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Rey I, Darmadi D. Comparative Efficacy of Microwave versus Radiofrequency Ablation in Hepatocellular Carcinoma: Systematic Review and Meta-Analysis of Randomized-Controlled Trials. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 0:rjim-2024-0022. [PMID: 38905615 DOI: 10.2478/rjim-2024-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Indexed: 06/23/2024]
Abstract
Introduction: Hepatocellular carcinoma (HCC) is a leading global cause of cancer-related deaths. Thermal ablation techniques, especially radiofrequency ablation (RFA) and microwave ablation (MWA), have become pivotal treatments for HCC. This systematic review and meta-analysis aim to compare these modalities, highlighting their efficacy, strengths, and limitations in treating HCC. Methods: A comprehensive literature search was conducted across major databases (PubMed, MEDLINE, Springer, ProQuest, EBSCOhost, Cochrane, and EMBASE) targeting studies on hepatocellular carcinoma with RFA and MWA. Heterogeneity analyses and pooled outcomes using random-effect models with were evaluated to compare both thermal ablation methods. Results: Nine studies, which consists of 368 patients underwent RFA and 387 patients underwent MWA, were included in review. The findings showed no significant differences in pooled analysis of volume of ablation, complete ablation rate, local tumor progression, survival rates, major complications, and adverse events. Subgroup analysis showed significantly higher risk of local tumor progression in RFA in African populations. Conclusion: No statistically significant difference was seen between outcomes across studies. MWA may offer a potential for longer therapeutic response with comparable risk of complications and adverse outcomes.
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Affiliation(s)
- Imelda Rey
- 1Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Darmadi Darmadi
- 1Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Vogl TJ, Martin SS, Gruber-Rouh T, Booz C, Koch V, Nour-Eldin NEA, Hussainy Said MN. Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial. ROFO-FORTSCHR RONTG 2024; 196:482-490. [PMID: 38065541 DOI: 10.1055/a-2203-2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
PURPOSE To compare the therapeutic response and clinical outcome of CT-guided percutaneous microwave (MWA) and radiofrequency ablation (RFA) for the treatment of small- and medium-sized HCC. MATERIALS AND METHODS In this prospective trial, 50 patients with HCC were randomly assigned to MWA or RFA treatment. MRI was performed 24 h before and after ablation and subsequently in 3-month intervals. Ablation volumes, ablation durations, adverse events (AE), technique efficacy, technical success, local tumor progression (LTP), disease-free survival (DFS), intrahepatic distant recurrence (IDR), and overall survival (OS) rates were evaluated. RESULTS The mean ablation volume was 66.5 cm³ for MWA and 29.2 cm³ for RFA (p < 0.01). The mean ablation durations for MWA and RFA were 11.2 ± 4.0 min and 16.3 ± 4.7 min, respectively (p < 0.01). Six mild AEs were documented (p > 0.05). All treatments had a technical success rate and a technique efficacy rate of 100 % (50/50, p = 1.00). LTP within 2 years occurred in 1/25 (4 %) in the MWA group and in 4/25 (16 %) in the RFA group (p = 0.06). IDR within 2 years was 8/25 (32 %) for MWA and 14/25 (56 %) for RFA (p < 0.05). The median DFS was 24.5 months and 13.4 months for MWA and RFA, respectively (p = 0.02). The 1-, 2-, 3-year OS rates were 100 %, 80 %, 72 % in the MWA group and 72 %, 64 %, 60 % in the RFA group, respectively (p ≥ 0.14). CONCLUSION The clinical outcome after MWA or RFA for HCC treatment was very similar with no significant differences in LTP or OS. However, MWA shows a trend toward better DFS with fewer IDRs than RFA. KEY POINTS · MWA allows for larger ablation volumes and a shorter treatment duration compared to RFA in patients with HCC.. · MWA shows a trend toward better disease-free survival and fewer intrahepatic distant recurrences compared to RFA.. · The three-year survival rates show no significant difference between the two methods..
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Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University, Faculty of Medicine, Cairo, Egypt
| | - M N Hussainy Said
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
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Lu Y, Cen Y, He X, Mo X, Luo F, Zhong Y. Magnetic resonance imaging-based rim enhancement could effectually predict poor prognosis in hepatocellular carcinoma: a meta-analysis. Eur J Gastroenterol Hepatol 2024; 36:505-512. [PMID: 38555599 PMCID: PMC10965130 DOI: 10.1097/meg.0000000000002727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/06/2023] [Indexed: 04/02/2024]
Abstract
Recent studies have initially shown that MRI-based rim enhancement associates with poor prognosis in hepatocellular carcinoma (HCC) patients, but their sample sizes are small, leading to a necessary of comprehensive analyses to make a relatively solid statement. Thus, this meta-analysis aimed to summarize the correlation between MRI-based rim enhancement and prognosis in HCC patients. Until March 2023, a literature search was conducted on Web of Science, PubMed, EMBASE, Cochrane, CNKI, Wangfang, and CQVIP databases in order to identify studies that report the correlation between MRI-based rim enhancement and the prognosis of HCC patients. MRI-based rim enhancement and prognostic data were extracted and analyzed. In our study, eight studies containing 1816 HCC patients were analyzed. Generally, the presence of MRI-based rim enhancement was related to shortened disease-free survival (DFS) [hazard ratio (HR): 2.77, 95% confidence interval (CI): 2.11-3.62, P < 0.001], and worse overall survival (OS) (HR: 5.43, 95% CI: 2.14-13.79, P < 0.001). While no other prognostic data could be retrieved. Funnel plots, Begg's test, and Egger's test all indicated that no publication bias existed; and the risk score by Newcastle-Ottawa Scale criteria ranged from 7-9 points, suggesting a generally low risk of bias. Meanwhile, the sensitivity analysis showed that the significant findings did not change by omitting each study. Then, subgroup analyses revealed that no matter stratified by tumor size, treatment option, or sample size, rim enhancement was linked with unsatisfied DFS (all P < 0.05). Conclusively, MRI-based rim enhancement could effectually estimate poor survival in HCC patients, indicating its good prognostic value.
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Affiliation(s)
- Yumin Lu
- Department of Radiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Yongyi Cen
- Department of Radiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Xin He
- Department of Radiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaping Mo
- Department of Radiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Fang Luo
- Department of Radiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Yubao Zhong
- Department of Radiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
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Alhasan AS, Daqqaq TS, Alhasan MS, Ghunaim HA, Aboualkheir M. Complication Rates and Risk of Recurrence After Percutaneous Radiofrequency Ablation and Microwave Ablation for the Treatment of Liver Tumors: a Meta-analysis. Acad Radiol 2024; 31:1288-1301. [PMID: 38087720 DOI: 10.1016/j.acra.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 04/14/2024]
Abstract
RATIONALE AND OBJECTIVES The rate of complications and risk of local recurrence following percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for liver tumors varies significantly between investigations. This meta-analysis aimed to assess complication rates and risk of local recurrence after percutaneous RFA and MWA. MATERIALS AND METHODS PubMed, Medline, Web of Science, the Cochrane Library, Embase, Google Scholar, and CINAHL were systematically searched from database inception until August 2022 to retrieve articles reporting the complication rates and risk of recurrence after percutaneous RFA and MWA for the treatment of liver tumors. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated and displayed by forest plots. To measure heterogeneity, Cochran Q and I2 statistics were also applied. Egger's test and funnel plots were also performed to assess any potential publication bias. Additionally, subgroup analysis was done to investigate the source of heterogeneity. RESULTS 26 studies including 2026 and 1974 patients for RFA and MWA, respectively, were included. The rate of minor complications was significantly higher after MWA compared to RFA, yielding an overall OR of 0.688 (95% CI: 0.549-0.862, P = 0.001). Similarly, the rate of major complications was significantly higher after MWA than RFA (P = 0.012), yielding an overall OR of 0.639 (95% CI: 0.450-0.907). No significant difference was found between RFA and MWA in terms of local recurrence after ablation (P > 0.05). In addition, there was no statistical evidence of publication bias. CONCLUSION When most factors are considered equally, percutaneous RFA and MWA can be considered safe modalities for the treatment of liver tumors, with RFA superior in terms of the incidence of minor and major complications.
