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. 2019 Aug 13:12:6407-6438.
doi: 10.2147/OTT.S204340. eCollection 2019.

Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Mrudula B Glassberg  1 , Sudip Ghosh  2 , Jeffrey W Clymer  3 , Rana A Qadeer  4 , Nicole C Ferko  4 , Behnam Sadeghirad  4 , George Wj Wright  4 , Joseph F Amaral  2
Affiliations

Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Mrudula B Glassberg et al. Onco Targets Ther. .

Abstract

Purpose: Percutaneous ablation techniques, including microwave ablation (MWA) and radiofrequency ablation (RFA), have become important minimally invasive treatment options for liver cancer. This systematic review compared MWA with RFA for treatment of liver cancer.

Methods: The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for randomized and observational studies published from 2006 onwards. A random-effects model was used for meta-analyses and local tumor progression (LTP), technique efficacy, overall survival (OS), disease-free survival (DFS), intrahepatic de novo lesions (IDL), extrahepatic metastases (EHM), length of stay (LOS), and complications were analyzed. Subgroup and sensitivity analyses were also conducted.

Results: Of 1379 studies identified, 28 randomized and observational studies met inclusion criteria. The main analysis demonstrated that LTP was significantly reduced by 30% with MWA versus RFA (RR=0.70; P=0.02) (all studies) and by 45% with MWA versus RFA (RR=0.55; P=0.007) (randomized studies only). There were no significant differences between MWA and RFA for other efficacy and safety outcomes. Higher frequency (2450 MHz) and larger tumor size (≥2.5 cm) are amongst variables that may be associated with improved outcomes for MWA. Sensitivity analyses were generally congruent with the main results.

Conclusion: MWA is at least as safe and effective as RFA for treating liver cancer and demonstrated significantly reduced LTP rates. Future studies should assess time and costs associated with these two treatment modalities.

Keywords: hepatocellular carcinoma; liver cancer; meta-analysis; microwave ablation; radiofrequency ablation.

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Conflict of interest statement

SG, JWC, MBG, and JFA are employees of Ethicon, Inc. (manufacturer of Neuwave microwave ablation instrumentation). RAQ, NCF, BS, and GWJW are employees of Cornerstone Research Group, who were sponsored to perform this study by Ethicon, Inc. MBG reports stocks and stock options from Johnson & Johnson during the conduct of the study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagram.Abbreviations: PRISM, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SLR, systematic literature review; MWA, microwave ablation; RFA, radiofrequency ablation.
Figure 2
Figure 2
Forest plot of random-effects meta-analysis results for LTP (P=0.02), stratified by RCTs (P=0.01) versus observational studies (P=0.07). Abbreviations: LTP, local tumor progression; RCT, randomized control trial.
Figure 3
Figure 3
Weighted one-, three-, and five-year OS and DFS for MWA and RFA. Notes: The error bars represent the 95% CIs for each estimate. Abbreviations: DFS, disease-free survival; MWA, microwave ablation; OS, overall survival; RFA, radiofrequency ablation.
Figure 4
Figure 4
Summary of meta-analyses. Abbreviations: DFS, disease-free survival; EHM, extrahepatic metastasis; IDL, intrahepatic de novo lesions; OS, overall survival.
Figure 5
Figure 5
Funnel plot assessing publication bias for LTP in 18 studies. Red points indicate RCTs and blue points indicate observational studies. Abbreviation: LTP, local tumor progression; MWA, microwave ablation; RCT, randomized control trial; RFA, radiofrequency ablation.
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