Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Purpose: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC). However, to date, studies comparing the two therapies have provided discordant results. The aim of this meta-analysis is to evaluate the efficacy and safety of the two treatments for HCC patients. Materials and methods: A computerised bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. The rates of complete response (CR), local recurrence (LRR), 3-year survival (SR) and major complications were compared between the two treatment groups by using the Mantel-Haenszel test in cases of low heterogeneity or the DerSimonian and Laird test in cases of high heterogeneity. Sources of heterogeneity were investigated using subgroup analyses. In order to confirm our finding, sensitivity analysis was performed restricting the analysis to high-quality studies. Results: One randomised controlled trial (RCT) and six retrospective studies with 774 patients were included in the meta-analysis. A non-significant trend of higher CR rates in the patients treated with MWA was found (odds ratio (OR)?=?1.12, 95% confidence interval (CI) 0.67–1.88, p?=?0.67]. Overall LRR was similar between the two treatment groups (OR 1.01, 95% CI 0.53–1.87, p?=?0.98) but MWA outperformed RFA in cases of larger nodules (OR 0.46, 95% CI 0.24–0.89, p?=?0.02). 3-year SR was higher after RFA without statistically significant difference (OR 0.95, 95% CI 0.58–1.57, p?=?0.85). Major complications were more frequent, although not significantly, in MWA patients (OR 1.63, 95% CI 0.88–3.03, p?=?0.12). Conclusions: Our results indicate a similar efficacy between the two percutaneous techniques with an apparent superiority of MWA in larger neoplasms.     

Radiofrequency ablation combined with percutaneous ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis

Background: Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) are important treatments for patients with hepatocellular carcinoma (HCC) who are not eligible for resection and liver transplantation. Therefore, it is important to establish comparisons between RFA, PEI and the two therapies in combination.

Aims: To evaluate the clinical efficacy and safety of combined RFA-PEI versus monotherapy with either RFA or PEI for HCC to provide references for clinical practice and further research.

Methods: We searched all eligible studies published before September 2015 in the Cochrane Library, PubMed, Embase, Web of Science and Chinese databases, such as CBM, CNKI, VIP and WanFang and also retrieved papers from other sources. All relevant controlled trials were collected. Meta-analyses were performed using RevMan version 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark).

Results: Thirteen trials with 1621 patients were identified. Compared with PEI, RFA was associated with significant improvement in overall survival (OS) rate at 1, 2, 3 and 4 years, cancer-free survival (CFS) rate at 1, 2 and 3 years and complete tumour necrosis. RFA was associated with a significant reduction in the local recurrence rate at 1, 2 and 3 years. However, RFA was also associated with a higher total risk of complications. Compared with RFA alone, combined RFA-PEI was associated with a significant improvement in the OS rate at 1.5, 2 and 3 years and a significant reduction in the local recurrence rate. However, combined RFA-PEI was also associated with a higher risk of fever.

Conclusion: The combination of RFA and PEI appears to be the optimal treatment strategy when considering combined RFA-PEI or either RFA or PEI alone. Combined RFA-PEI significantly improves OS and reduces the risk of local recurrence without increasing major complications. Further large-scale studies are needed to assess economic outcomes and quality of life.     

经皮肝穿刺射频热凝对复发性肝癌的治疗意义

目的 探讨对于无再次手术指征的复发性肝癌行B超引导经皮肝穿刺射频热凝(PRFA)治疗的意义。方法 1999年10月～2001年7月经病理证实为原发性肝癌，术后影像学和血清肿瘤标记物证实为肝癌复发的47患者进行B超引导PRFA治疗。复发瘤灶为单发者24例、多发者23例，其中复发灶为单发且小于3．5cm者12例。定期随访，复查AFP、肝功能和B超，1个月后复查MRI或CT了解肿瘤坏死情况，以后每3个月复查。Kaplan—Meier法计算累积生存率。结果 复发灶为单发者1、2、3年的生存率分别为65.2％、37．5％、37．5％，复发灶为单发且小于3.5cm者1、2、3年的生存率分别为83.3％、51．4％、51．4％。复发灶为多发者1、2年的生存率为41．7％、19．5％。结论 B超引导经皮肝穿刺射频热凝是肝癌综合治疗中一种重要手段，对于无再次手术指征的复发性肝癌可以根据复发瘤灶的大小、范围、复发时间，决定单独或结合TACE给予B超引导经皮肝穿刺射频热凝(PRFA)治疗，可以更加有效地控制复发、提高生存率。     