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Affiliation(s)
- Ayman S Alhasan
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.); Department of Radiology, King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia (A.S.A.).
| | - Tareef S Daqqaq
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Mustafa S Alhasan
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Hadeel A Ghunaim
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.); Department of Clinical Science /College of Medicine/Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia (M.A.)
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Wade R, South E, Anwer S, Sharif-Hurst S, Harden M, Fulbright H, Hodgson R, Dias S, Simmonds M, Rowe I, Thornton P, Eastwood A. Ablative and non-surgical therapies for early and very early hepatocellular carcinoma: a systematic review and network meta-analysis. Health Technol Assess 2023; 27:1-172. [PMID: 38149643 PMCID: PMC11017143 DOI: 10.3310/gk5221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background A wide range of ablative and non-surgical therapies are available for treating small hepatocellular carcinoma in patients with very early or early-stage disease and preserved liver function. Objective To review and compare the effectiveness of all current ablative and non-surgical therapies for patients with small hepatocellular carcinoma (≤ 3 cm). Design Systematic review and network meta-analysis. Data sources Nine databases (March 2021), two trial registries (April 2021) and reference lists of relevant systematic reviews. Review methods Eligible studies were randomised controlled trials of ablative and non-surgical therapies, versus any comparator, for small hepatocellular carcinoma. Randomised controlled trials were quality assessed using the Cochrane Risk of Bias 2 tool and mapped. The comparative effectiveness of therapies was assessed using network meta-analysis. A threshold analysis was used to identify which comparisons were sensitive to potential changes in the evidence. Where comparisons based on randomised controlled trial evidence were not robust or no randomised controlled trials were identified, a targeted systematic review of non-randomised, prospective comparative studies provided additional data for repeat network meta-analysis and threshold analysis. The feasibility of undertaking economic modelling was explored. A workshop with patients and clinicians was held to discuss the findings and identify key priorities for future research. Results Thirty-seven randomised controlled trials (with over 3700 relevant patients) were included in the review. The majority were conducted in China or Japan and most had a high risk of bias or some risk of bias concerns. The results of the network meta-analysis were uncertain for most comparisons. There was evidence that percutaneous ethanol injection is inferior to radiofrequency ablation for overall survival (hazard ratio 1.45, 95% credible interval 1.16 to 1.82), progression-free survival (hazard ratio 1.36, 95% credible interval 1.11 to 1.67), overall recurrence (relative risk 1.19, 95% credible interval 1.02 to 1.39) and local recurrence (relative risk 1.80, 95% credible interval 1.19 to 2.71). Percutaneous acid injection was also inferior to radiofrequency ablation for progression-free survival (hazard ratio 1.63, 95% credible interval 1.05 to 2.51). Threshold analysis showed that further evidence could plausibly change the result for some comparisons. Fourteen eligible non-randomised studies were identified (n ≥ 2316); twelve had a high risk of bias so were not included in updated network meta-analyses. Additional non-randomised data, made available by a clinical advisor, were also included (n = 303). There remained a high level of uncertainty in treatment rankings after the network meta-analyses were updated. However, the updated analyses suggested that microwave ablation and resection are superior to percutaneous ethanol injection and percutaneous acid injection for some outcomes. Further research on stereotactic ablative radiotherapy was recommended at the workshop, although it is only appropriate for certain patient subgroups, limiting opportunities for adequately powered trials. Limitations Many studies were small and of poor quality. No comparative studies were found for some therapies. Conclusions The existing evidence base has limitations; the uptake of specific ablative therapies in the United Kingdom appears to be based more on technological advancements and ease of use than strong evidence of clinical effectiveness. However, there is evidence that percutaneous ethanol injection and percutaneous acid injection are inferior to radiofrequency ablation, microwave ablation and resection. Study registration PROSPERO CRD42020221357. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme (NIHR award ref: NIHR131224) and is published in full in Health Technology Assessment; Vol. 27, No. 29. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ros Wade
- Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Emily South
- Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Sumayya Anwer
- Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Sahar Sharif-Hurst
- Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Melissa Harden
- Information Specialist, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Helen Fulbright
- Information Specialist, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Robert Hodgson
- Senior Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Sofia Dias
- Professor in Health Technology Assessment, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Mark Simmonds
- Senior Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Ian Rowe
- Honorary Consultant Hepatologist, Leeds Teaching Hospitals NHS Trust
| | | | - Alison Eastwood
- Professor of Research, Centre for Reviews and Dissemination, University of York, Heslington, UK
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Yang J, Liang S, Liu H, Hu C, Guan S, Kang H, Xu E, Yan R. Efficacy and Safety of Microwave Ablation Assisted by Ultrasound Fusion Imaging for Primary and Secondary Liver Cancers with a Diameter of 3-7 Cm. J Hepatocell Carcinoma 2023; 10:1839-1848. [PMID: 37873028 PMCID: PMC10590584 DOI: 10.2147/jhc.s424009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
Purpose To investigate the efficacy and safety of microwave ablation (MWA) assisted by ultrasound fusion imaging (FI) for primary and secondary liver cancers with a diameter of 3-7 cm. Patients and Methods A retrospective analysis was conducted on patients with primary and secondary liver cancers (3-7 cm) who underwent MWA with ultrasound FI assistance in our hospital from April 2020 to May 2022. Technical success, technique efficacy, local tumor progression (LTP), major complication, intrahepatic distant recurrence (IDR), and overall survival (OS) were assessed during the follow-up period. In addition, the ablation results of tumors between the medium-sized group (3.1-5.0 cm) and large-sized group (5.1-7.0 cm) were compared. Results 31 patients with 35 primary and secondary liver cancers were treated with MWA assisted by ultrasound FI. Complete ablation was achieved in 34 lesions with a technical success rate of 97.1%. Major complications occurred in 6.5% of patients (2/31), while no ablation-related deaths were reported. The median follow-up time of this study was 24 months (range:10 to 35 months). The technique efficacy rate was 97.1% (34/35), with LTP occurring in three lesions at a rate of 8.8% (3/34). The incidence of IDR was 38.7% (12/31) and the 2-year cumulative OS rate reached 96.7%. Moreover, there were no statistical differences in technique efficacy rate (p=0.286), LTP rate (p=0.328), major complication rate (p=0.503), IDR (p=0.857), and OS (p=0.118) between medium-sized group and large-sized group. Conclusion Ultrasound FI-assisted MWA has the potential to be an effective and safe therapeutic strategy for primary and secondary liver cancers ranging from 3-7 cm in size.
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Affiliation(s)
- Jing Yang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Shuang Liang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Huahui Liu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Cai Hu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Sainan Guan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Haiyu Kang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Ronghua Yan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, People’s Republic of China
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
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Kim HI, An J, Han S, Shim JH. Loco-regional therapies competing with radiofrequency ablation in potential indications for hepatocellular carcinoma: a network meta-analysis. Clin Mol Hepatol 2023; 29:1013-1028. [PMID: 37403319 PMCID: PMC10577337 DOI: 10.3350/cmh.2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND/AIMS There is no clear consensus on the relative ranking of interventional and radiation techniques with indications similar to those of radiofrequency ablation (RFA) for the treatment of early hepatocellular carcinoma (HCC). We used a network meta-analysis to compare the efficacy of non-surgical treatments for early HCC. METHODS We searched databases for randomized trials assessing the efficacy of loco-regional treatments for HCCs ≤5 cm with no extrahepatic spread or portal invasion. The primary outcome was the pooled hazard ratio (HR) for overall survival (OS), and secondary outcomes included overall and local progression-free survival (PFS). A frequentist network meta-analysis was performed, and the relative ranking of therapies was assessed with P-scores. RESULTS Nineteen studies comparing 11 different strategies in 2,793 patients were included. Chemoembolization plus RFA improved OS better than RFA alone (HR 0.52, 95% confidence interval [CI] 0.33-0.82; P-score=0.951). Cryoablation, microwave ablation, laser ablation, and proton beam therapy had similar effects on OS compared with RFA. For overall PFS, but not local PFS, only chemoembolization plus RFA performed significantly better than RFA (HR 0.61, 95% CI 0.42-0.88; P-score=0.964). Injection of percutaneous ethanol or acetic acid was significantly less effective than RFA for all measured outcomes, while no differences in progression outcomes were identified for other therapies included in the network. CONCLUSION Our results suggest that chemoembolization combined with RFA is the best option for local treatment of early HCC. Cases with potential contraindications for RFA may benefit from a tailored approach using thermal or radiation modalities.
