CONCLUSIONS

In conclusion, results indicated that MWA is just as safe and effective as RFA for the treatment of HCC or liver metastases. Compared with RFA, MWA is associated with statistically significantly lower rates of LTP across analyses. Subgroup analyses showed that higher frequency (ie, 2450 MHz MWA) and larger tumor size (ie, >2.5 cm) may be associated with improved outcomes for MWA versus RFA. Further studies are required to assess the cost and time savings associated with MWA versus RFA as well as the comparison of MWA with non ablative strategies (eg, resection).

Data availability


Continue Reading

The dataset supporting the conclusions of this article is included in the article (and its supplementary data).

Abbreviation list

DFS, disease free survival; EHM, extrahepatic metastasis; HCC, hepatocellular carcinoma; IDL, intrahepatic de novo lesions; IRB, institutional review board; LOS, length of stay; LTP, local tumor progression; LTR, local tumor recurrence; MWA, microwave ablation; NOS, Newcastle–Ottawa quality assessment scale; OS, overall survival; PICOS, population intervention comparator outcomes study design; PRESS, peer review of electronic search strategies; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized control trial; RFA, radiofrequency ablation; RoB, Cochrane risk of bias; RR, relative risk; TACE, transarterial chemoembolization; TAE, transarterial embolization; WMD, weighted mean difference.

Acknowledgments

This paper was presented at the Society of Interventional Oncology 2019 conference as a poster presentation with interim findings. The poster’s abstract was published online: https://www.eventscribe.com/2019/SIO2019/fsPopup.asp?efp=Q0JTUENDVUY4MDE1&PosterID=200029&rnd=0.7269141&mode=posterinfo. This work was sponsored by Ethicon, Inc., who provided funding to conduct the analysis and prepare the manuscript.

Author contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

SG, JWC, MBG, and JFA are employees of Ethicon, Inc. (manufacturer of Neuwave microwave ablation instrumentation). RAQ, NCF, BS, and GWJW are employees of Cornerstone Research Group, who were sponsored to perform this study by Ethicon, Inc. MBG reports stocks and stock options from Johnson & Johnson during the conduct of the study. The authors report no other conflicts of interest in this work.


Mrudula B Glassberg,1 Sudip Ghosh,2 Jeffrey W Clymer,3 Rana A Qadeer,4 Nicole C Ferko,4 Behnam Sadeghirad,4 George WJ Wright,4 Joseph F Amaral2
1Health Economics and Market Access, Ethicon Inc, Somerville, NJ, USA; 2Health Economics and Market Access, Ethicon Inc, Cincinnati, OH, USA; 3Medical Affairs, Ethicon Inc, Cincinnati, OH, USA; 4Cornerstone Research Group, Burlington, ON, Canada


References

1. World Health Organization. Cancer fact sheet. [Updated February 2018]. Available from: http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed April 3, 2018.

2. Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology. 2016;150(4):835–853. doi:10.1053/j.gastro.2015.12.041

3. Verslype C, Rosmorduc O, Rougier P, Group EGW. Hepatocellular carcinoma: ESMO-ESDO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(Suppl 7):vii41–vii48.

4. Seki T, Wakabayashi M, Nakagawa T, et al. Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer. 1994;74(3):817–825. doi:10.1002/1097-0142(19940801)74:3<817::AID-CNCR2820740306>3.0.CO;2-8

5. Laeseke PF, Lee FT Jr., van der Weide DW, Brace CL. Multiple-antenna microwave ablation: spatially distributing power improves thermal profiles and reduces invasiveness. J Interv Oncol. 2009;2(2):65–72.

6. Harari CM, Magagna M, Bedoya M, et al. Microwave ablation: comparison of simultaneous and sequential activation of multiple antennas in liver model systems. Radiology. 2016;278(1):95–103. doi:10.1148/radiol.2015142151

7. Knavel EM, Hinshaw JL, Lubner MG, et al. High-powered gas-cooled microwave ablation: shaft cooling creates an effective stick function without altering the ablation zone. AJR Am J Roentgenol. 2012;198(3):W260–W265. doi:10.2214/AJR.11.7971

8. Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;7(8):1054–1063. doi:10.4254/wjh.v7.i8.1054

9. Morrison P. Devices and equipment in interventional oncology and their operation. In: Dupuy DFY, McMullen W, editors. Image-Guided Cancer Therapy. New York (NY): Springer; 2013: 179-199.

10. Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria–a 10-year update. Radiology. 2014;273(1):241–260. doi:10.1148/radiol.14132958

11. Kim C. Understanding the nuances of microwave ablation for more accurate post-treatment assessment. Future Oncol. 2018;14(17):1755–1764. doi:10.2217/fon-2017-0736

12. Pathak S, Jones R, Tang JM, et al. Ablative therapies for colorectal liver metastases: a systematic review. Colorectal Dis. 2011;13(9):e252–e265. doi:10.1111/j.1463-1318.2011.02695.x

13. Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DS. Microwave liver ablation: influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol. 2008;19(7):1087–1092. doi:10.1016/j.jvir.2008.03.023

14. Goldberg SN, Hahn PF, Tanabe KK, et al. Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol. 1998;9(1 Pt 1):101–111.

15. Luo W, Zhang Y, He G, et al. Effects of radiofrequency ablation versus other ablating techniques on hepatocellular carcinomas: a systematic review and meta-analysis. World J Surg Oncol. 2017;15(1):126. doi:10.1186/s12957-017-1196-2

16. Huo YR, Eslick GD. Microwave ablation compared to radiofrequency ablation for hepatic lesions: a meta-analysis. J Vasc Interv Radiol. 2015;26(8):1139–1146 e1132.

17. Chinnaratha MA, Chuang MY, Fraser RJ, Woodman RJ, Wigg AJ. Percutaneous thermal ablation for primary hepatocellular carcinoma: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31(2):294–301. doi:10.1111/jgh.13028

18. Facciorusso A, Di Maso M, Muscatiello N. Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia. 2016;32(3):339–344. doi:10.3109/02656736.2015.1127434

19. Xu Y, Shen Q, Wang N, et al. Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma. Chin J Cancer. 2017;36(1):14. doi:10.1186/s40880-017-0183-x

20. Yu J, Yu XL, Han ZY, et al. Percutaneous cooled-probe microwave versus radiofrequency ablation in early-stage hepatocellular carcinoma: a phase III randomised controlled trial. Gut. 2017;66(6):1172–1173. doi:10.1136/gutjnl-2016-312629

21. Sheta E, El-Kalla F, El-Gharib M, et al. Comparison of single-session transarterial chemoembolization combined with microwave ablation or radiofrequency ablation in the treatment of hepatocellular carcinoma: a randomized-controlled study. Eur J Gastroenterol Hepatol. 2016;28(10):1198–1203. doi:10.1097/MEG.0000000000000688

22. Shady W, Petre EN, Do KG, et al. Percutaneous microwave versus radiofrequency ablation of colorectal liver metastases: ablation with clear margins (A0) provides the best local tumor control. J Vasc Interv Radiol. 2017;29(2):268–275.e261.

23. Lee KF, Wong J, Hui JW, et al. Long-term outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma by surgical approach: a retrospective comparative study. Asian J Surg. 2017;40(4):301–308. doi:10.1016/j.asjsur.2016.01.001

24. Potretzke TA, Ziemlewicz TJ, Hinshaw JL, et al. Microwave versus radiofrequency ablation treatment for hepatocellular carcinoma: a comparison of efficacy at a single center. J Vasc Interv Radiol. 2016;27(5):631–638. doi:10.1016/j.jvir.2016.01.136

25. van Tilborg AA, Scheffer HJ, de Jong MC, et al. MWA versus RFA for perivascular and peribiliary CRLM: a retrospective patient- and lesion-based analysis of two historical cohorts. Cardiovasc Intervent Radiol. 2016;39(10):1438–1446. doi:10.1007/s00270-016-1413-3

26. Vasnani R, Ginsburg M, Ahmed O, et al. Radiofrequency and microwave ablation in combination with transarterial chemoembolization induce equivalent histopathologic coagulation necrosis in hepatocellular carcinoma patients bridged to liver transplantation. Hepatobiliary Surg Nutr. 2016;5(3):225–233. doi:10.21037/hbsn.2016.01.05

