Comparison of radiofrequency ablation, microwave ablation and high-intensity focused ultrasound for hepatocellular carcinoma: a retrospective study

Wan S Cheung; Wong H She; Simon H Y Tsang; Wing C Dai; Albert C Y Chan; Tan T Cheung

doi:10.1016/j.hpb.2025.01.003

Comparison of radiofrequency ablation, microwave ablation and high-intensity focused ultrasound for hepatocellular carcinoma: a retrospective study

HPB (Oxford). 2025 Jan 7:S1365-182X(25)00003-6. doi: 10.1016/j.hpb.2025.01.003. Online ahead of print.

Authors

Wan S Cheung¹, Wong H She², Simon H Y Tsang³, Wing C Dai³, Albert C Y Chan³, Tan T Cheung³

Affiliations

¹ Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
² Department of Surgery, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China. Electronic address: [email protected].
³ Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China; Department of Surgery, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.

PMID: 39843271
DOI: 10.1016/j.hpb.2025.01.003

Abstract

Background: The recommended first-line treatment for respectable hepatocellular carcinoma (HCC) is surgical resection, but local ablation has gained popularity as a safe alternative. This study aims to compare the effectiveness of radiofrequency ablation (RFA), microwave ablation (MWA) and high-intensity focused ultrasound (HIFU) as first-line treatments for HCC.

Methods: In this single-centre retrospective study, 352 patients receiving RFA, MWA, or HIFU as first-line treatment for HCC were included. Pre- and post-treatment tumour sizes and overall and disease-free survival rates were analysed to compare the three local ablation modalities. Propensity-score matching was used to reduce the bias due to differences in pre-treatment liver function.

Results: Patients receiving HIFU had significantly higher pre-treatment MELD score and Child-Pugh grade. The complete response rates of HIFU patients were significantly lower than those of RFA and MWA groups (p < 0.001) despite propensity-score matching. However, the three groups had similar disease-free survival (p = 0.216) and comparable one-year survival (p = 0.173).

Discussion: HIFU serves as a last resort rescue therapy for patients with poor pre-treatment liver function who are not eligible for other local ablative means. Despite the low complete response rate, the overall survival and disease-free survival rates of patients having HIFU were comparable to those having RFA or MWA.