Retrospective evaluation of RFA and MWA for the treatment of HCC at the University Medical Center Hamburg 2008 – 2016

Purpose:

Ablation procedures are a recommended treatment option for patients with early hepatocellular carcinoma (HCC), who are not suitable for resection. The aim of this study was to compare the outcome and safety profile in a large cohort of patients with HCC receiving microwave (MWA) or radiofrequency ablation (RFA) at the University Medical Center Hamburg-Eppendorf.

Materials and Methods:

In this retrospective longitudinal single-center study we screened 987 patient records, who were diagnosed with HCC between January 2008 and December 2016 at our institution. Data on initial diagnosis, etiology of liver disease, liver function, BCLC stage, laboratory values, radiological response were recorded. Final data cut was 31.12.2017.

Results:

The overall cohort included 987 patients (800 men and 187 women) with a median age of 65 years (18 – 90 years). 91% presented with underlying liver cirrhosis at the time of HCC diagnosis. The main risk factors were: 37.6% alcohol-associated, 21.1% and 13.2% chronic hepatitis C or B, respectively, representing a typical western patient cohort. For our final analysis we were able to include 63 patients, who received an ablation treatment; 34 patients were treated with RFA (75 procedures) and 29 with MWA (76 procedures). The median OS was 27 months in the MWA group and 32 months in the RFA group (p = 0.98). Median recurrence-free survival (RFS) was 20 months in the MWA cohort and 21 months in the RFA cohort (p = 0.34). In the MWA group, a total of ten (13.2%) complications (CTCAE grade 1 or 2) occurred: 2 subcapsular hematomas, 2 events of abdominal pain, 5 superficial bleedings and 2 infections. Nine (12.0%) complications occurred in the RFA cohort: 1 patient died due to arterial bleeding, 1 major bile leakage and subcapsular hematoma, 5 events of diffuse abdominal pain, and 2 superficial bleedings.

Conclusion:

Our analysis demonstrated similar efficacy of both treatment modalities with comparable OS and RFS. Additionally, the safety profile was also comparable, mainly short-term abdominal pain, however one patient died due to an arterial bleeding in the RFA group.