康艾注射液对肝癌患者经皮射频消融术后生活质量的影响

目的:观察康艾注射液对肝癌患者经皮射频消融术后生活质量的影响.方法:经皮射频消融术后的58例肝癌患者随机分为观察组和对照组.观察组(29例),给予康艾注射液和行射频消融术治疗;对照组(29例),只行射频消融治疗.术前及术后第5天使用欧洲癌症研究及治疗组织生活质量核心量表(EORTC QLQ-C30)评价患者生活质量的改变.结果:观察组治疗后躯体功能、社会功能、总体健康情况、恶心和呕吐的评分较治疗前升高,疼痛的评分较治疗前降低.对照组治疗后食欲减退、恶心和呕吐、腹泻的评分较治疗前升高.两组治疗后比较:观察组的躯体功能、总体健康情况评分较对照组升高,恶心和呕吐、食欲减退、腹泻、疼痛、疲倦、失眠的评分较对照组降低.两组术后第5天复查肝功能示甲胎蛋白均明显下降,其中观察组有恢复正常的病例.结论:康艾注射液能明显提高肝癌患者经皮射频消融术后生活质量.     

射频消融术联合肝动脉化疗栓塞治疗肝癌的临床效果

目的探讨射频消融术后联合肝动脉化疗栓塞对肝癌的治疗效果。方法25例肝癌患者共34个瘤灶,中等大小肿瘤(3 cm~5 cm)9个,大肿瘤(>5.1 cm)25个。射频消融术后2~10周行肝动脉化疗栓塞术。治疗效果采用增强CT扫描和临床随访评估。结果射频消融术后CT扫描见治疗区仍有残留癌灶。化疗栓塞后CT扫描见大部分残留癌灶碘油沉积良好。16例患者AFP转阴或明显下降。24例获随访,累计生存率>1年(87.9%),>2年(70.8%)。结论射频消融术后联合肝动脉化疗栓塞是治疗肝癌的有效方法。     

Percutaneous CT-guided radiofrequency ablation for unresectable hepatocellular carcinoma pulmonary metastases

Purpose: This study aimed to evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for unresectable hepatocellular carcinoma pulmonary metastases (HCCPM) and to identify the prognostic factors for survival.

Materials and methods: We reviewed the medical records of 320 patients with HCCPM treated between January 2005 and January 2012. Among them, 29 patients with 68 lesions of unresectable HCCPM underwent 56 RFA sessions. Safety, local efficacy, survival and prognostic factors were evaluated. Survival was analysed using the Kaplan-Meier method. Univariate analyses were evaluated by the log-rank test.

Results: Pneumothorax requiring chest tube placement occurred in five (8.9%, 5/56) RFA sessions. During the median follow-up period of 23 months (range 6–70), 18 patients (62.1%, 18/29) died of tumour progression and 11 (37.9%, 11/29) were alive. The 1-, 2- and 3-year overall survival rates were 73.4%, 41.1% and 30%, respectively. The median progression-free survival was 18 months (95% confidence interval (CI) 9.8–26.2) and the median overall survival time was 21 months (95%CI, 9.7–32.3). The maximum tumour diameter ≤3?cm (p?=?0.002), the number of pulmonary metastases ≤3 (p?=?0.014), serum AFP level ≤400?ng/mL (p?=?0.003), and the controlled status of intrahepatic tumour after lung RFA (p?=?0.001) were favourable prognostic factors for overall survival.

Conclusions: Our study indicates that percutaneous CT-guided RFA, as an alternative treatment procedure to pulmonary metastasectomy, can be a safe and effective therapeutic option for unresectable HCCPM.     

