Microwave Ablation Versus Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Literature Search and Characteristics of Included Studies
2.2. Quality Assessment
2.3. Complete Response
2.4. Survival Outcomes
2.5. Recurrence and Safety
3. Discussion
4. Materials and Methods
4.1. Search Strategy and Selection Criteria
4.2. Data Abstraction and Quality Assessment
4.3. Outcomes Assessed
4.4. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Study, Year | Location; Time Period; Follow-Up | MWA, Number of Patients | RFA, Number of Patients | Multifocal/Bilobar Disease | Number of Nodules/Max Nodule Size (cm) |
---|---|---|---|---|---|
Abdelaziz, 2014 [18] | Egypt; NR; 2 years | AMICA® GEM machine delivering frequency of 2450 MHz through 14 gages (150 and 200 mm) cooled shift electrodes; 66 | Performed using 18 gauge (200 mm) internally Cool tip electrodes (Radionics®) connected to a 500-KHz radiofrequency generator; 45 | MWA: 9 (13.6%)/0 (0%) RFA: 8 (17.7%)/2 (4.4%) | MWA: 76/2.9 ± 0.97 RFA: 52/2.95 ± 1.03 |
Chong, 2020 [19] | Hong Kong; 2011–2017; 5 years | Microwave needle with various power and duration setting depending on tumor size; 47 | Cool-tip RFA needles of various sizes; 46 | MWA: 4 (8.5%)/NR RFA: 7 (15.2%)/NR | MWA: NR/3.1 (2–4.5) RFA: NR/2.8 (2–5.5) |
Kamal, 2019 [20] | Egypt; 2017–2018; 1 year | A 14 gauge 200 mm disposable MWA probe (AMICA probe MW) and a 2.45 GHz generator (AMICA® GEN); 28 | RITA StarBurst XL needle was used complying with manufacturer’s instructions; 28 | MWA: 4 (14.2%)/NR RFA: 6 (21.4%)/NR | MWA: 34/3.25 ± 0.92 RFA: 34/3.28 ± 0.91 |
Qian 2012 [21] | China; 2009–2010; 1 year | MWA with 100 W for 8 min; 22 | Single-application ablation in an automatic mode for 12 min; 20 | MWA: 0 (0%)/0 (0%) RFA: 0 (0%)/0 (0%) | MWA: 22/2.1 ± 0.4 RFA: 20/2 ± 0.5 |
Shibata, 2002 [22] | Japan; 1999–2000; 2 years | MW generator which emits a 2450-MHz microwave, and a MW electrode 1.6 mm in diameter and 25 cm in length; 36 | Monopolar-array 15-gauge needle electrode with 8 or 10 hook-shaped expandable electrode tines delivering 460-kHz frequency; 36 | MWA: NR/NR RFA: NR/NR | MWA: 46/2.2 (0.9–3.4) RFA: 48/2.3 (1–3.7) |
Vietti Violi, 2018 [23] | France/Switzerland; 2011–2015; 2 years | 15-gauge liquid-cooled antenna and a 2·45 GHz generator with a power of 140 W; 71 | 200 W generator in the impedance control mode and a clustered internally cooled electrode; 73 | MWA: 24 (33%)/NRRFA: 26 (35%)/NR | MWA: 98/1.8 ± 0.65 RFA: 104/1.8 ± 0.71 |
Yu, 2017 [24] | China; 2008–2015; 5 years | Cooled-shaft system; 203 | Cooled-shaft system; 200 | MWA: NR/NR RFA: NR/NR | MWA: 265/2.7 ± 1 RFA: 251/2.6 ± 1 |
Variable | Subgroup | No. of Studies | No. of Patients | RR (95% CI) | Within-Group Heterogeneity (I2) |
---|---|---|---|---|---|
Nodule Size | ≤3 cm | 5 | MWA: 402 RFA: 370 | 1.00 (0.99–1.01) | 0% |
>3 cm | 4 | MWA: 105 RFA: 105 | 1.00 (0.87–1.13) | 42% | |
