Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial

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.

Zusammenfassung

Ziel Vergleich des therapeutischen Ansprechens und der klinischen Ergebnisse der CT-gesteuerten perkutanen Mikrowellenablation (MWA) und der Radiofrequenzablation (RFA) zur Behandlung von kleinen und mittelgroßen HCC.

Material und Methoden In dieser prospektiven Studie wurden 50 Patienten mit HCC nach dem Zufallsprinzip einer MWA- oder RFA-Behandlung zugewiesen. Das MRT wurde 24 Stunden vor und nach der Ablation und anschließend in 3-monatigen Abständen durchgeführt. Ausgewertet wurden Ablationsvolumen, Ablationsdauer, adverse events (AE), technische Wirksamkeit, technischer Erfolg, local tumor progression (LTP), disease free survival (DFS), intrahepatic distant recurrence (IDR) und das overall survival (OS).

Ergebnisse Das mittlere Ablationsvolumen für MWA betrug 66,5 cm³ und für RFA 29,2 cm³ (p < 0,01). Die mittlere Ablationsdauer für MWA und RFA betrug 11,2 ± 4,0 min bzw. 16,3 ± 4,7 min (p < 0,01). Es wurden sechs leichte AE dokumentiert (p > 0,05). Alle Behandlungen hatten einen technischen Erfolg und eine technische Wirksamkeitsrate von 100 % (50/50, p = 1,00). Eine LTP innerhalb von 2 Jahren trat bei 1/25 (4 %) in der MWA- und bei 4/25 (16 %) in der RFA-Gruppe auf (p = 0,06). Die IDR innerhalb von 2 Jahren betrug 8/25 (32 %) bei MWA und 14/25 (56 %) bei RFA (p < 0,05). Das mediane DFS betrug 24,5 Monate für die MWA und 13,4 Monate für die RFA (p = 0,02). Die 1-, 2- und 3-Jahres-OS-Raten betrugen 100 %, 80 % und 72 % in der MWA-Gruppe bzw. 72 %, 64 % und 60 % in der RFA-Gruppe (p ≥ 0,14).

Schlussfolgerung Die klinischen Ergebnisse nach MWA- und RFA-Behandlung von HCC waren ähnlich, ohne signifikante Unterschiede bei LTP oder OS. Die MWA zeigt jedoch einen Trend zu einer besseren krankheitsfreien Überlebensrate mit weniger IDR als die RFA hin.

Kernaussagen: 

• MWA ermöglicht größere Ablationsvolumina und eine kürzere Behandlungsdauer als RFA bei Patienten mit HCC.

• MWA zeigt einen Trend zu einer besseren krankheitsfreien Überlebensrate mit weniger intrahepatischen Fernrezidiven im Vergleich zur RFA.

• Die Überlebensraten nach drei Jahren zeigen keinen signifikanten Unterschied zwischen den beiden Methoden.

Zitierweise

• Vogl TJ, Martin SS, Gruber-Rouh T et al. Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial. Fortschr Röntgenstr 2024; 196: 482 – 490

Key words

ablation procedures - MR-imaging - radiofrequency (RF) ablation

Publication History

Received: 17 May 2023

Accepted: 15 October 2023

Article published online:
08 December 2023

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