Microwave thermosphere versus radiofrequency ablation for hepatocellular carcinoma: Are we approaching the time to end the debate?

Abstract

Although microwave ablation (MWA) exhibits high thermal efficiency, the major limitations of conventional MWA systems are unpredictability of the ablation zone size and the elliptical shape of necrosis. Many studies have compared the efficacy of MWA to radiofrequency ablation (RFA), but most used conventional MWA before 2014. The Emprint™ Ablation System was approved for use by the Food and Drug Administration on April 28, 2014, and it can provide predictable ablation results and outcomes regardless of the target location or tissue type. The unique properties that allow Emprint Ablation to produce reliable large spherical zones of ablation rely on three types of energy control: (1) thermal, (2) field, and (3) wavelength. Few studies have compared Emprint™ Ablation System with Thermosphere™ Technology to RFA.Recently, Tamai et. al evaluated the safety and efficacy of new next-generation microwave thermosphere ablation (MTA) for small hepatocellular carcinoma (HCC) 1 . This retrospective study of 513 patients determined that MTA was superior to RFA, based on both the local tumor progression rate and overall survival rate at 3 years.

NEDD4 and NEDD4L: Ubiquitin Ligases Closely Related to Digestive Diseases

“…It was therefore hypothesized that NEDD4L is a potential prognostic biomarker and a therapeutic target for HCC [103]. Radiofrequency ablation (RFA), a thermal ablation technique, is one of the effective treatments for early-stage liver cancer [141,142]. However, patients treated with RFA may encounter a condition known as "insufficient ablation".…”

Chemoembolization combined with radiofrequency ablation is the best option for the local treatment of early hepatocellular carcinoma?

“…This study presents a valuable contribution to the field of hepatocellular carcinoma (HCC) treatment, addressing the ongoing debate surrounding the most effective nonsurgical approaches for early stage HCC [ 1 ]. The researchers conducted a network meta-analysis to compare the efficacy of various locoregional treatments, and their results elucidated the relative ranking of these interventions.…”

“…This study indicates that combined RFA and chemoembolization therapy is the most effective option for the local treatment of early HCC [ 1 ]; however, acknowledging the potential shortcomings and limitations associated with this treatment approach is essential.…”

“…Similarly, radiofrequency ablation is seldom performed in patients with tumors >3 cm at our institute. However, the inclusion criterion in this study was a tumor size of <5 cm [ 1 ]. Tumors 3–5 cm in size may benefit more from the combined therapy of ablation and chemoembolization [ 6 ].…”

“…Fourth, the combination of RFA and chemoembolization represents a complex treatment regimen that involves multiple interventions and requires expertise in both the techniques. This complexity may increase the risk of procedural complications and adverse events [ 13 ], although many studies have reported that combination treatment does not increase serious complications [ 1 , 14 ]. The study may have not fully addressed the safety profile and potential complications associated with this combined approach, thereby warranting further investigation to assess its risk–benefit ratio.…”