Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

Background: Microwave ablation (MWA) has several advantages over radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). We aimed to compare the efficacy and safety of MWA with those of RFA for HCC from the perspectives of percutaneous and laparoscopic approaches. Methods: PubMed/MEDLINE, Embase, the Cochrane library, and China Biology Medicine databases were searched. Studies comparing the efficacy and safety of MWA with those of RFA in patients with HCC were considered eligible. Complete ablation (CA), local recurrence (LR), disease-free survival (DFS), overall survival (OS), and the major complication rate were compared between MWA and RFA. Results: Four randomized controlled trials and 10 cohort studies were included. For percutaneous ablation, no significant difference was found between MWA and RFA regarding CA, LR, DFS, OS, and the major complication rate. A subgroup analysis of tumors measuring !3 cm revealed no difference in CA and LR for percutaneous ablation. For laparoscopic ablation, a significantly lower LR rate and a non-significant trend toward a higher major complication rate were observed for the MWA group (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.16-4.02, p ¼ .01 for LR; OR 0.21, 95% CI 0.04-1.03, p ¼ .05 for major complication rate). CA, DFS, and OS were similar between the two groups. Conclusions: Percutaneous (P)-MWA had similar therapeutic effects compared with P-RFA for HCC. Patients undergoing laparoscopic MWA had a lower LR rate; however, their major complication rate appeared to be higher. The superiority of MWA over RFA remains unclear and needs to be confirmed by high-quality evidence.

About the Interstitial Microwave Cancer Ablation: Principles, Advantages and Challenges

“…Microwave ablation has many advantages over the other ablation techniques, in particular RFA [35]- [38]. Advantages of MWA can be summarized in the following points [8], [11], [39], [40]:…”

Pilot in vivo studies on transcutaneous boiling histotripsy in porcine liver and kidney

“…With recent imaging advances leading to early diagnosis, an increasing number of patients now present with early-stage disease 2 . For patients with small localized tumors, minimally invasive focal therapies such as radiofrequency ablation 3,4 , cryotherapy 5,6 , and microwave ablation 7,8 have been used as an alternative to surgical approaches.…”

Heating technology for malignant tumors: a review

“…This concept has been further explored to develop a probe for transurethral treatment of prostate cancer allowing full or focal gland ablation under MR-guidance [247]. The imaging [154,155,189,193,214] LI: Liver [50,70,82,83,101,145,146,159,163,193,196,[215][216][217][218][219] LU: Lung [87,88,99,114,138,144,157,169,190] PA: [86,93,95,137,158,185,[193][194][195] [150][151][152][153]191] Open circles represent explorative (small/few phase I/II) use and solid black circles represent many/large phase I/II trials, retrospective analyses or phase III evidence.…”

“…RFA and MWA are both widely used to ablate thoracic and gastrointenstinal tumors, e.g., liver [142,145,146,263], lung [142,[147][148][149], thyroid [150][151][152][153], kidney [154,155], breast [156], esophagus [144,157] and pancreas [158]. MWA is deemed capable of creating larger and more spherical ablation zones than RFA and thus clinical results of MWA are comparable to RFA for smaller lesions, but may be better for larger lesions [145,146]. A randomized controlled trial involving 76 patients with hepatocellular carcinoma treated with RFA and 76 patients treated with MWA showed that at 2 years 6/98 lesions (6%) had local tumor progression in the MWA arm, versus 12/104 (12%) in the RFA arm (p ¼ 0.27) [159].…”