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

BACKGROUND:

Radiofrequency ablation (RFA) is becoming a well‐known local therapy for hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) is expected to enhance the effects of subsequent RFA by reducing arterial blood flow. However, the long‐term efficacy of this combined therapy has not been elucidated. In this study, the survival rates of patients who received TACE combined with RFA (TACE + RFA) were compared with those of patients treated surgically.

METHODS:

The study included consecutive patients who received TACE + RFA or surgical resection as the initial curative treatment for HCC between 2000 and 2005 at Tokai University Hospital. Inclusion criteria were a single HCC ≤50 mm or up to 3 HCCs ≤30 mm, presence of cirrhosis classified as Child‐Pugh class A, no vascular invasion, and no extrahepatic metastasis.

RESULTS:

Sixty‐two patients (23 women, 39 men; aged 67.5 ± 8.4 years [mean ± standard deviation]) received TACE + RFA, and 55 patients (15 women, 40 men; aged 66.1 ± 8.4 years) underwent surgical resection. Median follow‐up periods were similar (50 months in the TACE + RFA group vs 49 months in the resection group). The probabilities of overall survival at 1, 3, and 5 years in the TACE + RFA group (100%, 94.8%, and 64.6%, respectively) were similar (P = .788) to those in the resection group (92.5%, 82.7%, and 76.9%, respectively). Two major RFA‐related complications were observed (1.5%).

CONCLUSIONS:

RFA combined with TACE is an efficient and safe treatment that provides overall survival rates similar to those achieved with surgical resection. Cancer 2010. © 2010 American Cancer Society.     

Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma

Background: Percutaneous radiofrequency ablation (RFA) is a first-line treatment for very-early-stage hepatocellular carcinoma (HCC), whereas the efficacy of percutaneous microwave ablation (MWA) for very-early-stage HCC remains unclear. The purpose of this study was to clarify this issue by comparing the safety and efficacy of percutaneous MWA with percutaneous RFA in treating very-early-stage HCC. Methods: Clinical data of 460 patients who were diagnosed with very-early-stage HCC and treated with percutane-ous MWA or RFA between January 2007 and July 2012 at the Eastern Hepatobiliary Surgery Hospital, The Second Mili-tary Medical University, in Shanghai, China were retrospectively analyzed. Of these 460 patients, 159 received RFA, 301 received MWA. Overall survival (OS), recurrence-free survival (RFS), local tumor progression (LTP), complete ablation, and complication occurrence rates were compared between the two groups, and the prognostic factors associated with survival were analyzed. Results: No significant differences were observed between the two groups in terms of the 1-, 3-, or 5-year OS rates (99.3%, 90.4%, and 78.3% for MWA vs. 98.7%, 86.8%, and 73.3% for RFA, respectively;P= 0.331). Furthermore, no signif-icant differences were observed between the two groups in terms of the corresponding RFS rates (94.4%, 71.8%, and 46.9% for MWA vs. 89.9%, 67.3%, and 54.9% for RFA, respectively;P= 0.309), the LTP rates (9.6% vs. 10.1%,P= 0.883), the complete ablation rates (98.3% vs. 98.1%,P= 0.860), or the occurrence rates of major complications (0.7% vs. 0.6%,P= 0.691). By multivariate analysis, LTP, antiviral therapy, and treatment of recurrence were independent risk fac-tors for OS (P < 0.001), and the alpha-fetoprotein level was an independent prognostic factor for RFS (P= 0.002). Conclusions: MWA is as safe and effective as RFA in treating very-early-stage HCC, supporting MWA as a first-line treatment option for this disease.     

Comparison of percutaneous 915 MHz microwave ablation and 2450 MHz microwave ablation in large hepatocellular carcinoma

Purpose: To compare the effectiveness of ultrasound (US)-guided percutaneous 915 MHz microwave (MW) ablation with the 2450 MHz MW ablation for large hepatocellular carcinoma (HCC) (>4 cm in diameter).

