Abstract
The purpose of this study is to compare the efficacy and safety of microwave ablation (MWA) versus laser-induced thermotherapy (LITT) as a local treatment for hepatocellular carcinoma (HCC,) with regard to therapy response, survival rates, and complication rates as measurable outcomes. This retrospective study included 250 patients (52 females and 198 males; mean age: 66 ± 10 years) with 435 tumors that were treated by MWA and 53 patients (12 females and 41 males; mean age: 67.5 ± 8 years) with 75 tumors that were treated by LITT. Tumor response was evaluated using CEMRI (contrast-enhanced magnetic resonance imaging). Overall, 445 MWA sessions and 76 LITT sessions were performed. The rate of local tumor progression (LTP) and the rate of intrahepatic distant recurrence (IDR) were 6% (15/250) and 46% (115/250) in the MWA-group and 3.8% (2/53) and 64.2% (34/53) in the LITT-group, respectively. The 1-, 3-, and 5-year overall survival (OS) rates calculated from the date of diagnosis were 94.3%, 65.4%, and 49.1% in the MWA-group and 96.2%, 54.7%, and 30.2% in the LITT-group, respectively (p-value: 0.002). The 1-, 2-, and 3-year disease-free survival (DFS) rates were 45.9%, 30.6%, and 24.8% in the MWA-group and 54.7%, 30.2%, and 17% in the LITT-group, respectively (p-value: 0.719). Initial complete ablation rate was 97.7% (425/435) in the MWA-group and 98.7% (74/75) in the LITT-group (p-value > 0.99). The overall complication rate was 2.9% (13/445) in the MWA-group and 7.9% (6/76) in the LITT-group (p-value: 0.045). Based on the results, MWA and LITT thermal ablation techniques are well-tolerated, effective, and safe for the local treatment of HCC. However, MWA is recommended over LITT for the treatment of HCC, since the patients in the MWA-group had higher survival rates.
Highlights
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and the sixth most common cancer [1] that typically occurs in a cirrhotic liver [2]
We enrolled a total of 303 patients with histologically diagnosed HCC: 250 patients (52 females and 198 males; mean age: 66 ± 10 years) with 435 tumors that were treated by 445 microwave ablation (MWA) sessions and 53 patients (12 females and 41 males; mean age: 67.5 ± 8 years) with tumors that were treated by laser-induced thermotherapy (LITT) sessions, with the intention of local tumor control
The decision whether HCC should be treated by surgery, image-guided thermal ablation, intra-arterial methods, or by radiation therapy must be taken by interdisciplinary teams consisting of surgeons, interventional radiologists, oncologists, hepatologists, and radiation oncologists, and must take into consideration the location and size of the tumor, liver function, existence of extrahepatic manifestation, and overall health of the patients and their preference
Summary
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and the sixth most common cancer [1] that typically occurs in a cirrhotic liver [2]. The incidence of HCC is increasing worldwide, with the highest rates reported in Asia and Africa [3]. HCC is up to 8 times more often in men than women [1]. Liver transplantation (LT) is most suitable for patients within the Milan criteria and surgical resection for patients with solitary HCC and adequate liver function [4]. Local ablative treatments, such as microwave ablation (MWA), radiofrequency ablation (RFA), and laser-induced thermotherapy (LITT), can be performed in the case of unresectable or early-stage HCC [1]. Local ablation therapies could be curatively applied in patients with HCC [5]
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