Microwave Ablation Versus Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials

Abstract

There are limited and discordant results on the comparison between microwave ablation (MWA) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). This meta-analysis aims to compare the two treatments in terms of efficacy and safety, based on a meta-analysis of randomized-controlled trials (RCTs). A computerized bibliographic search was performed on the main databases throughout August 2020. The primary outcome was the complete response rate, while survival rate (at 1-, 2-, 3-, and 5-year), disease-free survival rate (at 1-, 2-, 3-, and 5-year), local and distant recurrence rate, adverse event rate, and number of treatment sessions were the secondary outcomes. Seven RCTs enrolling 921 patients were included. No difference in terms of complete response between the two treatments was observed (risk ratio (RR) 1.01, 95% CI 0.99–1.02). Survival rates were constantly similar, with RRs ranging from 1.05 (0.96–1.15) at 1 year to 0.91 (0.81–1.03) at 5 years. While local recurrence rate was similar between MWA and RFA (RR 0.70, 0.43–1.14), distant recurrence rate was significantly lower with MWA (RR 0.60, 0.39–0.92). Disease-free survival at 1, 2, and 3 years was similar between the two groups with RR 1.00 (0.96–1.04), 0.94 (0.84–1.06), and 1.06 (0.93–1.21), respectively. On the other hand, RR for disease-free survival at 5 years was significantly in favor of MWA (3.66, 1.32–42.27). Adverse event rate was similar between the two treatments (RR 1.06, 0.48–2.34), with bleeding and hematoma representing the most frequent complications. Our results indicate a similar efficacy and safety profile between the two techniques. MWA seems to decrease the rate of long-term recurrences, but this finding needs to be confirmed in further trials.

Effect of Severity of Liver Cirrhosis on Surgical Outcomes of Hepatocellular Carcinoma After Liver Resection and Microwave Coagulation

“…Meanwhile, PMCT can overcome the "heat sink effect" which is an obvious disadvantage of RFA (32). A Meta-Analysis of randomized controlled trials indicated a similar efficacy and safety profile between PMCT and RFA, however, distant recurrence rate was significantly lower with PMCT (RR=0.60, 0.39-0.92) in comparison with RFA (8). In China, more than 80% of HCC patients are associated with varied degrees of liver cirrhosis (14).…”

“…Therefore, LR is still widely considered as the first option for the treatment of HCC patients without cirrhosis or Child-Pugh class A cirrhosis without portal hypertension (PH) (3,5). In recent years, local ablations (LA), such as percutaneous microwave coagulation therapy(PMCT) and radiofrequency ablation (RFA), have been recommended as the first-line therapeutic options for patients with early-stage HCC and PMCT seems to show some advantages over RFA regarding efficacy, including better tumor control for perivascular HCCs, and better necrosis rate for cirrhotic liver (6)(7)(8). LR may sacrifice additional normal liver tissue which is critical for those with advanced liver cirrhosis, and may lead to severe surgical complications, such as liver failure (9).…”

Current Management of Oligometastatic Lung Cancer and Future Perspectives: Results of Thermal Ablation as a Local Ablative Therapy

“…Subgroup analysis showed no difference in median OS between RFA (28.4 months) and MWA (24.4 months) groups. In liver, no difference was observed in terms of local efficacy between RFA and MWA, although long-term recurrence seemed lower with MWA [92].…”

Percutaneous thermal ablation versus open liver resection for recurrent hepatoblastoma: a retrospective study

“…Moreover, percutaneous TA treatment in this study included two methods: RFA and microwave ablation. However, many studies have indicated a similar efficacy and safety profile exists for these two techniques [27,28]. Finally, combination therapy has been a hot topic in recent years.…”