Efficacy of microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma in patients with chronic liver disease: a randomised controlled phase 2 trial

Violi, Naïk Vietti; Durán, Rafael; Guiu, Boris; Cercueil, Jean‐Pierre; Aubé, Christophe; Digklia, Antonia; Pache, Isabelle; Deltenre, Pierre; Knebel, Jean-François; Denys, Alban

doi:10.1016/s2468-1253(18)30029-3

Cited by 240 publications

(150 citation statements)

References 30 publications

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“…Thus, RFA can be considered more indicated than MWA. Finally, a recent high level of evidence supports that RFA and MWA are probably clinically equivalent . Thus, our data are consistent with a safe clinical practice of patients with cirrhosis.…”

Section: Discussionsupporting

confidence: 89%

Assessment of Radiofrequency Ablation Efficacy for Hepatocellular Carcinoma by Histology and Pretransplant Radiology

Serra¹,

Cucchetti

Felicani

et al. 2019

Liver Transpl

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Radiofrequency ablation (RFA) represents a potentially curative option for early‐stage hepatocellular carcinoma (HCC). This study aims at evaluating the histologic response after RFA of small HCCs arising in cirrhosis. Data were reviewed from 78 patients with de novo HCCs who were treated with RFA and subsequently transplanted. The last radiological assessment before liver transplantation (LT) was used for comparison between modified Response Evaluation Criteria in Solid Tumors (mRECIST) and histological findings. A total of 125 de novo HCCs (median diameter, 20 mm) were treated with RFA only in 92 sessions. There were 98 nodules that did not show local recurrence during follow‐up (78.4%), and the remaining were retreated, except 1 because of subsequent LT. On explanted livers, complete pathological response (CPR) was observed in 61.6%, being 76.9% when <2 cm, 55.0% when 2‐3 cm, and 30.8% when >3 cm. Tumors near hepatic vessels had CPR in 50% of patients versus 69.3% for tumors distant from vessels (P = 0.039). Of the 125 HCCs, 114 had available radiological assessment within a median of 3 months before LT. Complete radiological response, according to mRECIST, was observed in 77.2% of nodules before LT. The Cohen κ was 0.48 (moderate agreement). The overall accuracy was 78.1%. A total of 18 complications were recorded with only 1 graded as major. In conclusion, RFA can provide high CPR for HCC, especially in smaller tumors distant from hepatic veins or portal branches. The agreement between mRECIST and histology is only moderate. Further refinements in radiological assessment are essential to accurately assess the true effectiveness of RFA.

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Section: Discussionsupporting

confidence: 89%

Assessment of Radiofrequency Ablation Efficacy for Hepatocellular Carcinoma by Histology and Pretransplant Radiology

Serra¹,

Cucchetti

Felicani

et al. 2019

Liver Transpl

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“…Besides, MWA is reported to induce lower risk of unintended injury for lesions abutting visceral organs [33]. However, recent randomized, controlled, phase 2 trial, comparing the efficacy and safety between RFA and MWA, demonstrated that microwave ablation was not superior to radiofrequency ablation in terms of procedure time, local tumor progression, frequency of complications, or overall survival [34]; and some researchers demonstrated that RFA could be considered for HCC lesions adjacent to visceral organs without compromising the efficacy of the procedure or increasing the frequency of complications [35]. It should be noted that the comparison between MWA and RFA for lymph node metastases has not been established yet.…”

Section: Discussionmentioning

confidence: 99%

Safety and technical feasibility of percutaneous ablation for lymph node metastases of hepatocellular carcinoma