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Affiliation(s)
- Ha Il Kim
- Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri, Korea
| | - Jihyun An
- Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri, Korea
| | - Seungbong Han
- Biostatistics, College of Medicine, Korea University, Seoul, Korea
| | - Ju Hyun Shim
- Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Claasen MPAW, Sneiders D, Rakké YS, Adam R, Bhoori S, Cillo U, Fondevila C, Reig M, Sapisochin G, Tabrizian P, Toso C. European Society of Organ Transplantation (ESOT) Consensus Report on Downstaging, Bridging and Immunotherapy in Liver Transplantation for Hepatocellular Carcinoma. Transpl Int 2023; 36:11648. [PMID: 37779513 PMCID: PMC10533675 DOI: 10.3389/ti.2023.11648] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023]
Abstract
Liver transplantation offers the best chance of cure for most patients with non-metastatic hepatocellular carcinoma (HCC). Although not all patients with HCC are eligible for liver transplantation at diagnosis, some can be downstaged using locoregional treatments such as ablation and transarterial chemoembolization. These aforementioned treatments are being applied as bridging therapies to keep patients within transplant criteria and to avoid them from dropping out of the waiting list while awaiting a liver transplant. Moreover, immunotherapy might have great potential to support downstaging and bridging therapies. To address the contemporary status of downstaging, bridging, and immunotherapy in liver transplantation for HCC, European Society of Organ Transplantation (ESOT) convened a dedicated working group comprised of experts in the treatment of HCC to review literature and to develop guidelines pertaining to this cause that were subsequently discussed and voted during the Transplant Learning Journey (TLJ) 3.0 Consensus Conference that took place in person in Prague. The findings and recommendations of the working group on Downstaging, Bridging and Immunotherapy in Liver Transplantation for Hepatocellular Carcinoma are presented in this article.
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Affiliation(s)
- Marco Petrus Adrianus Wilhelmus Claasen
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Multi-Organ Transplant Program, University Health Network (UHN), Toronto, ON, Canada
| | - Dimitri Sneiders
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Yannick Sebastiaan Rakké
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - René Adam
- Centre Hépato-Biliaire, APHP Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Paris, France
| | - Sherrie Bhoori
- Hepatology, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Umberto Cillo
- Chirurgia Generale 2, Epato-Bilio-Pancreatica e Centro Trapianto di Fegato, Azienda Ospedale Università Padova, Padova, Italy
| | | | - Maria Reig
- BCLC Group, Liver Unit, Digestive Disease Institute, Hospital Clínic, IDIBAPS CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gonzalo Sapisochin
- Multi-Organ Transplant Program, University Health Network (UHN), Toronto, ON, Canada
| | - Parissa Tabrizian
- Liver Transplant and Hepatobiliary Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christian Toso
- Division of Abdominal Surgery, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Yoon JH, Choi SK. Management of early-stage hepatocellular carcinoma: challenges and strategies for optimal outcomes. JOURNAL OF LIVER CANCER 2023; 23:300-315. [PMID: 37734717 PMCID: PMC10565545 DOI: 10.17998/jlc.2023.08.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023]
Abstract
Although hepatocellular carcinoma (HCC) is associated with a poor prognosis, management of early-stage HCC is often successful with highly efficacious treatment modalities such as liver transplantation, surgical resection, and radiofrequency ablation. However, unfavorable clinical outcomes have been observed under certain circumstances, even after efficient treatment. Factors that predict unsuitable results after treatment include tumor markers, inflammatory markers, imaging findings reflecting tumor biology, specific outcome indicators for each treatment modality, liver functional reserve, and the technical feasibility of the treatment modalities. Various strategies may overcome these challenges, including the application of reinforced treatment indication criteria with predictive markers reflecting tumor biology, compensation for technical issues with up-to-date technologies, modification of treatment modalities, downstaging with locoregional therapies (such as transarterial chemotherapy or radiotherapy), and recently introduced combination immunotherapies. In this review, we discuss the challenges to achieving optimal outcomes in the management of early-stage HCC and suggest strategies to overcome these obstacles.
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Affiliation(s)
- Jae Hyun Yoon
- Department of Gastroenterology and hepatology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Kyu Choi
- Department of Gastroenterology and hepatology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Podlasek A, Abdulla M, Broering D, Bzeizi K. Recent Advances in Locoregional Therapy of Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:3347. [PMID: 37444457 DOI: 10.3390/cancers15133347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is responsible for 90% of primary hepatic cancer cases, and its incidence with associated morbidity and mortality is growing worldwide. In recent decades, there has been a revolution in HCC treatment. There are three main types of locoregional therapy: radiofrequency ablation, transarterial chemoembolisation, and transarterial radioembolisation. This article summarises recent advances in locoregional methods.
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Affiliation(s)
- Anna Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), University of Dundee, Dundee DD1 4HN, UK
- Precision Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Maheeba Abdulla
- Salmaniya Medical Complex, Arabian Gulf University, Manama 323, Bahrain
| | - Dieter Broering
- Department of Liver Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Khalid Bzeizi
- Department of Liver Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
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11
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Vandeputte M, Saveyn T, Lutin B, De Meyere C, Parmentier I, D'Hondt M. Combined Ablation and Resection for Colorectal Liver Metastases in the Minimally Invasive Surgical Era. Surg Laparosc Endosc Percutan Tech 2023; 33:121-128. [PMID: 36821654 DOI: 10.1097/sle.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/12/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND Thermal ablation is an accepted treatment modality for small and central liver tumors. In extensive colorectal liver metastatic disease (CRLM), hepatectomy can be combined with ablation, resulting in a parenchymal-sparing strategy. This may increase salvageability rates in case of recurrence. METHODS All patients with advanced CRLM that underwent combined ablation and resection between April 2012 and April 2021, were retrospectively analyzed from a prospectively maintained database. Primary endpoints include postoperative 30-day morbidity and ablation-site recurrence (ASR). The surgical approaches were compared. Ablated lesions were screened for ASR on postoperative follow-up imaging. RESULTS Of 54 patients that underwent combined ablation and resection, 32 (59.3%) were performed through a minimally invasive approach. Eleven (20.4%) were minor resections, 32 (59.3%) were technically major and 11 (20.4%) were anatomically major resections. Twelve complications occurred (22.2%), among which 2 (3.8%) major complications (Clavien-Dindo ≥IIIa). Ninety-day mortality rate was 1.9%. Out of 82 ablated lesions, 6 ASRs (11.1%) occurred. Median blood loss was significantly lower in the minimally invasive group, compared with open [90 mL (32.5 to 200) vs. 200 mL (100 to 400), P =0.005]. Pringle maneuver was significantly performed less in the minimally invasive group [8 (25.0%) vs. 16 (72.7%), P =0.001], but took more time [36.1 min (±15.6) vs. 21.6 (±9.9); P =0.011]. Short-term (1 y) overall and disease-free survival were respectively 81.4% and 50.0%. CONCLUSION Combining microwave ablation and liver resection is a feasible and safe parenchymal-sparing technique, through both minimally invasive and open approach for treating extended CRLM disease. It has a low ablation-related complication rate and acceptable ablation-site recurrence rate.
