Efficacy and safety of single- and multiple-antenna microwave ablation for the treatment of hepatocellular carcinoma and liver metastases: A systematic review and network meta-analysis

Abstract

Background: There is a myriad of microwave ablation (MWA) systems used in clinical settings worldwide for the management of liver cancer that offer a variety of features and capabilities. However, an analysis on which features and capabilities result in the most favorable efficacy and safety results has never been completed due to a lack of head-to-head comparisons. The aim of this study is to compare single-antenna and multiple-antenna MWA using radiofrequency ablation (RFA) as a common comparator in the treatment of very-early, early hepatocellular carcinoma (HCC) and ≤5 cm liver metastases. Methods: This network meta-analysis was performed according to PRISMA guidelines. PubMed, Cochrane, and Web of Science databases were searched for comparative studies. Complete ablation (CA) rate, local tumor progression-free (LTPF) rate, overall survival (OS), and major complication rate were assessed. Subgroup analyses were further performed based on synchronous or asynchronous MWA generators and tumor size (<2 cm or ≥2 cm). Results: Twenty-one studies (3424 patients), including 3 randomized controlled trials (RCTs) and 18 observational studies, met eligibility criteria. For CA, LTPF and major complications, as compared to single-antenna MWA, multiple-antenna MWA had relative risks (RRs) of 1.051 (95% CI: 0.987–1.138), 1.099 (95% CI: 0.991–1.246), and 0.605 (95% CI: 0.193–1.628), respectively. For 1-year and 3-year OS, as compared to single-antenna MWA, multiple-antenna MWA had odds ratios (ORs) of 0.9803 (95% CI: 0.6772–1.449) and 1.046 (95% CI: 0.615–1.851), respectively. Subgroup analysis found synchronized multi-antenna MWA was associated with significantly better LTPF by 22% (RR: 1.22, 95% CI 1.068, 1.421), and 21.4% (RR: 1.214, 95% CI 1.035, 1.449) compared with single-antenna MWA, and asynchronous multiple-antenna MWA, respectively, with more evident differences in larger tumors (≥2 cm). Conclusion: Multi-antenna and single-antenna MWA showed similar effectiveness for local treatment of liver tumors, but synchronous multi-antenna MWA exhibited better LTPF compared to other MWA approaches, particularly for larger liver tumors (≥2 cm). Large-scale RCTs should be further conducted.

Thermal ablation of hepatocellular carcinoma

“…The possibility to obtain very large ablation zones (larger than 6 cm) by means of the triple‐antenna approach in association with reliable repositioning under CT guidance has also been reported 27 . A recently published meta‐analysis showed that multiple‐antenna MW ablation has the best results in terms of complete ablation rate at 1 month and local tumour progression‐free, 3‐year overall survival (OS), and major complications, and is the optimal technology for tumours ≥2 cm in diameter 28 . Simultaneous multiple‐antenna MW ablation is able to improve heat distribution, with higher temperatures reached peripherally, and reduce the occurrence of clefting, which often arises when repositioning a single antenna and leads to sunken tissue between two sequential ablation zones 28,29 .…”

“…27 A recently published metaanalysis showed that multiple-antenna MW ablation has the best results in terms of complete ablation rate at 1 month and local tumour progression-free, 3-year overall survival (OS), and major complications, and is the optimal technology for tumours ≥2 cm in diameter. 28 Simultaneous multiple-antenna MW ablation is able to improve heat distribution, with higher temperatures reached peripherally, and reduce the occurrence of clefting, which often arises when repositioning a single antenna and leads to sunken tissue between two sequential ablation zones. 28,29 These factors may contribute to lower rates of local tumour recurrence and increased treatment efficacy.…”

“…28 Simultaneous multiple-antenna MW ablation is able to improve heat distribution, with higher temperatures reached peripherally, and reduce the occurrence of clefting, which often arises when repositioning a single antenna and leads to sunken tissue between two sequential ablation zones. 28,29 These factors may contribute to lower rates of local tumour recurrence and increased treatment efficacy.…”

Construction of BaTiO3–TiO2 hollow sphere heterojunctions for enhanced microwave dynamic therapy in cancer treatment

“…[8][9][10] However, this procedure often leads to hyperthermia-induced side effects on important organs adjacent to the lesion undergoing ablation. [11][12][13] Therefore, it is necessary to explore and develop novel treatment technologies to address these challenges.…”