Yuan

Xing

Zheng

et al. 2019

International Journal of Hyperthermia

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Purpose: This study aimed to assess the safety and technical feasibility of percutaneous ablation therapy for lymph node (LN) metastases of hepatocellular carcinoma (HCC). Material and Methods: A total of 31 consecutive HCC patients with LN metastases who were treated with ablation were included in this retrospective study. Percutaneous ablation was performed under local anesthesia and computed tomography-guidance. The primary endpoint was technique success; secondary endpoints were overall survival (OS), progression-free survival (PFS), and local progressionfree survival (LPFS). Survival curves were constructed using Kaplan-Meier method. Results: The median diameter of metastatic LNs was 30 mm (range, 10-77 mm). The 1-, 3-, and 5-year OS rates were 74.6%, 50.3%, and 50.3%, respectively. The 1-, 3-, and 5-year PFS rates were 24.7%, 0%, and not available for calculation (NA), respectively. The 1-, 3-, and 5-year LPFS rates were 78.7%, 69.9%, and 69.9%, respectively. The technique success and technical effectiveness rates were 100% and 64.5%, respectively. The technical effectiveness rates were 65.4% (17/26) and 60% (3/5) in abdominal LN metastases and distant LN metastases, respectively. Only one patient (1/31, 3.2%) had major complications (massive pleural effusion and severe pneumonia) related to ablation. Minor complications related to ablation included mild abdominal pain (10/31, 32.3%) and self-limiting hematoma (2/ 31, 6.5%). No ablation-related death occurred. Conclusion: Percutaneous ablation appears to be a safe and feasible method for treatment of metastatic LNs in patients with HCC.

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“…Microwave is a type of high-frequency electromagnetic wave that converts electromagnetic wave energy into MWA energy through a microwave emitter, causing intense movement of water molecules in the tissue to heat the tumor to 60 to 100 °C and resulting in cell coagulation necrosis. [ 11 , 12 ] In the past, MWA had been limited to small ablation ranges, long treatment times, and skin and soft tissue burns. However, recently, research on MWA has gradually developed, and the purpose is to obtain a larger area of tumor necrosis compared with RFA.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency ablation versus microwave ablation for early stage hepatocellular carcinoma

Han

Yong-sheng²,

Wang³

2020

Medicine

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Background: Several randomized control trials (RCTs) were conducted to compare microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) over the years. The purpose of this study was to compare the efficacy of RFA and MWA for early stage HCC. Methods: Studies were systematically searched on Emabse, Ovid Medline, PubMed, and Cochrane Library until March 20, 2020. Continuous variables and dichotomous variables were compared using weighted mean difference (WMD) and odds ratio (OR), respectively. For the comparison of overall survival (OS) and disease-free survival (DFS), the hazard ratio (HR) and 95% confidence interval (CI) were extracted from univariate analysis or survival plots. Results: A total of 26 studies (5 RCTs and 21 cohorts) with 4396 patients (2393 patients in RFA and 2003 patients in MWA) were included in our study. Of these patients, 47% received treatment under general anesthesia in the MWA group and 84% in the RFA group (OR = 0.529, P < .001). The median ablation time was reduced in the MWA group (12 minutes) compared with RFA group (29 minutes) (WMD = –15.674, P < .001). In total, 17.6% patients exhibited progression during follow-up in the MWA group compared with 19.5% in the RFA group (OR = 0.877, P = .225). No statistically significant differences were observed between MWA and RFA groups in terms of OS and DFS (HR = 0.891 and 1.014, P = .222 and .852, respectively). Conclusions: MWA exhibited similar therapeutic effects as RFA in the treatment of early stage HCC. Given the shorter ablation time, MWA can be performed under local anesthesia.

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Efficacy of microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma in patients with chronic liver disease: a randomised controlled phase 2 trial

Cited by 240 publications

References 30 publications

Assessment of Radiofrequency Ablation Efficacy for Hepatocellular Carcinoma by Histology and Pretransplant Radiology

Assessment of Radiofrequency Ablation Efficacy for Hepatocellular Carcinoma by Histology and Pretransplant Radiology

Safety and technical feasibility of percutaneous ablation for lymph node metastases of hepatocellular carcinoma

Radiofrequency ablation versus microwave ablation for early stage hepatocellular carcinoma

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