Abstract
Simple SummaryThrough 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.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.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most commonly occurring type of cancer, and is the leading cause of mortality in cirrhotic patients [1]. up to 60% of HCC patients in developed countries are currently amenable to curative therapies, such as surgical or ablative treatments, at the time of diagnosis [2,3], tumor recurrence and long-term survival remain unsolved issues [4].In the last few years, imaging-guided ablative therapies have gained a fundamental role in the treatment of HCC, due to their safety and efficacy, leading to complete necrosis of the tumoral nodule
While local recurrence rate was similar between microwave ablation (MWA) and radiofrequency ablation (RFA), with an risk ratio (RR) of 0.70 (0.43–1.14), distant recurrence rate was significantly lower with MWA (RR 0.60, 0.39–0.92; I2 = 0%) based on three
Reviews and Meta-Analyses (PRISMA) statement and was conducted following a priori established protocol [27]. Studies included in this meta-analysis were randomized-controlled trials (RCTs) that met the following inclusion criteria: (a) patients: adults HCC patients treated with (b) interventions: percutaneous MWA or (c) comparator: percutaneous RFA and reported (d) outcome: complete ablation of the treated nodules, defined as complete response (CR)
Summary
Up to 60% of HCC patients in developed countries are currently amenable to curative therapies, such as surgical or ablative treatments, at the time of diagnosis [2,3], tumor recurrence and long-term survival remain unsolved issues [4]. In the last few years, imaging-guided ablative therapies have gained a fundamental role in the treatment of HCC, due to their safety and efficacy, leading to complete necrosis of the tumoral nodule. The significant incidence of local and distant recurrences was found to affect survival [7,8] and, several prognostic predictors of post-treatment outcomes have been extensively studied [9], other competitive ablation therapies were tested and introduced into clinical practice. Among the more recent ablative techniques, microwave ablation (MWA) has gained a pivotal role as a valuable alternative to RFA for thermal ablation of HCC [10]. The main advantages of MWA technology, compared with other thermal ablation technologies, include consistently higher intratumoral temperatures, larger tumor ablation volumes, faster ablation times, and an improved convection profile, and, as a consequence, lower risk of a heat-sink effect (i.e., the treatment outcome is less affected by vessels in proximity to the tumor) [3]
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