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Affiliation(s)
| | | | | | | | | | - Mathieu D'Hondt
- Departments of Digestive and Hepatobiliary/Pancreatic Surgery
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12
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Koza A, Bhogal RH, Fotiadis N, Mavroeidis VK. The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes. Biomedicines 2023; 11:biomedicines11041062. [PMID: 37189680 DOI: 10.3390/biomedicines11041062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. JOURNAL OF LIVER CANCER 2023; 23:1-120. [PMID: 37384024 PMCID: PMC10202234 DOI: 10.17998/jlc.2022.11.07] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/30/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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Affiliation(s)
- Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea
- Corresponding author: KLCA-NCC Korea Practice Guideline Revision Committee (KPGRC) (Committee Chair: Joong-Won Park) Center for Liver and Pancreatobiliary Cancer, Division of Gastroenterology, Department of Internal Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea Tel. +82-31-920-1605, Fax: +82-31-920-1520, E-mail:
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14
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2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol 2022; 23:1126-1240. [PMID: 36447411 PMCID: PMC9747269 DOI: 10.3348/kjr.2022.0822] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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15
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol 2022; 28:583-705. [PMID: 36263666 PMCID: PMC9597235 DOI: 10.3350/cmh.2022.0294] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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16
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Goyal P, Salem R, Mouli SK. Role of interventional oncology in hepatocellular carcinoma: Future best practice beyond current guidelines. Br J Radiol 2022; 95:20220379. [PMID: 35867889 PMCID: PMC9815732 DOI: 10.1259/bjr.20220379] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. Liver transplant remains the goal of curative treatment, but limited supply of organs decreases accessibility and prolongs waiting time to transplantation. Therefore, interventional oncology therapies have been used to treat the majority of HCC patients, including those awaiting transplant. The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used staging system in management of HCC that helps allocate treatments. Since its inception in 1999, it was updated for the fifth time in November 2021 and for the first time shaped by expert opinions outside the core BCLC group. The most recent version includes additional options for early-stage disease, substratifies intermediate disease into three groups, and lists alternates to Sorafenib that can double the expected survival of advanced-stage disease. The group also proposed a new BCLC staging schema for disease progression, and endorsed treatment stage migration (TSM) directly into the main staging and treatment algorithm. This article reviews the recent developments underlying the current BCLC guidelines and highlights ongoing research, particularly involving radioembolization, that will shape future best practice.
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Affiliation(s)
- Piyush Goyal
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Samdeep K. Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
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17
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Tang MJ, Eslick GD, Lubel JS, Majeed A, Majumdar A, Kemp W, Roberts SK. Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis. World J Meta-Anal 2022; 10:220-237. [DOI: 10.13105/wjma.v10.i4.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies to date comparing outcomes of microwave ablation (MWA) with radiofrequency ablation (RFA) on patients with hepatocellular carcinoma have yielded conflicting results, with no clear superiority of one technique over the other. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of MWA with RFA.
AIM To perform a systematic review and meta-analysis comparing the efficacy and safety of MWA with RFA.
METHODS A systematic literature search was performed using Ovid Medline, Embase, PubMed, Reference Citation Analysis, Cochrane Central and Cochrane Systematic Review databases, and Web of Science. Abstracts and full manuscripts were screened for inclusion utilising predefined inclusion and exclusion criteria comparing outcomes of MWA and RFA. A random-effects model was used for each outcome. Meta-regression analysis was performed to adjust for the difference in follow-up period between the studies. Primary outcome measures included complete ablation (CA) rate, local recurrence rate (LRR), survival [local recurrence-free survival (LRFS), overall survival (OS)] and adverse events.
RESULTS A total of 42 published studies [34 cohort and 8 randomised controlled trials (RCT)] with 6719 patients fulfilled the selection criteria. There was no significant difference in tumour size between the treatment groups. CA rates between MWA and RFA groups were similar in prospective cohort studies [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.28–3.23] and RCTs (OR 1.18, 95%CI 0.64–2.18). However, retrospective studies reported higher rates with MWA (OR 1.29, 95%CI 1.06–1.57). Retrospective cohort studies reported higher OS (OR 1.54, 95%CI 1.15–2.05 and lower LRR (OR 0.67, 95%CI 0.51–0.87). No difference in terms of LRFS or 30-d mortality was observed between both arms. MWA had an increased rate of adverse respiratory events when compared to RFA (OR 1.99, 95%CI 1.07–3.71, P = 0.03).
CONCLUSION MWA achieves similar CA rates and as good or better longer-term outcomes in relation to LRR and OS compared to RFA. Apart from an increased rate of respiratory events post procedure, MWA is as safe as RFA.
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Affiliation(s)
- Myo Jin Tang
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Monash Medical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Guy D Eslick
- Department of Statistics, Clued Pty Ltd, Sydney 2006, New South Wales, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Victoria, Australia
- Department of Medicine, Austin Campus, University of Medicine, Melbourne 3084, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
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Mansur A, Garg T, Shrigiriwar A, Etezadi V, Georgiades C, Habibollahi P, Huber TC, Camacho JC, Nour SG, Sag AA, Prologo JD, Nezami N. Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics (Basel) 2022; 12:diagnostics12061300. [PMID: 35741109 PMCID: PMC9221861 DOI: 10.3390/diagnostics12061300] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timothy C. Huber
- Vascular and Interventional Radiology, Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Sherif G. Nour
- Department of Radiology and Medical Imaging, Florida State University College of Medicine, Gainesville, FL 32610, USA;
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - John David Prologo
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence: or
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19
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Luerken L, Haimerl M, Doppler M, Uller W, Beyer LP, Stroszczynski C, Einspieler I. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. ROFO-FORTSCHR RONTG 2022; 194:1075-1086. [PMID: 35545102 DOI: 10.1055/a-1768-0954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. Because many hepatocellular carcinomas are already unresectable at the time of initial diagnosis, percutaneous tumor ablation has become established in recent decades as a curative therapeutic approach for very early (BCLC 0) and early (BCLC A) HCC. The aim of this paper is to provide a concise overview of the percutaneous local ablative procedures currently in use, based on their technical characteristics as well as clinical relevance, taking into account the current body of studies. MATERIALS AND METHODS The literature search included all original papers, reviews, and meta-analyses available via MEDLINE and Pubmed on the respective percutaneous ablation procedures; the primary focus was on randomized controlled trials and publications from the last 10 years. RESULTS AND CONCLUSIONS Radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established procedures that are considered equal to surgical resection in the treatment of stage BCLC 0 and A HCC with a diameter up to 3 cm due to their strong evidence in international and national guidelines. For tumors with a diameter between 3 and 5 cm, the current S3 guidelines recommend a combination of transarterial chemoembolization (TACE) and thermal ablation using RFA or MWA as combination therapy is superior to thermal ablation alone in tumors of this size and shows comparable results to surgical resection in terms of overall survival. Alternative, less frequently employed thermal procedures include cryotherapy (CT) and laser ablation (LA). Non-thermal procedures include irreversible electroporation (IRE), interstitial brachytherapy (IBT), and most recently, electrochemotherapy (ECT). Due to insufficient evidence, these have only been used in individual cases and within the framework of studies. However, the nonthermal methods are a reasonable alternative for ablation of tumors adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods. With advances in the technology of the respective procedures, increasingly good evidence, and advancements in supportive techniques such as navigation devices and fusion imaging, percutaneous ablation procedures may expand their indications for the treatment of larger and more advanced tumors in the coming years. KEY POINTS · RFA and MWA are considered equal to surgical resection as a first-line therapy for the curative treatment of stage BCLC 0 and A HCCs with a diameter of up to 3 cm.. · For HCCs with a diameter between 3 and 5 cm, a combination of TACE and RFA or MWA is recommended. This combination therapy yields results comparable to those of surgical resection in terms of overall survival.. · Due to insufficient evidence, alternative ablation methods have only been used in individual cases and within the framework of studies. However, nonthermal methods, such as IRE, IBT, and, most recently, ECT, are a reasonable alternative for ablation of HCCs adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods.. CITATION FORMAT · Luerken L, Haimerl M, Doppler M et al. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1768-0954.
