Habibollahi Peiman, Sheth Rahul A, Cressman Erik N K
Department of Interventional Radiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2020 Dec 31;13(1):104. doi: 10.3390/cancers13010104.
Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most widely studied and applied ablation techniques for treating primary and secondary liver tumors. These techniques are considered curative for small hepatic tumors, with post-ablation outcomes most commonly assessed by an imaging follow up. However, there is increasing evidence of a discrepancy between radiological and pathological findings when ablated lesions are evaluated following liver resection or liver transplantation. A comprehensive review of the available literature reporting the complete pathological response (cPR) following RFA and MWA was performed to estimate the success rate and identify the factors associated with treatment failure. Following RFA, cPR is reported in 26-96% of tumors compared to 57-95% with MWA. Larger tumor size and vessels larger than 3 mm adjacent to the treated tumor are the most important factors identified by previous studies associated with viable residual tumors after RFA. Correlating post-ablation radiological studies with pathological findings shows that computed tomography (CT) and magnetic resonance imaging (MRI) have low sensitivity but high specificity for detecting residual viable or recurrent hepatocellular carcinoma (HCC) tumors. There are promising recent reports combining multiprobe ablation techniques with three-dimensional treatment planning software and stereotactic-aiming instrumentation to achieve more than 90% cPR in both small and large HCC tumors. In conclusion, the reported success for achieving cPR in HCC following RFA and MWA is highly variable in different studies and decreases with increasing lesion size and unfavorable tumor characteristics. Very few studies have reported a high rate of cPR. As these studies are single-center and retrospective, they need to be further validated and reproduced in other clinical settings.
射频消融（RFA）和微波消融（MWA）是治疗原发性和继发性肝肿瘤研究和应用最为广泛的消融技术。这些技术被认为对小肝癌具有治愈性，消融后的疗效最常通过影像学随访进行评估。然而，越来越多的证据表明，在肝切除或肝移植后评估消融病灶时，影像学和病理学结果之间存在差异。我们对现有文献进行了全面综述，报告了RFA和MWA后的完全病理缓解（cPR）情况，以估计成功率并确定与治疗失败相关的因素。RFA后，26%-96%的肿瘤报告有cPR，而MWA为57%-95%。肿瘤体积较大以及治疗肿瘤附近有大于3mm的血管是既往研究确定的与RFA后存在存活残留肿瘤相关的最重要因素。将消融后的影像学研究与病理结果相关联表明，计算机断层扫描（CT）和磁共振成像（MRI）在检测残留存活或复发性肝细胞癌（HCC）肿瘤方面敏感性低但特异性高。最近有一些很有前景的报告，将多探头消融技术与三维治疗计划软件和立体定向瞄准仪器相结合，在小肝癌和大肝癌中均实现了超过90%的cPR。总之，不同研究中报道的RFA和MWA后HCC实现cPR的成功率差异很大，且随着病灶大小增加和肿瘤特征不利而降低。很少有研究报告有高cPR率。由于这些研究是单中心回顾性的，需要在其他临床环境中进一步验证和重复。
