Microwave ablation of hepatocellular carcinoma

Abstract

Although surgical resection is still the optimal treatment option for early-stage hepatocellular carcinoma (HCC) in patients with well compensated cirrhosis, thermal ablation techniques provide a valid non-surgical treatment alternative, thanks to their minimal invasiveness, excellent tolerability and safety profile, proven efficacy in local disease control, virtually unlimited repeatability and cost-effectiveness. Different energy sources are currently employed in clinics as physical agents for percutaneous or intra-surgical thermal ablation of HCC nodules. Among them, radiofrequency (RF) currents are the most used, while microwave ablations (MWA) are becoming increasingly popular. Starting from the 90s', RF ablation (RFA) rapidly became the standard of care in ablation, especially in the treatment of small HCC nodules; however, RFA exhibits substantial performance limitations in the treatment of large lesions and/or tumors located near major heat sinks. MWA, first introduced in the Far Eastern clinical practice in the 80s', showing promising results but also severe limitations in the controllability of the emitted field and in the high amount of power employed for the ablation of large tumors, resulting in a poor coagulative performance and a relatively high complication rate, nowadays shows better results both in terms of treatment controllability and of overall coagulative performance, thanks to the improvement of technology. In this review we provide an extensive and detailed overview of the key physical and technical aspects of MWA and of the currently available systems, and we want to discuss the most relevant published data on MWA treatments of HCC nodules in regard to clinical results and to the type and rate of complications, both in absolute terms and in comparison with RFA.

Keywords: Complications; Hepatocellular carcinoma; Laparoscopic microwave ablation; Microwave ablation; Percutaneous microwave ablation; Thermal ablation.

Figure 1

Contrast-enhanced computed tomography scan shows, in the region surrounding what was the probe active tip position during the ablation (white arrow), an inner hyper-dense core contrasting with an outer thicker and hypo-dense annulus.

Figure 2

Time-lapse of ultrasound-guided percutaneous microwave ablation of medium-sized hepatocellular carcinoma of the right lobe. A: Ultrasound evaluation before ablation; B: Needle insertion; C: Hyperechoic boiling effect in the ablation area during the procedure; D: One month later ultrasound evaluation: The inner hyperechoic track corresponds to the position of the active probe.