Prospective double-blinded randomized controlled trial of Microwave versus RadioFrequency Ablation for hepatocellular carcinoma (McRFA trial)

Abstract

Background: Microwave (MWA) and radiofrequency ablation are the commonly used local ablation for hepatocellular carcinoma (HCC). Studies comparing both techniques are scarce. The aim of this study was to compare the efficacy of MWA versus RFA as a treatment for HCC.Methods: Patients with HCC who were suitable for local ablation were randomized into MWA or RFA. All patients were followed up regularly with contrast-enhanced computed tomography (CT) performed at 1, 3, 6 and 12 months after ablation. Both patients and the radiologists who interpreted the postprocedure CT scans were blinded to the treatment allocation. Treatment-related morbidity, overall and disease-free survivals were analyzed.Results: A total of 93 patients were recruited. Among them, 47 and 46 patients were randomized to MWA and RFA respectively. Patients in two groups were comparable in baseline demographics and tumor characteristics. With a median follow-up of around 30 months, there were no significant difference in the treatment-related morbidity, overall and disease-free survivals. MWA had a significantly shorter overall ablation time when compared with RFA (12 min vs 24 min, p < 0.001).Conclusions: MWA is no different to RFA with respect to completeness of ablation and survivals. It is, however, as safe and effective as RFA in treating small HCC.

Radiofrequency ablation versus microwave ablation for early stage hepatocellular carcinoma

“…Two studies assessed ablation time. [ 26 , 29 ] The median ablation time was shorter in the MWA group (12 minutes) compared with the RFA group (29 minutes) (WMD = –15.674, 95% CI = –17.187 to –14.161, I 2 = 6.5%, P < .001).…”

“…Theoretically, multipolar needles could provide a larger ablation range than monopolar needles and result in a shorter ablation time. [ 26 ] However, due to the small number of samples that compare the efficacy of multipolar needles among studies, further investigations are still needed to compare different ablations using different needles. In our meta-analysis, we found that the proportion of patients under local anesthesia was greater in the WMA group compared with the RFA group.…”

New advances in the diagnosis and management of hepatocellular carcinoma

“…Many treatment modalities are available for the local ablation of hepatocellular carcinoma with generally similar outcomes. [82][83][84][85][86] Radiofrequency ablation and microwave ablation are the most commonly used ablation treatments. A recent, multicenter, single blinded, phase II randomized controlled trial enrolled 76 patients for radiofrequency ablation and 76 patients for microwave ablation; patients each had a maximum of three hepatocellular carcinoma lesions of up to 4 cm each.…”

“…84 However, another randomized trial of 93 patients with hepatocellular carcinoma receiving microwave ablation or radiofrequency ablation showed no difference in treatment related morbidity, overall survival, or disease free survival, although procedure time was shorter with microwave ablation. 85 Percutaneous ethanol ablation induces tumor cell death via intracellular dehydration and activation of coagulation cascades. Local tumor control is not as effective as other local ablation modalities.…”

Microwave ablation in the treatment of liver tumors. A better tool or simply more power?

“…However, it must be emphasized that the majority of the initial studies were retrospective in nature and on small cohorts. Until now, only 5 randomized control (RCT) studies were published showing no difference between MWA and RFA for small HCC [46][47][48][49][50] (Table II). Consequently, two metanalysis found no major differences between the two ablation techniques [51][52].…”