Materials and methods: Patients with HCC >4 cm in diameter who underwent US-guided percutaneous MW ablation with curative intention between March 2007 and December 2008 (39) were randomly divided into two groups, 915 MHz MW group and 2450 MHz MW group. We compared the results of ablation between the two groups.

Results: Fewer antenna insertions for each tumour were required in the 915 MHz MW group (3.69 ± 0.6) than in the 2450 MHz MW group (4.71 ± 1.61) (p = 0.01). According to the follow-up contrast-enhanced imagings, technique effectiveness rate was 85.7% (18/21) and 73.7% (14/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). The rate of local tumour progression (LTP) was 14.3% (3/21) and 26.3% (5/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). There were no deaths and no thrombosis of major vessels in any patient.

Conclusions: Compared with 2450 MHz MW ablation, our initial experience showed that percutaneous 915 MHz MW ablation with cooled-shaft antennae was safe and could achieve a high technique effectiveness rate with fewer insertion numbers in the treatment of large HCC. Therefore, percutaneous 915 MHz MW ablation may provide a new method for the treatment of large HCC.     

Combination of radiofrequency ablation and sequential cellular immunotherapy improves progression‐free survival for patients with hepatocellular carcinoma

Hepatocellular carcinoma (HCC) recurs frequently after minimally invasive therapy. The aim of our study was to observe the efficiency and safety of the combined treatment of radiofrequency ablation (RFA) with cellular immunotherapy (CIT) for HCC patients. In our study, 62 patients with HCC who were treated with radical RFA were divided into two groups: RFA alone (32 patients) and RFA/CIT (30 patients). Autologous mononuclear cells were collected from the peripheral blood and separated by apheresis, and then induced into natural killer (NK) cells, γδT cells and cytokine‐induced killer (CIK) cells. These cells were identified by flow cytometry with their specific antibodies and then were infused intravenously to RFA/CIT patients for three or six courses. The tumor recurrent status of these patients was evaluated with computed tomography or magnetic resonance imaging every 3 months after RFA. Progression‐free survival (PFS), liver function, viral load and adverse effects were examined. The results implied that PFS was higher in RFA/CIT group than that in RFA group. In RFA/CIT group, six courses had better survival prognosis than three courses. Viral load of hepatitis C was decreased in two of three patients without antiviral therapy in RFA/CIT group, but was increased in RFA group. No significant adverse reaction was found in the patients with CIT. In summary, these preliminary results suggest that combination of sequential CIT with RFA for HCC patients was efficient and safe, and may be helpful in the prevention of the recurrence for the patients with HCC after RFA.     

肝细胞癌冷循环射频治疗与手术切除治疗的前瞻性对比研究

Objective: The aim of this study was to compare the therapeutic efficacy of radiofrequency ablation (RFA) and surgical resection for the patients with hepatocellular carcinoma (HCC). Methods: From January 2002 to June 2009, 87 HCC patients with 3 or fewer nodules, no more than 3 cm in diameter, and liver function of Child-Pugh class A or B were enrolled. Forty-seven underwent RFA while 40 underwent surgical resection. Follow-up ranged from 6 to 69 months. We compared the overall and disease-free survival ra...     

Survival and intra-hepatic recurrences after laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis

