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

Abstract

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.

Local control of hepatocellular carcinoma and colorectal liver metastases after surgical microwave ablation without concomitant hepatectomy

“…Studies concerning percutaneous MWA of HCC show a local recurrence rate between 9.9 and 19 % using CT or ultrasound guidance [18][19][20][21]. These results are better than our local recurrence rate per tumor of 29.7% in the present series.…”

TIGIT Blockade Exerts Synergistic Effects on Microwave Ablation Against Cancer

“…Studies have found that MWA provides several advantages over the other forms of thermal ablation. Specifically, MWA induces larger volumes of necrosis, achieves faster ablation rates, and results in greater sphericity of the necrotic area, which can ablate larger nodules ( 29 , 30 ). Therefore, we used MWA to treat mice with MC38 colon cancer and assessed the immune response.…”

Alkaline Phosphatase to Albumin Ratio: A Novel Prognostic Biomarker for Hepatocellular Carcinoma after Microwave Ablation as the Initial Treatment

“…In most studies, this diameter is 3cm. Whereas, in a study by Gaia S et al, it was reported that for HCC between 15-20 mm MWA was not signi cantly different in terms of complete response rate and overall survival, while MWA was superior to RFA for HCC between 21 and 35mm [10]. Additionally, the anatomical location of HCC may also affect the e ciency of locoregional ablation.…”