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Affiliation(s)
- Lukas Luerken
- Department of Radiology, University Hospital Regensburg, Germany
| | - Michael Haimerl
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany
| | - Michael Doppler
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Lukas Philipp Beyer
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany.,Diagnostische und Interventionelle Radiologie, Klinikum Ernst von Bergmann gGmbH, Potsdam, Germany
| | | | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, Germany
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20
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Voesch S, Bitzer M, Malek N. [Clinical relevance of the new S3 guideline on hepatocellular carcinoma and biliary tract cancer for practitioners]. Radiologe 2022; 62:200-204. [PMID: 35147708 DOI: 10.1007/s00117-022-00970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 01/27/2023]
Abstract
The update of the S3 German guideline for the management of the hepatocellular carcinoma and biliary tract cancer contains a comprehensive revision of the guideline for hepatocellular carcinoma and establishes a new guideline for biliary tract cancer. In recent years several studies have been conducted to improve diagnostic and therapeutic options for liver cancer. Magnetic resonance imaging (MRI) and biopsy are important for the diagnosis of hepatocellular carcinoma or cholangiocarcinoma. This guideline shows the progress in the treatment options for hepatocellular carcinoma, including advances in liver transplantation, bridging and downstaging. For cholangiocarcinoma there is a focus on interventional treatment and resection. This guideline also emphasizes the need of molecular diagnostics and the resulting treatment options in targeted therapy.
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Affiliation(s)
- Sabrina Voesch
- Medizinische Klinik I, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - M Bitzer
- Medizinische Klinik I, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - N Malek
- Medizinische Klinik I, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
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21
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Zanus G, Tagliente G, Rossi S, Bonis A, Zambon M, Scopelliti M, Brizzolari M, Grossi U, Romano M, Finotti M. Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14030748. [PMID: 35159014 PMCID: PMC8833939 DOI: 10.3390/cancers14030748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Hepatocellular carcinoma (HCC) is the seventh most frequent neoplasm and the second most common oncologic cause of death, mostly in patients with end-stage liver disease. HCC treatment is complex and different solutions are available, ranging from liver transplants to local therapies. In this study, we analyze the role of pulsed microwave liver ablation as an additional treatment option. Abstract This study aimed to analyze the outcomes of HCC patients treated with a novel technique—pulsed microwave ablation (MWA)—in terms of safety, local tumor progression (LTP), intrahepatic recurrence (IHR), and overall survival (OS). A total of 126 pulsed microwave procedures have been performed in our center. We included patients with mono- or multifocal HCC (BCLC 0 to D). The LTP at 12 months was 9.9%, with an IHR rate of 27.8% at one year. Survival was 92.0% at 12 months with 29.4% experiencing post-operative complications (28.6% Clavien–Dindo 1–2, 0.8% Clavien–Dindo 3–4). Stratifying patients by BCLC, we achieved BCLC 0, A, B, C, and D survival rates of 100%, 93.2%, 93.3%, 50%, and 100%, respectively, at one year, which was generally superior to or in line with the expected survival rates among patients who are started on standard treatment. The pulsed MWA technique is safe and effective. The technique can be proposed not only in patients with BCLC A staging but also in the highly selected cases of BCLC B, C, and D, confirming the importance of the concept of stage migration. This procedure, especially if performed with a minimally invasive technique (laparoscopic or percutaneous), is repeatable with a short postoperative hospital stay.
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Affiliation(s)
- Giacomo Zanus
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Giovanni Tagliente
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Serena Rossi
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Alessandro Bonis
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Mattia Zambon
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Michele Scopelliti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Marco Brizzolari
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Ugo Grossi
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Maurizio Romano
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Michele Finotti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
- Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75204, USA
- Correspondence:
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22
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Safety and efficacy of microwave versus radiofrequency ablation for large hepatic hemangioma: a multicenter retrospective study with propensity score matching. Eur Radiol 2022; 32:3309-3318. [DOI: 10.1007/s00330-021-08425-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
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23
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Microwave versus radiofrequency ablation for the treatment of liver malignancies: a randomized controlled phase 2 trial. Sci Rep 2022; 12:316. [PMID: 35013377 PMCID: PMC8748896 DOI: 10.1038/s41598-021-03802-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/08/2021] [Indexed: 12/24/2022] Open
Abstract
Microwave (MWA) and radiofrequency ablation (RFA) are main ablative techniques for hepatocellular carcinoma (HCC) and colorectal liver metastasis (MT). This randomized phase 2 clinical trial compares the effectiveness of MWA and RFA as well as morphology of corresponding ablation zones. HCC and MT patients with 1.5–4 cm tumors, suitable for ablation, were randomized into MWA or RFA Groups. The primary endpoint was short-to-long diameter ratio of ablation zone (SLR). Primary technical success (TS) and a cumulative local tumor progression (LTP) after a median 2-year follow-up were compared. Between June 2015 and April 2020, 82 patients were randomly assigned (41 patients per group). For the per-protocol analysis, five patients were excluded. MWA created larger ablation zones than RFA (p = 0.036) although without differences in SLR (0.5 for both groups, p = 0.229). The TS was achieved in 98% (46/47) and 90% (45/50) (p = 0.108), and LTP was observed in 21% (10/47) vs. 12% (6/50) (OR 1.9 [95% CI 0.66–5.3], p = 0.238) of tumors in MWA vs. RFA Group, respectively. Major complications were found in 5 cases (11%) vs. 2 cases (4%), without statistical significance. MWA and RFA show similar SLR, effectiveness and safety in liver tumors between 1.5 and 4 cm.
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24
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Yu Z, Li G, Yu H, Asakawa T. Changes of immune cells in patients with hepatocellular carcinoma treated by radiofrequency ablation and hepatectomy, a pilot study. Open Life Sci 2021; 16:1002-1009. [PMID: 34616914 PMCID: PMC8450610 DOI: 10.1515/biol-2021-0105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/18/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022] Open
Abstract
In this pilot study, we compared the dynamic changes of circulating immune cells between patients with hepatocellular carcinoma (HCC) who underwent radiofrequency ablation (RFA) and hepatectomy. Seventy-three patients were enrolled in this study. Flow cytometry assay was performed to determine the immune cells in the peripheral blood mononuclear cells (PBMCs) before treatment and on days 7, 14, and 28 after treatment. We found that in the RFA group, the circulating cluster of differentiation (CD)4+ cells, the CD4+/CD8+ ratio, and natural killer (NK) cells continued to increase, and the circulating CD8+ cells continued to decrease after the treatment. In contrast, in the surgery group, the circulating CD4+ cells and CD4+/CD8+ ratio decreased over the first seven postoperative days and then began to increase, and CD8+ cells decreased on the first 7 postoperative days and began to increase thereafter. The changes of immune cells in tumor tissues consisted of an increase in the number of CD4+ cells, CD8+ cells, CD3+ cells, and NK cells immediately after RFA. Our results show that postoperative immune function continued to improve after RFA, but after surgery, it decreased in the first week and started to improve thereafter. These findings are important for clinicians when selecting the appropriate therapy for HCC.