27. Thornton LM, Cabrera R, Kapp M, Lazarowicz M, Vogel JD, Toskich BB. Radiofrequency vs microwave ablation after neoadjuvant transarterial bland and drug-eluting microsphere chembolization for the treatment of hepatocellular carcinoma. Curr Probl Diagn Radiol. 2017;46(6):402–409. doi:10.1067/j.cpradiol.2017.02.006

28. Yang B, Li Y. A comparative study of laparoscopic microwave ablation with laparoscopic radiofrequency ablation for colorectal liver metastasis. J Buon. 2017;22(3):667–672.

29. Santambrogio R, Chiang J, Barabino M, et al. Comparison of laparoscopic microwave to radiofrequency ablation of small hepatocellular carcinoma (</=3 cm). Ann Surg Oncol. 2017;24(1):257–263.

30. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097

31. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40–46. doi:10.1016/j.jclinepi.2016.01.021

32. Vogl TJ, Farshid P, Naguib NN, et al. Ablation therapy of hepatocellular carcinoma: a comparative study between radiofrequency and microwave ablation. Abdom Imaging. 2015;40(6):1829–1837. doi:10.1007/s00261-015-0355-6

33. Higgins J, Green S, (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0. [Updated March 2011]. Available from: http://handbook.cochrane.org. Accessed April 2018.

34. Wells G, Shea B, O’Connell D, et al. The Newcastle–Ottawa scale (NOS) for assessing the quality of nonrandomized studies in metaanalysis. [Updated 2014]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed November 2017.

35. Sterne JA, Sutton AJ, Ioannidis JP, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002. doi:10.1136/bmj.d4002

36. Abdelaziz AO, Nabeel MM, Elbaz TM, et al. Microwave ablation versus transarterial chemoembolization in large hepatocellular carcinoma: prospective analysis. Scand J Gastroenterol. 2015;50(4):479–484. doi:10.3109/00365521.2014.1003397

37. Bhutiani N, Philips P, Scoggins CR, McMasters KM, Potts MH, Martin RC. Evaluation of tolerability and efficacy of irreversible electroporation (IRE) in treatment of Child-Pugh B (7/8) hepatocellular carcinoma (HCC). HPB (Oxford). 2016;18(7):593–599. doi:10.1016/j.hpb.2016.03.609

38. Veltri A, Gazzera C, Calandri M, et al. Percutaneous treatment of Hepatocellular carcinoma exceeding 3 cm: combined therapy or microwave ablation? Preliminary results. Radiol Med. 2015;120(12):1177–1183. doi:10.1007/s11547-014-0465-1

39. Zhou F, Yu XL, Liang P, et al. Microwave ablation is effective against liver metastases from gastric adenocarcinoma. Int J Hyperthermia. 2017;33(7):830–835.

40. Abdelaziz A, Elbaz T, Shousha HI, et al. Efficacy and survival analysis of percutaneous radiofrequency versus microwave ablation for hepatocellular carcinoma: an Egyptian multidisciplinary clinic experience. Surg Endosc. 2014;28(12):3429–3434. doi:10.1007/s00464-013-3343-3

41. Di Vece F, Tombesi P, Ermili F, Maraldi C, Sartori S. Coagulation areas produced by cool-tip radiofrequency ablation and microwave ablation using a device to decrease back-heating effects: a prospective pilot study. Cardiovasc Intervent Radiol. 2014;37(3):723–729.

42. Chinnaratha MA, Sathananthan D, Pateria P, et al. High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice. Eur J Gastroenterol Hepatol. 2015;27(3):349–354. doi:10.1097/MEG.0000000000000270

43. Cillo U, Noaro G, Vitale A, et al. Laparoscopic microwave ablation in patients with hepatocellular carcinoma: a prospective cohort study. HPB (Oxford). 2014;16(11):979–986. doi:10.1111/hpb.12264

44. Correa-Gallego C, Fong Y, Gonen M, et al. A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases. Ann Surg Oncol. 2014;21(13):4278–4283. doi:10.1245/s10434-014-3817-0