Study Location | East | 4 | MWA: 380 RFA: 365 | 0.99 (0.95–1.03) | 32% |
West/Africa | 3 | MWA: 208 RFA: 190 | 1.00 (0.96–1.05) | 0% | |
Quality | High quality trials | 3 | MWA: 191 RFA: 198 | 0.98 (0.93–1.02) | 0% |
Variable | Time Point | No. of Studies | No. of Patients | RR (95% CI) | Within-Group Heterogeneity (I2) |
---|---|---|---|---|---|
Survival Rate | 1-year | 4 | MWA: 387 RFA: 364 | 1.05 (0.96–1.15) | 81% |
2-year | 3 | MWA: 184 RFA: 164 | 1.03 (0.89–1.18) | 14% | |
3-year | 2 | MWA: 250 RFA: 246 | 0.99 (0.91–1.09) | 0% | |
5-year | 2 | MWA: 250 RFA: 246 | 0.91 (0.81–1.03) | 0% | |
Disease-Free survival Rate | 1-year | 6 | MWA: 407 RFA: 403 | 1.00 (0.96–1.04) | 0% |
2-year | 4 | MWA: 220 RFA: 200 | 0.94 (0.84–1.06) | 0% | |
3-year | 2 | MWA: 250 RFA: 246 | 1.06 (0.93–1.21) | 0% | |
5-year | 2 | MWA: 250 RFA: 246 | 3.66 (1.32–42.27) | 69% | |
Recurrence | Local Recurrence Rate | 6 | MWA: 426 RFA: 402 | 0.70 (0.43–1.14) | 27% |
Distant Recurrence Rate | 3 | MWA: 116 RFA: 93 | 0.60 (0.39–0.92) | 0% | |
Adverse Events | Adverse Event Rate | 7 | MWA: 473 RFA: 448 | 1.06 (0.48–2.34) | 13% |
Variable | No. of Studies | No. of patients | Mean Difference (95% CI) | Within-Group Heterogeneity (I2) | |
Number of Sessions | 6 | MWA: 407 RFA: 403 | 0.08 (−0.07 to 0.23) | 92% |
Trial | MWA | RFA |
---|---|---|
Abdelaziz, 2014 [18] | Hematoma: 1 patient Burn: 1 patient | Hematoma: 2 patients Burn: 1 patient Pleural effusion: 2 patients |
Chong, 2020 [19] | Ileus: 1 patient (2.1%) | Ascites: 1 patient (2.2%) |
Kamal, 2019 [20] | Bleeding: 1 patient (3.6%) Hematemesis: 1 patient (3.6%) | None |
Qian, 2012 [21] | None | None |
Shibata, 2002 [22] | Abscesses: 2 patients Hematoma: 1 patient Cholangitis: 1 patient | Necrosis: 1 patient |
Vietti Violi, 2018 [23] | Bleeding: 2 patients (2%) | Pneumothorax: 1 patient Bleeding: 1 patient Necrosis: 1 patient |
Yu, 2017 [24] | Overall: 7 patients (3.4%) | Overall: 5 patients (2.5%) |
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Facciorusso, A.; Abd El Aziz, M.A.; Tartaglia, N.; Ramai, D.; Mohan, B.P.; Cotsoglou, C.; Pusceddu, S.; Giacomelli, L.; Ambrosi, A.; Sacco, R. Microwave Ablation Versus Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials. Cancers 2020, 12, 3796. https://doi.org/10.3390/cancers12123796
Facciorusso A, Abd El Aziz MA, Tartaglia N, Ramai D, Mohan BP, Cotsoglou C, Pusceddu S, Giacomelli L, Ambrosi A, Sacco R. Microwave Ablation Versus Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials. Cancers. 2020; 12(12):3796. https://doi.org/10.3390/cancers12123796
Chicago/Turabian StyleFacciorusso, Antonio, Mohamed A. Abd El Aziz, Nicola Tartaglia, Daryl Ramai, Babu P. Mohan, Christian Cotsoglou, Sara Pusceddu, Luca Giacomelli, Antonio Ambrosi, and Rodolfo Sacco. 2020. "Microwave Ablation Versus Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials" Cancers 12, no. 12: 3796. https://doi.org/10.3390/cancers12123796