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Affiliation(s)
- Zusheng Yu
- Department of Hepatobiliary Surgery, The First People's Hospital of Fuyang Hangzhou, Hangzhou, 311400, China
| | - Guowei Li
- Department of Hepatobiliary Surgery, The First People's Hospital of Fuyang Hangzhou, Hangzhou, 311400, China
| | - Hang Yu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Tetsuya Asakawa
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shennanzhong Road 3025, Shenzhen, Guangdong·Province, 518033, China.,Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, 4313192, Japan.,Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
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25
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Luo L, He X, Li K, Long Y, Zeng Q, Tan L, Zheng R, Xu E. Thermal ablation of medium-sized hepatocellular carcinomas using intraoperative ultrasound fusion imaging: A propensity score-matched analysis. Clin Res Hepatol Gastroenterol 2021; 45:101581. [PMID: 33761441 DOI: 10.1016/j.clinre.2020.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore the value of ultrasound fusion imaging for the thermal ablation of medium-sized hepatocellular carcinomas (HCCs). MATERIALS AND METHODS From December 2010 to June 2018, patients with medium-sized (3.1-5.0cm) HCCs who underwent radiofrequency ablation (RFA) or microwave ablation (MWA) with the assistance of ultrasound fusion imaging were enrolled in this retrospective study. Technical efficacy, local tumor progression (LTP), intrahepatic distant recurrence (IDR), overall survival (OS), tumor-free survival (TFS) and major complications were evaluated during the follow-up period. The therapeutic outcomes were compared between the RFA/MWA combined with trans-arterial chemoembolization (TACE) group and the RFA/MWA alone group with propensity-score matching (PSM) analysis. RESULTS A total of 112 patients with 115 medium-sized HCCs were finally enrolled in this study. The median duration of follow-up was 33 months (range, 2-104 months). The technique efficacy was 100% (115/115). The 1-, 3-, 5-year OS rates and TFS rates were 95.5%, 76.7%, 71.5% and 74.1%, 48.7%, 41.8%, respectively. The corresponding LTP rates and IDR rates were 5.4%, 7.3%, 7.3% and 21.8%, 46.9%, 50.3%, respectively. The incidence of major complications was 5.4% (6/112). After PSM analysis (19 patients in each group), the therapeutic outcomes, including the OS, TFS, and LTP rates, were comparable in the two groups (P > 0.05). CONCLUSIONS With the assistance of ultrasound fusion imaging, thermal ablation of medium-sized HCC could achieve a satisfactory local control rate and long-term survival. The outcomes were comparable in the stratified analysis between the RFA/MWA alone group and the RFA/MWA+TACE group after PSM analysis.
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Affiliation(s)
- Liping Luo
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, PR China
| | - Xuqi He
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, PR China
| | - Kai Li
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, PR China
| | - Yinglin Long
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, PR China
| | - Qingjing Zeng
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, PR China
| | - Lei Tan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, PR China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, PR China.
| | - Erjiao Xu
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China; Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, PR China.
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Ward EM, Sherif AE, O'Neill S, Hughes M, Ireland H, Wigmore SJ, Adair A. Clinical Outcomes of Ablation Compared with Resection for Single Hepatocellular Carcinoma Lesions, as a Primary Treatment or Bridging to Liver Transplantation: A Retrospective Comparative Study. Ann Transplant 2021; 26:e931980. [PMID: 34326301 PMCID: PMC8330445 DOI: 10.12659/aot.931980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Ablative therapies (AT) are widely utilized as bridging treatment for liver transplantation (LT) candidates with hepatocellular carcinoma (HCC) who are on the transplant waiting list to minimize dropout rate. We aimed to investigate whether AT could be considered a primary treatment modality for LT candidates with single, small HCC lesions. Material/Methods We retrospectively investigated the outcomes of patients with AT for single HCC lesions as primary treatment or bridging to LT between 2010 and 2017, compared with surgical resection (SR) during the same time period as control. Univariate and multivariate survival analyses were performed. Matched analysis, after propensity score matching (PSM), was performed to minimize the selection bias confounding effect on outcomes. Results Of 162 patients identified, 92 received AT and 70 had SR. PSM identified 38 paired matches in each group. Overall survival (OS) and disease-free survival (DFS) before matching showed comparable outcomes for each treatment after 1, 3, and 5 years. Multivariate analysis using Cox regression models adjusting the study confounders showed lesion size (>30 mm), not treatment received, was associated with worse DFS (hazard ratio, 2.21 [95% confidence interval, 1.14–4.28]). In the matched groups, OS and DFS were equivalent and consistent with the whole-cohort survival outcomes. Explant histopathology of patients having AT as a bridge to LT showed complete pathological response in 85.7% of patients. Conclusions This study supports the use of AT with curative intent for single ≤3-cm HCCs, particularly in LT candidates, with salvage transplantation kept as a backup in case of recurrence.
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Affiliation(s)
- Elizabeth M Ward
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom
| | - Ahmed Elshawadfy Sherif
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom.,Department of Hepato-Pancreato-Biliary (HPB) Surgery, National Liver Institute, Menoufia University, Shibin Elkom, Egypt
| | - Stephen O'Neill
- Department of Transplant Surgery, Belfast City Hospital, Belfast, United Kingdom
| | - Michael Hughes
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom
| | - Hamish Ireland
- Department of Interventional Radiology, Vascular Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Stephen J Wigmore
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom
| | - Anya Adair
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom
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27
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Crocetti L, Scalise P, Bozzi E, Campani D, Rossi P, Cervelli R, Bargellini I, Ghinolfi D, De Simone P, Cioni R. Microwave Ablation of Very-Early- and Early-Stage HCC: Efficacy Evaluation by Correlation with Histology after Liver Transplantation. Cancers (Basel) 2021; 13:3420. [PMID: 34298633 PMCID: PMC8303326 DOI: 10.3390/cancers13143420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/22/2022] Open
Abstract
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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Affiliation(s)
- Laura Crocetti
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (P.S.); (E.B.); (P.R.); (R.C.); (I.B.); (R.C.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.C.); (P.D.S.)
| | - Paola Scalise
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (P.S.); (E.B.); (P.R.); (R.C.); (I.B.); (R.C.)
| | - Elena Bozzi
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (P.S.); (E.B.); (P.R.); (R.C.); (I.B.); (R.C.)
| | - Daniela Campani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.C.); (P.D.S.)
- Division of Pathology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Piercarlo Rossi
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (P.S.); (E.B.); (P.R.); (R.C.); (I.B.); (R.C.)
| | - Rosa Cervelli
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (P.S.); (E.B.); (P.R.); (R.C.); (I.B.); (R.C.)
| | - Irene Bargellini
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (P.S.); (E.B.); (P.R.); (R.C.); (I.B.); (R.C.)
| | - Davide Ghinolfi
- Division of Hepatobiliary Surgery and Liver Transplantation, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Paolo De Simone
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.C.); (P.D.S.)
- Division of Hepatobiliary Surgery and Liver Transplantation, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Roberto Cioni
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (P.S.); (E.B.); (P.R.); (R.C.); (I.B.); (R.C.)
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28
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Khan A, Mostowy M, Owusu M, Mutambanengwe M, Habimana S, Bence S, Facciorusso A. Microwave ablation determines similar survival outcomes as compared to radiofrequency ablation for the treatment of hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2021; 15:829-833. [PMID: 33356655 DOI: 10.1080/17474124.2021.1869939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES It is still unclear whether microwave ablation (MWA) outperforms radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC). Aim of this manuscript is to compare the two treatments through a meta-analysis of randomized-controlled trials (rcts). METHODS Computerized bibliographic search was performed on main databases through August 2020. The primary outcome was the complete response rate, with survival rate, disease-free survival rate, and adverse event rate as secondary outcomes. Results were expressed in terms of risk ratio (RR) and 95% confidence interval (CI). RESULTS Seven rcts enrolling 1143 patients were included. Rates of complete response were similar (RR 1.01, 95% CI 0.99-1.02); likewise, survival rates were constantly similar, with rrs ranging from 1.05 (0.96-1.15) at 1-year to 0.91 (0.81-1.03) at 5-year. Disease-free survival at 1-, 2-, and 3-year was similar between the two groups with RR 1.00 (0.96-1.04), 0.94 (0.84-1.06), and 1.06 (0.93-1.21), respectively. On the other hand, RR for disease-free survival at 5-year was significantly in favor of MWA (3.66, 1.32-42.27). Adverse event rate was similar between the two treatments (RR 1.06, 0.48-2.34), with bleeding and hematoma as most frequent complications. CONCLUSIONS MWA seems to determine similar outcomes as compared to RFA.
