Percutaneous microwave ablation versus radiofrequency ablation of hepatocellular carcinoma: a meta-analysis of randomized controlled trials

Purpose: Percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) are well-validated interventions for hepatocellular carcinoma (HCC). The purpose of this study was to compare their safety and efficacy through a meta-analysis of randomized controlled trials (RCT).

Methods: MEDLINE, Pubmed, and the Cochrane Library were queried up to September 2020 using the terms "microwave", "radiofrequency", "hepatocellular", and "randomized". Only RCTs investigating MWA versus RFA for HCC were included. Baseline study characteristics, complete ablation rate, ablation time, overall survival, local recurrence, and complication rates were investigated.

Results: Among the five original studies included, a total of 413 and 431 patients were treated with RFA and MWA, respectively. All studies focused on very early and early-stage HCC only (Barcelona Clinic Liver Cancer Stage 0 and A). No statistical significance was observed in terms of complete ablation rate (96.7 vs 96.9%, p = 0.882), overall survival (6 month: 95.7 vs 100%, p = 0.492; 1 year: 91.9 vs 94.1%, p = 0.264; 3 year: 77.5 vs 78.4%, p = 0.905), recurrence-free survival (6 month: 99.1 vs 99.7%, p = 0.717; 1 year: 94.6 vs 93.9%, p = 0.675; 3 year: 76.8 vs 77.1%, p = 0.935), and complication rates (p > 0.05 in all types). The mean ablation time of MWA was significantly shorter than RFA (26.9 vs 14.1 min, p < 0.001).

Conclusion: For very early and early-stage HCC, RFA and MWA are equally safe and effective, though the former is associated with a longer ablation time.