Divisions of Hepatobiliary Surgery, "Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale", Naples, Italy.
Divisions of Radiology, "Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale", Naples, Italy
Oncologist. 2019 Oct;24(10):e990-e1005. doi: 10.1634/theoncologist.2018-0337. Epub 2019 Jun 19.
This article provides an overview of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of primary liver tumors and hepatic metastasis. Only studies reporting RFA and MWA safety and efficacy on liver were retained. We found 40 clinical studies that satisfied the inclusion criteria. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive to treat hepatic tumors. According to the literature, the overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with hepatocellular carcinoma (HCC) treated with RFA vary between 53.2 ± 3.0 months and 66 months, between 59.8% and 63.1%, between 2% and 10.5%, between 22.0 ± 2.6 months and 39 months, and between 0% and 1.2%, respectively. According to the literature, overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with HCC treated with MWA (compared with RFA) vary between 22 months for focal lesion >3 cm (vs. 21 months) and 50 months for focal lesion ≤3 cm (vs. 27 months), between 5% (vs. 46.6%) and 17.8% (vs. 18.2%), between 2.2% (vs. 0%) and 61.5% (vs. 45.4%), between 14 months (vs. 10.5 months) and 22 months (vs. no data reported), and between 0% (vs. 0%) and 15% (vs. 36%), respectively. According to the literature, the overall survival, local recurrence, complication rates, and mortality in liver metastases patients treated with RFA (vs. MWA) are not statistically different for both the survival times from primary tumor diagnosis and survival times from ablation, between 10% (vs. 6%) and 35.7% (vs. 39.6), between 1.1% (vs. 3.1%) and 24% (vs. 27%), and between 0% (vs. 0%) and 2% (vs. 0.3%). MWA should be considered the technique of choice in selected patients, when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size. IMPLICATIONS FOR PRACTICE: Although technical features of the radiofrequency ablation (RFA) and microwave ablation (MWA) are similar, the differences arise from the physical phenomenon used to generate heat. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive than RFA to treat hepatic tumors. The benefits of MWA are an improved convection profile, higher constant intratumoral temperatures, faster ablation times, and the ability to use multiple probes to treat multiple lesions simultaneously. MWA should be considered the technique of choice when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size.
本文概述了射频消融（RFA）和微波消融（MWA）在原发性肝癌和肝转移瘤治疗中的应用。我们只保留了报告 RFA 和 MWA 治疗肝脏安全性和疗效的研究。我们发现符合纳入标准的临床研究有 40 项。由于 RFA 具有疗效确切、可重复性好、并发症发生率低、应用广泛等优点，已成为一种成熟的治疗方法。与 RFA 相比，MWA 具有一些优势，这可能使其更具吸引力来治疗肝肿瘤。文献报道，接受 RFA 治疗的肝细胞癌（HCC）患者的总生存率、局部复发率、并发症发生率、无病生存率和死亡率分别为 53.2±3.0 个月至 66 个月、59.8%至 63.1%、2%至 10.5%、22.0±2.6 个月至 39 个月和 0%至 1.2%。文献报道，接受 MWA 治疗的 HCC 患者的总生存率、局部复发率、并发症发生率、无病生存率和死亡率（与 RFA 相比）分别为：病灶直径＞3cm 的患者为 22 个月（vs.21 个月），病灶直径≤3cm 的患者为 50 个月（vs.27 个月）；5%（vs.46.6%）和 17.8%（vs.18.2%）；2.2%（vs.0%）和 61.5%（vs.45.4%）；14 个月（vs.10.5 个月）和 22 个月（vs.无数据报道）；0%（vs.0%）和 15%（vs.36%）。文献报道，RFA 治疗肝转移瘤患者的总生存率、局部复发率、并发症发生率和死亡率（与 MWA 相比）在从原发性肿瘤诊断开始和从消融开始的生存时间方面均无统计学差异，分别为 10%（vs.6%）和 35.7%（vs.39.6%）、1.1%（vs.3.1%）和 24%（vs.27%）以及 0%（vs.0%）和 2%（vs.0.3%）。对于直径≥3cm 的肿瘤或靠近大血管的肿瘤，无论肿瘤大小如何，MWA 均应作为首选治疗方法。
虽然射频消融（RFA）和微波消融（MWA）的技术特点相似，但产生热量的物理现象不同。由于 RFA 具有疗效确切、可重复性好、并发症发生率低、应用广泛等优点，已成为一种成熟的治疗方法。与 RFA 相比，MWA 具有一些优势，这可能使其更具吸引力来治疗肝肿瘤。MWA 的优点包括改进的对流分布、更高的恒定肿瘤内温度、更快的消融时间以及同时使用多个探头治疗多个病灶的能力。对于直径≥3cm 的肿瘤或靠近大血管的肿瘤，无论肿瘤大小如何，MWA 均应作为首选治疗方法。
