Factors Associated with Tumor Progression After Percutaneous Ablation of Hepatocellular Carcinoma: Comparison Between Monopolar Radiofrequency and Microwaves. Results of a Propensity Score Matching Analysis

Bouda, Damien; Barrau, Vincent; Raynaud, Lucas; Burgio, Marco Dioguardi; Paulatto, Luisa; Roche, Vincent; Sibert, Annie; Moussa, Nadia; Vilgrain, Valérie; Ronot, Maxime

doi:10.1007/s00270-020-02549-8

Cited by 10 publications

(8 citation statements)

References 84 publications

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“…Potretzke et al found a 2-fold increased risk of long-term progression after RFA with respect to MWA: HCC greater than 3 cm in diameter showed the greatest difference in progression risk between MWA and RFA [ 14 ]. A recent study published by Bouda et al found a higher efficacy of MWA compared to RFA ablation in 149 patients with naive HCC at very early or early stage in terms of local tumor progression, but they did not evaluate overall survival [ 15 ]. On the other hand, the study of McDevitt et al showed no difference in the risk of primary failure or local progression between RFA and MWA in 136 patients.…”

Section: Discussionmentioning

confidence: 99%

Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma

et al. 2021

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Background: Contrasting data are available in the literature regarding the superiority of percutaneous microwave ablation (MWA) or radiofrequency ablation (RFA) in very early or early (BCLA 0 or A) hepatocellular carcinoma (HCC). Aims: The primary outcome was to compare the efficacy of RFA and MWA in achieving complete response in cirrhotic patients with early and very early HCC. The secondary outcomes were to evaluate the overall survival and the recurrence rate. Methods: A retrospective, observational, single-center study was performed. Inclusion criteria were liver cirrhosis, new diagnosis of a single node of HCC measuring a maximum of 50 mm or up to three nodules with diameter up to 35 mm, treatment with RFA or MWA. Radiological response was evaluated with multiphasic contrast-enhanced Computed Tomography or Magnetic Resonance Imaging at 5–7 weeks after thermal ablation. Complete response was defined when no vital tissue was detected after treatment. Results: Overall, 251 HCC patients were included in this study; 81 patients were treated with MWA and 170 with RFA. The complete response rate was similar in MWA and RFA groups (out of 331 nodules, 87.5% (91/104) were treated with MWA and 84.2% (186/221) were treated with RFA, p = 0.504). Interestingly, a subanalysis demonstrated that for 21–35 mm nodules, the probability to achieve a complete response using MWA was almost 5 times higher than for RFA (OR = 4.88, 95% CI 1.37–17.31, p = 0.014). Moreover, recurrence rate in 21–35 mm nodules was higher with RFA with respect to MWA (31.9% versus 13.5%, p = 0.019). Overall survival was 80.4% (45/56) when treated with MWA and 62.2% (56/90) when treated with RFA (p = 0.027). No significant difference was observed between MWA and RFA treatment in the 15–20 mm nodules group. Conclusion: This study showed that MWA is more efficient than RFA in achieving complete response in HCC nodules with 21 to 35 mm diameter.

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Section: Discussionmentioning

confidence: 99%

Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma

et al. 2021

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“…Percutaneous minimally-invasive locoregional treatment of HCC includes transarterial chemoembolization (TACE), transarterial radioembolization (TARE), radiofrequency (RFA), or microwave (MWA) ablation (thermal ablation), as well as cryoablation [ 194 , 195 , 196 , 197 , 198 , 199 , 200 ]. Among these, thermal ablation and TACE are the most widely adopted [ 200 ].…”

Section: Imaging Assessment Of Hcc Following Percutaneous Locoregiona...mentioning

confidence: 99%

Current Imaging Diagnosis of Hepatocellular Carcinoma

Chartampilas

Rafailidis

Georgopoulou

et al. 2022

Cancers

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Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer related death worldwide. Radiology has traditionally played a central role in HCC management, ranging from screening of high-risk patients to non-invasive diagnosis, as well as the evaluation of treatment response and post-treatment follow-up. From liver ultrasonography with or without contrast to dynamic multiple phased CT and dynamic MRI with diffusion protocols, great progress has been achieved in the last decade. Throughout the last few years, pathological, biological, genetic, and immune-chemical analyses have revealed several tumoral subtypes with diverse biological behavior, highlighting the need for the re-evaluation of established radiological methods. Considering these changes, novel methods that provide functional and quantitative parameters in addition to morphological information are increasingly incorporated into modern diagnostic protocols for HCC. In this way, differential diagnosis became even more challenging throughout the last few years. Use of liver specific contrast agents, as well as CT/MRI perfusion techniques, seem to not only allow earlier detection and more accurate characterization of HCC lesions, but also make it possible to predict response to treatment and survival. Nevertheless, several limitations and technical considerations still exist. This review will describe and discuss all these imaging modalities and their advances in the imaging of HCC lesions in cirrhotic and non-cirrhotic livers. Sensitivity and specificity rates, method limitations, and technical considerations will be discussed.

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“…The authors concluded that the percentage of local tumor progression (LTP) was lower after MW in comparison to RF independently from tumor dimension and the vicinity to vascular structures, and RF ablation was identified as an independent predictor for LTP, even in lesions up to 30 mm. [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Microwave Ablation of Very-Early- and Early-Stage HCC: Efficacy Evaluation by Correlation with Histology after Liver Transplantation

Crocetti

Scalise

Bozzi

et al. 2021

Cancers

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Microwave (MW) ablation is a worldwide-diffused technique for the percutaneous ablation of hepatocellular carcinoma (HCC). Nevertheless, the efficacy of this technique still needs to be confirmed in pathological specimens. The purpose of this study was to evaluate the efficacy of MW ablation by correlation with histology in excised liver samples at the time of liver transplantation (LT). All patients with MW-ablated HCC who subsequently underwent LT between 2012 and 2020 were retrospectively evaluated. In the explanted livers, the treated lesions were evaluated at pathology, and the necrosis was classified as complete or partial. Thirty-six HCCs were ablated in 30 patients (20.9 ± 6.1 mm, a range of 10–30 mm). Ablations were performed with a single insertion of a MW antenna under ultrasound or CT guidance. A complete radiological response was demonstrated in 30/36 nodules (83.3%) in 24/30 patients (80%) at imaging performed one-month after MW ablation. At pathology, of the 36 treated nodules, 28 (77.8%) showed a complete necrosis, and 8 (22.2%) showed a pathological partial necrosis. Good agreement was found between the imaging performed one-month after treatment and the complete pathological response (Cohen’s k = 0.65). The imaging accuracy in detecting a complete response to treatment was 88.9%. All lesions with complete necrosis did not show recurrence at follow-up imaging until transplantation. The rad-path correlation in the explanted livers showed that MW ablation achieved a high rate of complete necrosis if a macroscopical complete ablation was obtained.

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Factors Associated with Tumor Progression After Percutaneous Ablation of Hepatocellular Carcinoma: Comparison Between Monopolar Radiofrequency and Microwaves. Results of a Propensity Score Matching Analysis

Cited by 10 publications

References 84 publications

Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma

Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma

Current Imaging Diagnosis of Hepatocellular Carcinoma

Microwave Ablation of Very-Early- and Early-Stage HCC: Efficacy Evaluation by Correlation with Histology after Liver Transplantation

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