Percutaneous microwave ablationvsradiofrequency ablation in the treatment of hepatocellular carcinoma

Abstract

Hepatocellular cancer ranks fifth among cancers and is related to chronic viral hepatitis, alcohol abuse, steatohepatitis and liver autoimmunity. Surgical resection and orthotopic liver transplantation have curative potential, but fewer than 20% of patients are suitable candidates. Interventional treatments are offered to the vast majority of patients. Radiofrequency (RFA) and microwave ablation (MWA) are among the therapeutic modalities, with similar indications which include the presence of up to three lesions, smaller than 3 cm in size, and the absence of extrahepatic disease. The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent (approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival.

Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article

“…Thus, MWA might be advantageous due to reduced ablation times and the lower cooling effect of neighboring vessels. For patients the reduced pain due to the shorter ablation time is considered advantageous [16].…”

“…Although resection can be performed in some of these patients with advanced liver disease, the mortality is higher and liver transplantation or ablation could be more beneficial. Although recommendations of BCLC and the guidelines of the American Association of the Study of the Liver Disease (AASLD) refer only to RFA, studies have proved that MWA has comparable local control rates and similar survival rates to RFA [16].…”

Thermoablatiós lehetőségek a benignus térfoglaló képletek gyógyításában

“…Hasonlóságai mellett (úgy-mint az ablatio sikeressége, hosszú távú túlélés, alacsony szövődményráta) ennek az eljárásnak előnyei is vannak az RFA-val szemben. Mivel a kezelt szövet kiszáradása és szenesedése kevésbé befolyásolja a kezelés hatékonysá-gát, valamint az erek hűtőhatása kevésbé érvényesül a laesiók kezelésekor, ezért az MWT az RFA-hoz viszonyítva gyorsabban kivitelezhető [5].…”

Combined Sorafenib and Yttrium-90 Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma

“…Curative treatments, including liver transplantation and liver resection, carry a 5-year survival of 50% -75%, but can be used in only 30% -40% of the cases in Europe and United States 7,8 . In patients for whom resection or transplantation is not readily feasible, locoregional treatments are offered: radiofrequency, cryo-, percutaneous alcohol injection, or microwave ablation 9,10 and bland embolization, radioembolization, or transarterial chemoembolization, which might be conventional or might use drug-eluting beads 11,12 .…”