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Affiliation(s)
- Amer Khan
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Universiti Sains Malaysia
| | - Marcin Mostowy
- Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Michael Owusu
- College of Health Sciences, Department of Medical Diagnostic, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | | | - Somoskoi Bence
- Department of Obstetrics and Clinic for Production Animal, University of Veterinary Medicine, Budapest, Hungary
| | - Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
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Zhou Y, Yang Y, Zhou B, Wang Z, Zhu R, Chen X, Ouyang J, Li Q, Zhou J. Challenges Facing Percutaneous Ablation in the Treatment of Hepatocellular Carcinoma: Extension of Ablation Criteria. J Hepatocell Carcinoma 2021; 8:625-644. [PMID: 34189133 PMCID: PMC8232857 DOI: 10.2147/jhc.s298709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
As an emerging minimally invasive treatment method, percutaneous ablation is more and more widely used in the treatment of liver tumors. It has been recommended by guidelines for diagnosis and treatment of hepatocellular carcinoma (HCC) as a curative treatment alongside surgical resection and liver transplantation. In recent years, with the continuous advancement and innovation of percutaneous ablation technologies, their clinical efficacy and safety have been significantly improved, which has led to the expanded application of percutaneous ablation in the treatment of HCC—more and more patients who were previously considered unsuitable for ablation therapies are now being treated with percutaneous ablation. Obviously, percutaneous ablation can reduce the risk of treatment changes from curative strategies to palliative strategies. Based on clinical practice experience, this review enumerates the advantages and disadvantages of different ablative modalities and summarizes the existing combinations of ablation techniques, thus will help clinicians choose the most appropriate ablative modality for each patient and will provide scientific guidance for improving prognosis and making evidence-based treatment decisions. In addition, we point out the challenges and future prospects of the ablation therapies, thereby providing direction for future research.
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Affiliation(s)
- Yanzhao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Yi Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Bingyan Zhou
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People's Republic of China
| | - Zhengzheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Ruili Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Xun Chen
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jingzhong Ouyang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Qingjun Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jinxue Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
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Lin CC, Lui KW, Chen WT, Hsieh YC, Cheng YT, Teng W, Lin SM. Switching monopolar radiofrequency ablation improves long-term outcomes of medium-sized hepatocellular carcinoma. Eur Radiol 2021; 31:8649-8661. [PMID: 33895858 DOI: 10.1007/s00330-021-07729-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/24/2020] [Accepted: 01/28/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Radiofrequency ablation (RFA) of medium-sized (3-5 cm) hepatocellular carcinoma (HCC) is suboptimal. Switching monopolar RFA (SW-RFA) enlarges the ablative volume to better cover larger tumors. This study aims to compare the long-term outcomes of medium-sized HCC treated by either SW-RFA or single-monopolar RFA (S-RFA). METHODS We retrospectively reviewed 139 cases (147 medium-size HCC) between 2008 and 2014. Under propensity score matching, a total of 43 paired patients with medium-size HCC and balanced clinical variables treated by either SW-RFA or S-RFA were selected for comparison. RESULTS SW-RFA showed a higher rate of achieving an adequate safety margin (p = 0.002). After a mean follow-up period of 40.4 months, SW-RFA produced significantly lower global RFA failure rates (p < 0.001) and better overall survival (p = 0.005) compared to S-RFA. SW-RFA was independently associated with a decreased risk of global RFA failure (hazard ratio [HR]: 0.136, 95% confidence interval [CI]: 0.030-0.607, p = 0.009) and improved overall survival (HR: 0.337, 95% CI: 0.152-0.747, p = 0.007). By last follow-up, the SW-RFA group maintained a superior tumor-free rate (p = 0.010) and fewer progressions to Barcelona Clinic Liver Cancer stage C (p = 0.011). Major complication rates were comparable in both groups (SW-RFA: 2.3% vs. S-RFA: 4.7%, p = 1.000). CONCLUSIONS The switching multi-monopolar ablation technique could be beneficial for patients with medium-sized HCCs given sustained control of larger tumors with better overall survival. KEY POINTS • Switching monopolar ablation could provide a sustained local tumor control and better overall survival than single-monopolar ablation for the medium-sized hepatocellular carcinoma. • Compared to single-monopolar ablation, switching monopolar ablation could create a larger homogeneous coagulation volume by using a shorter total ablation time to achieve a higher rate of adequate safety margin for a medium-sized HCC. • Patients with medium-sized HCC can be maintained at a higher rate of tumor-free status and at a lower risk of progression into BCLC stage C in the follow-up period after ablation by switching monopolar than by single-monopolar ablation.
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Affiliation(s)
- Chen-Chun Lin
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Kar-Wai Lui
- Department of Medical Imaging & Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Yi-Chung Hsieh
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Ya-Ting Cheng
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Wei Teng
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Shi-Ming Lin
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333.
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31
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Li Z, Wang C, Si G, Zhou X, Li Y, Li J, Jiao D, Han X. Image-guided microwave ablation of hepatocellular carcinoma (≤5.0 cm): is MR guidance more effective than CT guidance? BMC Cancer 2021; 21:366. [PMID: 33827464 PMCID: PMC8028080 DOI: 10.1186/s12885-021-08099-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Given their widespread availability and relatively low cost, percutaneous thermal ablation is commonly performed under the guidance of computed tomography (CT) or ultrasound (US). However, such imaging modalities may be restricted due to insufficient image contrast and limited tumor visibility, which results in imperfect intraoperative treatment or an increased risk of damage to critical anatomical structures. Currently, magnetic resonance (MR) guidance has been proven to be a possible solution to overcome the above shortcomings, as it provides more reliable visualization of the target tumor and allows for multiplanar capabilities, making it the modality of choice. Unfortunately, MR-guided ablation is limited to specialized centers, and the cost is relatively high. Is ablation therapy under MR guidance better than that under CT guidance? This study retrospectively compared the efficacy of CT-guided and MR-guided microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC ≤ 5.0 cm). METHODS In this retrospective study, 47 patients and 54 patients received MWA under the guidance of CT and MR, respectively. The inclusion criteria were a single HCC ≤ 5.0 cm or a maximum of three. The local tumor progression (LTP), overall survival (OS), prognostic factors for local progression, and safety of this technique were assessed. RESULTS All procedures were technically successful. The complication rates of the two groups were remarkably different with respect to incidences of liver abscess and pleural effusion (P < 0.05). The mean LTP was 44.264 months in the CT-guided group versus 47.745 months in the MR-guided group of HCC (P = 0.629, log-rank test). The mean OS was 56.772 months in the patients who underwent the CT-guided procedure versus 58.123 months in those who underwent the MR-guided procedure (P = 0.630, log-rank test). Multivariate Cox regression analysis further illustrated that tumor diameter (< 3 cm) and the number of lesions (single) were important factors affecting LTP and OS. CONCLUSIONS Both CT-guided and MR-guided MWA are comparable therapies for the treatment of HCC (< 5 cm), and there was no difference in survival between the two groups. However, MR-guided MWA could reduce the incidence of complications.
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Affiliation(s)
- Zhaonan Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Chaoyan Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Guangyan Si
- Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, 646000, China
| | - Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Jing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
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Kuroda H, Nagasawa T, Fujiwara Y, Sato H, Abe T, Kooka Y, Endo K, Oikawa T, Sawara K, Takikawa Y. Comparing the Safety and Efficacy of Microwave Ablation Using Thermosphere TM Technology versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Propensity Score-Matched Analysis. Cancers (Basel) 2021; 13:cancers13061295. [PMID: 33803926 PMCID: PMC7998443 DOI: 10.3390/cancers13061295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Microwave ablation using ThermosphereTM technology is a novel locoregional treatment for hepatocellular carcinoma. This study compared the safety and efficacy outcomes of this microwave ablation strategy versus radiofrequency ablation using propensity score-matched analysis. Microwave ablation led to a high rate of curative ablation (94.7%) and a low rate of local recurrence (3.3%), with an overall survival rate of 99.3% at 1 year (recurrence-free survival: 81.1%) and 88.4% at 2 years (recurrence-free survival: 60.5%). There were no significant differences in survival outcomes after microwave and radiofrequency ablation. However, microwave ablation required significantly fewer insertions (1.22 ± 0.49 vs. 1.59 ± 0.94; p < 0.0001). Based on the similar survival outcomes, we recommend microwave ablation using ThermosphereTM technology for hepatocellular carcinoma with a diameter of >2 cm because of the lower number of insertions. Abstract There is limited information regarding the oncological benefits of microwave ablation using ThermosphereTM technology for hepatocellular carcinoma. This study compared the overall survival and recurrence-free survival outcomes among patients with hepatocellular carcinoma after microwave ablation using ThermosphereTM technology and after radiofrequency ablation. Between December 2017 and August 2020, 410 patients with hepatocellular carcinoma (a single lesion that was ≤5 cm or ≤3 lesions that were ≤3 cm) underwent ablation at our institution. Propensity score matching identified 150 matched pairs of patients with well-balanced characteristics. The microwave ablation and radiofrequency ablation groups had similar overall survival rates at 1 year (99.3% vs. 98.2%) and at 2 years (88.4% vs. 87.5%) (p = 0.728), as well as similar recurrence-free survival rates at 1 year (81.1% vs. 76.2%) and at 2 years (60.5% vs. 62.1%) (p = 0.492). However, the microwave ablation group had a significantly lower mean number of total insertions (1.22 ± 0.49 vs. 1.59 ± 0.94; p < 0.0001). This retrospective study revealed no significant differences in the overall survival and recurrence-free survival outcomes after microwave ablation or radiofrequency ablation. However, we recommend microwave ablation for hepatocellular carcinoma tumors with a diameter of >2 cm based on the lower number of insertions.