BACKGROUND: The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection. However, only a small percentage of patients are operative candidates. Percutaneous radiofrequency interstitial thermal ablation proved to be effective, too. Our objective was to assess a novel operative combination of laparoscopic ultrasound (LUS) with laparoscopic radiofrequency (LRF) in the treatment of HCC not amenable to liver resection. METHODS: One hundred and four patients with HCC in liver cirrhosis were submitted to laparoscopic LRF. A LRF was indicated in patients not amenable to liver resection that had at least one of the following criteria: (a) severe impairment of the coagulation tests; (b) large tumors (but <5 cm) or multiple lesions requiring repeated punctures; (c) superficial lesions adjacent to visceral structures; (d) deep-sited lesions with a very difficult or impossible percutaneous approach; (e) short-term recurrence of HCC following percutaneous loco-regional therapies. RESULTS: The LRF procedure was completed in 102 out of 104 patients (98% feasibility rate). LUS identified 26 new malignant lesions (25%) undetected by pre-operative imaging. There was no operative mortality. Seventy-six patients had no complication (73%). At 1-month computed tomography (CT) evaluation, a complete response with a 100% necrosis was achieved in 88 out of 101 patients (87%). During the follow-up (mean follow-up: 22.5 +/- 15.9 months), 55 patients (54%) developed new malignant nodules (42% of these recurrences were localized in the same segment of the HCC treated). CONCLUSIONS: LRF of HCC proved to be a safe and effective technique at least in the short and mid-term: in fact it permits to treat lesions not treatable with the per cutaneous approach, to detect 25% of new HCC nodules and it has a low morbidity rate.     

Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a comparative study

BACKGROUND: This study compared the effectiveness of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and liver metastases. METHODS: We compared the outcomes of 240 patients with HCC and 44 patients with liver metastases treated with RFA. Data were prospectively collected and retrospectively analyzed. Effects of different variables on recurrences were studied. RESULTS: A total of 406 tumor nodules were treated. The median size of the largest ablated tumor was 2.5 cm, and the median tumor number was 1. Complete tumor ablation was achieved in 91.2%. Local recurrence rate was 15.4% after a median follow-up of 24.5 months. There was no significant impact of tumor pathology on local recurrence. However, patients with liver metastasis had higher extrahepatic recurrence rate (P = 0.019) and shorter disease-free survival (P = 0.007). Patients with multiple tumors had higher local (P = 0.047) and extrahepatic (P = 0.019) recurrence rates than those with a solitary tumor. Tumor size had an impact on local recurrence rate only in patients with liver metastasis with a higher rate in those with tumor > 2.5 cm in diameter (P = 0.028). CONCLUSIONS: Tumor pathology does not appear to have a significant impact on local recurrence rates. RFA is effective in local tumor control for both HCC and liver metastasis.     

Liposomal doxorubicin plus radiofrequency ablation for complete necrosis of a hepatocellular carcinoma

Radiofrequency ablation (rfa) is a standard treatment for small, unresectable hepatocellular carcinomas (hccs). However, rfa for larger tumours is less successful, and intravenous lyso-thermosensitive liposomal doxorubicin during rfa is one technique postulated to potentially address that limitation. This drug-plus-device combination therapy was used to completely treat a hcc in a patient who underwent liver transplantation 79 days later.     

射频消融联合肝动脉栓塞化疗治疗原发性肝癌的系统评价

目的:系统评价射频消融(RFA)联合肝动脉栓塞化疗(TACE)治疗原发性肝癌(hepatocellular carci-noma,HCC)的临床疗效。方法:计算机检索Cochrane Library、PubMed、中国知网数据库、中国生物医学文献数据库、中文科技期刊全文数据库,检索时间从数据库建库至2011年12月20日,同时辅助其它检索,纳入RFA联合TACE治疗HCC的临床对照试验。评价纳入研究的质量并提取资料,并用RevMan 5.1软件进行统计分析。结果:共纳入14篇临床对照试验,分析结果显示:与单纯TACE相比,TACE联合RFA能提高HCC治疗的有效率(RR=1.21,95%CI:1.13-1.31,P<0.001)和肿瘤完全坏死率(RR=1.95,95%CI:1.22-3.10,P=0.005),提高AFP转阴率(RR=2.13,95%CI:1.04-4.38,P=0.04)及患者1年(RR=1.38,95%CI:1.18-1.60,P<0.0001)、2年(RR=1.6 6,9 5%CI:1.3 9-1.9 9,P<0.0 0 0 0 1)、3年(RR=2.11,95%CI:1.57-2.84,P<0.00001)生存率,降低癌症复发率(RR=0.55,95%CI:0.33-0.91,P=0.02)。结论:TACE联合RFA可提高HCC治疗有效率和生存率,降低复发率,值得临床推广使用。