment groups ( 30 [ 83 % ] of 36 tumors following PCS vs 34 [ 83 % ] of 41 tumors following PRF ) . However , local recurrences occurred more frequently after PCS than after PRF ( 16 [ 53 % ] of 30 vs 6 [ 18 % ] of 34 ; P = .003 ) . The higher rate of local recurrence was identified for metastases ( 10 [ 71 % ] of 14 after PCS vs 3 [ 19 % ] of 16 after PRF ; P = .004 ) , while the difference was not significant for hepatocellular carcinoma ( 6 [ 38 % ] of 16 after PCS vs 3 [ 17 % ] of 18 after PRF ; P = .25 ) . Multivariate analysis demonstrated that the use of PCS ( P = .003 ) and more than 1 treatment ( P = .05 ) were independent risk factors for local tumor recurrence . CONCLUSION While similar initial treatment success and complication rates are observed following either PCS or PRF , local recurrences occur more frequently following PCS , particularly for metastases PURPOSE To compare the safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis . MATERIAL S AND METHODS This retrospective HIPAA-compliant study received institutional review board approval . Forty-two adult patients with cirrhosis underwent image-guided percutaneous ablation of hepatocellular carcinoma from 2003 to 2011 . Twenty-five patients underwent 33 cryoablation procedures to treat 39 tumors , and 22 underwent 30 radiofrequency ablation procedures to treat 39 tumors . Five patients underwent both cryoablation and radiofrequency ablation procedures . Complication rates and severity per procedure were compared between the ablation groups . Potential confounding patient , procedure , and tumor-related variables were also compared . Statistical analyses included Kruskal-Wallis , Wilcoxon rank sum , and Fisher 's exact tests . Two-sided P-values < 0.05 were considered significant . RESULTS The overall complication rates , 13 ( 39.4 % ) of 33 cryoablation procedures versus eight ( 26.7 % ) of 30 radiofrequency ablation procedures and severe/fatal complication rates , two ( 6.1 % ) of 33 cryoablation procedures versus one ( 3.3 % ) of 30 radiofrequency ablation procedures , were not significantly different between the ablation groups ( both P=0.26 ) . Severe complications included pneumothoraces requiring chest tube insertion during two cryoablation procedures . One death occurred within 90 days of a radiofrequency ablation procedure ; all other complications were managed successfully . CONCLUSION No significant difference was seen in the overall safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis 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 
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Conclusions Compared with RFA , identical effects were found in MWA and CRA groups .
Fewer complications were observed in PEI and LSA group .
PEI plus RFA appeared more effective , with a higher rate of complications .