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Facciorusso A, Abd El Aziz MA, Tartaglia N, Ramai D, Mohan BP, Cotsoglou C, Pusceddu S, Giacomelli L, Ambrosi A, Sacco R. Microwave Ablation Versus Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials. Cancers (Basel) 2020; 12:cancers12123796. [PMID: 33339274 PMCID: PMC7766963 DOI: 10.3390/cancers12123796] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Through a meta-analysis of seven randomized-controlled trials we found difference in terms of complete response and survival rates between microwave ablation (MWA) and radiofrequency ablation (RFA). While local recurrence rate was similar between MWA and RFA, distant recurrence rate was significantly lower with MWA. As a consequence, disease-free survival at 1, 2, and 3 years was similar between the two groups whereas disease-free survival at 5 years was significantly in favor of MWA. Adverse event rate was similar between the two treatments. Our results indicate a similar efficacy and safety profile between the two techniques. MWA seems to decrease the rate of long-term recurrences, but this finding needs to be confirmed in further trials. Abstract There are limited and discordant results on the comparison between microwave ablation (MWA) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). This meta-analysis aims to compare the two treatments in terms of efficacy and safety, based on a meta-analysis of randomized-controlled trials (RCTs). A computerized bibliographic search was performed on the main databases throughout August 2020. The primary outcome was the complete response rate, while survival rate (at 1-, 2-, 3-, and 5-year), disease-free survival rate (at 1-, 2-, 3-, and 5-year), local and distant recurrence rate, adverse event rate, and number of treatment sessions were the secondary outcomes. Seven RCTs enrolling 921 patients were included. No difference in terms of complete response between the two treatments was observed (risk ratio (RR) 1.01, 95% CI 0.99–1.02). Survival rates were constantly similar, with RRs ranging from 1.05 (0.96–1.15) at 1 year to 0.91 (0.81–1.03) at 5 years. While local recurrence rate was similar between MWA and RFA (RR 0.70, 0.43–1.14), distant recurrence rate was significantly lower with MWA (RR 0.60, 0.39–0.92). Disease-free survival at 1, 2, and 3 years was similar between the two groups with RR 1.00 (0.96–1.04), 0.94 (0.84–1.06), and 1.06 (0.93–1.21), respectively. On the other hand, RR for disease-free survival at 5 years was significantly in favor of MWA (3.66, 1.32–42.27). Adverse event rate was similar between the two treatments (RR 1.06, 0.48–2.34), with bleeding and hematoma representing the most frequent complications. Our results indicate a similar efficacy and safety profile between the two techniques. MWA seems to decrease the rate of long-term recurrences, but this finding needs to be confirmed in further trials.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, 71122 Foggia, Italy;
| | | | - Nicola Tartaglia
- Department of Medical Sciences, General Surgery Unit, University of Foggia, 71122 Foggia, Italy; (N.T.); (A.A.)
| | - Daryl Ramai
- Gastroenterology and Hepatology, Brooklyn Hospital Medical Center, Brooklyn, NY 11201, USA;
| | - Babu P. Mohan
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA;
| | | | - Sara Pusceddu
- Fondazione IRCCS—Istituto Nazionale dei Tumori Via G. Venezian 1 IT, 20133 Milan, Italy;
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16126 Genoa, Italy;
- Polistudium SRL, 20124 Milan, Italy
| | - Antonio Ambrosi
- Department of Medical Sciences, General Surgery Unit, University of Foggia, 71122 Foggia, Italy; (N.T.); (A.A.)
| | - Rodolfo Sacco
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, 71122 Foggia, Italy;
- Correspondence: ; Tel.: +39-08-8173-2110; Fax: +39-08-8173-3545
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Abstract
Hepatocellular carcinoma is one of the leading causes of cancer related death in the world. Biannual surveillance for the disease in patients with cirrhosis and in high risk carriers of hepatitis B virus allows early stage cancer detection and treatment with good long term outcomes. Liver ultrasonography and serum α fetoprotein are the most commonly used surveillance tests. If suspicious results are found on the surveillance test, multiphasic computed tomography or magnetic resonance imaging should be undertaken to confirm the diagnosis of hepatocellular carcinoma. If radiologic tests show inconclusive results, liver biopsy or repeat imaging could be considered for confirmation of hepatocellular carcinoma. Management of the disease is complex. Patients should be evaluated by a multidisciplinary team, and the selection of treatment should consider factors such as tumor burden, severity of liver dysfunction, medical comorbidities, local expertise, and preference of patients. Early stage hepatocellular carcinoma is best managed by curative treatment, which includes resection, ablation, or transplantation. Patients with intermediate stage disease often receive locoregional treatment. Systemic treatment is reserved for patients with advanced disease. Several positive, phase III, randomized controlled trials have expanded the systemic treatment options for advanced hepatocellular carcinoma with promising long term outcomes, especially trials using combination treatments, which could also have eventual implications for the treatment of earlier stage disease.
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Affiliation(s)
- Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julie K Heimbach
- Division of Transplant Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Han J, Fan YC, Wang K. Radiofrequency ablation versus microwave ablation for early stage hepatocellular carcinoma: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22703. [PMID: 33120763 PMCID: PMC7581069 DOI: 10.1097/md.0000000000022703] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several randomized control trials (RCTs) were conducted to compare microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) over the years. The purpose of this study was to compare the efficacy of RFA and MWA for early stage HCC. METHODS Studies were systematically searched on Emabse, Ovid Medline, PubMed, and Cochrane Library until March 20, 2020. Continuous variables and dichotomous variables were compared using weighted mean difference (WMD) and odds ratio (OR), respectively. For the comparison of overall survival (OS) and disease-free survival (DFS), the hazard ratio (HR) and 95% confidence interval (CI) were extracted from univariate analysis or survival plots. RESULTS A total of 26 studies (5 RCTs and 21 cohorts) with 4396 patients (2393 patients in RFA and 2003 patients in MWA) were included in our study. Of these patients, 47% received treatment under general anesthesia in the MWA group and 84% in the RFA group (OR = 0.529, P < .001). The median ablation time was reduced in the MWA group (12 minutes) compared with RFA group (29 minutes) (WMD = -15.674, P < .001). In total, 17.6% patients exhibited progression during follow-up in the MWA group compared with 19.5% in the RFA group (OR = 0.877, P = .225). No statistically significant differences were observed between MWA and RFA groups in terms of OS and DFS (HR = 0.891 and 1.014, P = .222 and .852, respectively). CONCLUSIONS MWA exhibited similar therapeutic effects as RFA in the treatment of early stage HCC. Given the shorter ablation time, MWA can be performed under local anesthesia.
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Guiu B. MWA Versus RFA in HCC: Superior? Equivalent? Will We Ever Know? Cardiovasc Intervent Radiol 2020; 43:1619-1620. [PMID: 32909065 DOI: 10.1007/s00270-020-02635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Boris Guiu
- Department of Radiology, St-Eloi University Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
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