<p>Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis</p>

Abstract

Purpose Percutaneous ablation techniques, including microwave ablation (MWA) and radiofrequency ablation (RFA), have become important minimally invasive treatment options for liver cancer. This systematic review compared MWA with RFA for treatment of liver cancer. Methods The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for randomized and observational studies published from 2006 onwards. A random-effects model was used for meta-analyses and local tumor progression (LTP), technique efficacy, overall survival (OS), disease-free survival (DFS), intrahepatic de novo lesions (IDL), extrahepatic metastases (EHM), length of stay (LOS), and complications were analyzed. Subgroup and sensitivity analyses were also conducted. Results Of 1379 studies identified, 28 randomized and observational studies met inclusion criteria. The main analysis demonstrated that LTP was significantly reduced by 30% with MWA versus RFA (RR=0.70; P=0.02) (all studies) and by 45% with MWA versus RFA (RR=0.55; P=0.007) (randomized studies only). There were no significant differences between MWA and RFA for other efficacy and safety outcomes. Higher frequency (2450 MHz) and larger tumor size (≥2.5 cm) are amongst variables that may be associated with improved outcomes for MWA. Sensitivity analyses were generally congruent with the main results. Conclusion MWA is at least as safe and effective as RFA for treating liver cancer and demonstrated significantly reduced LTP rates. Future studies should assess time and costs associated with these two treatment modalities.

The Application of Laparoscopic B-Ultrasound Microwave Ablation Technology in Liver Metastasis of Colorectal Cancer

“…The microwave antenna can be directly buried in the liver lesions under the B-ultrasound location. This treatment scheme has been proved to be safe and effective [5]. In the study of microwave ablation of liver cancer, many scholars [6] have proved that ≤5 cm of liver cancer can achieve therapeutic effect in recent years.…”

The Contemporary Role of Resection and Ablation in Colorectal Cancer Liver Metastases

“…97 Furthermore, in a meta-analysis that compared RFA and MWA for the treatment of hepatocellular carcinoma and liver metastases, the risk of local tumor progression was lower across all studies (risk ratio [RR] ¼ 0.70; p ¼ 0.02) as well as for randomized studies only (RR ¼ 0.55; p ¼ 0.007). 98 However, some studies have demonstrated higher complication rates following MWA likely due to higher temperatures. In a study that included 122 patients with 199 unresectable CRLM that were perivascular or peribiliary in location, overall severe complication rates (18.8 vs. 7.9%; p ¼ 0.09) and biliary complication rates following peribiliary ablation (57 vs. 3%; p ¼ 0.002) were higher for MWA compared with RFA.…”

Radiofrequency ablation versus microwave ablation for early stage hepatocellular carcinoma

“…Some systematically reviews and meta-analyses were performed to evaluate the efficacy of RFA and MWA in the treatment of HCC. [ 15 – 17 ] However, some meta-analyses included not only the primary liver cancer but also liver metastasis in their studies, which may led to a heterogeneity in the long-term outcome considering that metastasis is not representative of early stage tumors. [ 15 ] In addition, some studies enrolled patients who simultaneously underwent other treatments, such as transarterial chemoembolization (TACE), which may also be regarded as an incurable method for HCC, and resulted in decreased long-term outcomes.…”

“…[ 15 – 17 ] However, some meta-analyses included not only the primary liver cancer but also liver metastasis in their studies, which may led to a heterogeneity in the long-term outcome considering that metastasis is not representative of early stage tumors. [ 15 ] In addition, some studies enrolled patients who simultaneously underwent other treatments, such as transarterial chemoembolization (TACE), which may also be regarded as an incurable method for HCC, and resulted in decreased long-term outcomes. [ 15 , 18 ] Moreover, most studies compared the survival outcome with living patients in each year, which may also represent a bias in assessing the impact of treatment due to lack of the “time-to-event” data.…”