45. Ding J, Jing X, Liu J, et al. Comparison of two different thermal techniques for the treatment of hepatocellular carcinoma. Eur J Radiol. 2013;82(9):1379–1384. doi:10.1016/j.ejrad.2013.04.025

46. Ginsburg M, Zivin SP, Wroblewski K, Doshi T, Vasnani RJ, Van Ha TG. Comparison of combination therapies in the management of hepatocellular carcinoma: transarterial chemoembolization with radiofrequency ablation versus microwave ablation. J Vasc Interv Radiol. 2015;26(3):330–341. doi:10.1016/j.jvir.2014.10.047

47. Hompes R, Fieuws S, Aerts R, Thijs M, Penninckx F, Topal B. Results of single-probe microwave ablation of metastatic liver cancer. Eur J Surg Oncol. 2010;36(8):725–730. doi:10.1016/j.ejso.2010.05.013

48. Kuang M, Xie XY, Huang C, et al. Long-term outcome of percutaneous ablation in very early-stage hepatocellular carcinoma. J Gastrointest Surg. 2011;15(12):2165–2171. doi:10.1007/s11605-011-1716-2

49. Liu Y, Li S, Wan X, et al. Efficacy and safety of thermal ablation in patients with liver metastases. Eur J Gastroenterol Hepatol. 2013;25(4):442–446. doi:10.1097/MEG.0b013e32835cb566

50. Ohmoto K, Yoshioka N, Tomiyama Y, et al. Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinomas. J Gastroenterol Hepatol. 2009;24(2):223–227. doi:10.1111/j.1440-1746.2008.05596.x

51. Qian GJ, Wang N, Shen Q, et al. Efficacy of microwave versus radiofrequency ablation for treatment of small hepatocellular carcinoma: experimental and clinical studies. Eur Radiol. 2012;22(9):1983–1990. doi:10.1007/s00330-012-2442-1

52. Sakaguchi H, Seki S, Tsuji K, et al. Endoscopic thermal ablation therapies for hepatocellular carcinoma: a multi-center study. Hepatol Res. 2009;39(1):47–52. doi:10.1111/j.1872-034X.2008.00410.x

53. Simo KA, Sereika SE, Newton KN, Gerber DA. Laparoscopic-assisted microwave ablation for hepatocellular carcinoma: safety and efficacy in comparison with radiofrequency ablation. J Surg Oncol. 2011;104(7):822–829. doi:10.1002/jso.21933

54. Yin XY, Xie XY, Lu MD, et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer. 2009;115(9):1914–1923. doi:10.1002/cncr.24196

55. Zhang L, Wang N, Shen Q, Cheng W, Qian GJ. Therapeutic efficacy of percutaneous radiofrequency ablation versus microwave ablation for hepatocellular carcinoma. PLoS One. 2013;8(10):e76119. doi:10.1371/journal.pone.0076119

56. Hefaiedh R, Ennaifer R, Romdhane H, et al. Gender difference in patients with hepatocellular carcinoma. Tunis Med. 2013;91(8–9):505–508.

57. Zhu RX, Seto WK, Lai CL, Yuen MF. Epidemiology of hepatocellular carcinoma in the Asia-Pacific region. Gut Liver. 2016;10(3):332–339. doi:10.5009/gnl15257

58. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242(2):158–171. doi:10.1097/01.sla.0000171032.99149.fe

59. Vogl TJ, Roman A, Nour-Eldin NA, Hohenforst-Schmidt W, Bednarova I, Kaltenbach B. A comparison between 915 MHz and 2450 MHz microwave ablation systems for the treatment of small diameter lung metastases. Diagn Interv Radiol. 2018;24(1):31–37. doi:10.5152/dir.2018.17017

60. Liu FY, Yu XL, Liang P, Wang Y, Zhou P, Yu J. Comparison of percutaneous 915 MHz microwave ablation and 2450 MHz microwave ablation in large hepatocellular carcinoma. Int J Hyperthermia. 2010;26(5):448–455. doi:10.3109/02656731003717574

Source: Oncotargets and Therapy.
Originally published August 13, 2019.

READ FULL ARTICLE Curated publisher From Dovepress