Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update
Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update
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DOI：
10.1634/theoncologist.2018-0337
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发表时间：
2019-10-01
期刊：
影响因子：
5.8
通讯作者：
Curley, Steven A.
中科院分区：
文献类型：
--
作者：
Izzo, Francesco;Granata, Vincenza;Curley, Steven A.
本文综述了射频消融（RFA）和微波消融（MWA）治疗原发性肝肿瘤和肝转移瘤的方法。仅保留了报告RFA和MWA对肝脏安全性和有效性的研究。我们发现40项临床研究符合纳入标准。RFA因其有效性、可重复性、低并发症发生率和可用性而成为一种既定的治疗方式。MWA与RFA相比有几个优点，这可能使其在治疗肝脏肿瘤方面更具吸引力。根据文献，接受RFA治疗的肝细胞癌（HCC）患者的总生存期、局部复发、并发症发生率、无病生存期和死亡率在53.2 +/- 3.0个月至66个月之间、59.8%至63.1%之间、2%至10.5%之间、22.0 +/- 2.6个月至39个月之间，0%~ 1.2%。根据文献，MWA治疗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）在22个月（病灶直径>3 cm）和50个月（病灶直径= 3 cm或接近大血管）之间变化，与其大小无关。尽管射频消融（RFA）和微波消融（MWA）的技术特征相似，但差异来自用于产生热量的物理现象。RFA因其有效性、可重复性、低并发症发生率和可用性而成为一种既定的治疗方式。MWA与RFA相比有几个优点，这可能使其在治疗肝脏肿瘤方面比RFA更具吸引力。MWA的受益是改善对流特征、更高的恒定瘤内温度、更快的消融时间以及使用多个穿刺针同时治疗多个病变的能力。当肿瘤直径>= 3 cm或接近大血管时，MWA应被视为首选技术，与其大小无关。
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 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.