Microwave ablation of hepatic tumors with a third generation system: loco‑regional efficacy in a prospective cohort study with intermediate term follow-up

Abstract

Purpose: To evaluate the safety and intermediate-term efficacy of percutaneous microwave ablation (MWA) in primary and secondary liver tumors using a third generation MWA device, under ultrasound guidance.

Patients and methods: Sixty-two patients (median age 74 years, 73 % males) with 69 liver tumors were enrolled in this prospective observational study. Forty-seven patients (76 %) had hepatocellular carcinoma (HCC) and 15 (24 %) metastases. Median follow-up was 3.6 years.

Results: Median tumor diameter at contrast enhanced computed tomography was 23 mm (I–III quartiles, 18 – 31 mm). All procedures were performed percutaneously using a 2.45 GHz generator. Median ablation time was 10 minutes (I–III quartiles, 10 – 14 minutes). A single percutaneous antenna insertion was performed for 56/69 (81 %) of the tumors. Technical success was obtained in all tumors. Primary efficacy at 24 hours was achieved in 68/69 (99 %) tumors. The overall one-year cumulative local tumor progression rate was 15.1 % (95 % CI, 7.7 – 24.8 %) with no significant difference between HCC and metastases (p = 0.26). There was one procedure-related mortality (1.6 %) and one major bleeding (1.6 %).

Conclusion: Microwave ablation is a valid option for thermal ablation of HCC and liver metastases with comparable complication rate to other local ablative procedures.

Zusammenfassung

Einleitung: Die Mikrowellenablation (MWA) ist eine mögliche Alternative zu anderen lokal ablativen Verfahren. Die hier vorgestellte Studie erfolgte zur Überprüfung des Therapieerfolgs und Sicherheit bei primären und sekundären Lebertumoren der Mikrowellenablation.

Patienten und Methoden: Prospektive Beobachtungsstudie an 62 Patienten mit 69 Lebertumoren (medianes Alter: 74 Jahre, 73 % männlich). 47 (76 %) Patienten mit hepatozellulärem Karzinom und 15 (24 %) mit Metastasen. Der mediane Überwachungszeitraum war 3,6 Jahre. Alle Prozeduren wurden mit einem 2,45 Gigahertz MWA-Generator der dritten Generation unter Ultraschallführung durchgeführt.

Ergebnisse: Der mediane Tumordiameter lag bei 23 mm [18 – 31 mm]. Die mittlere Ablationszeit war 10 Minuten [10 – 14 Minuten]. Eine Einzelnadelapplikation erfolgte bei 80 % der Tumoren. Erfolgreiche Primärtherapie bei 98/69 (99 %) Tumoren. Die kumulative Tumorprogression nach 1 Jahr betrug 15,1 % (95 % CI. 7 – 24. 8 %). Die prozedurbezogene Mortalität lag bei 1,6 % (1 Patient). Eine Blutung wurde beobachtet (1,6 %).

Diskussion: Die MWA ist eine effektive Methode zur Thermoablation von primären und sekundären Lebertumoren mit vergleichbarer Komplikationsrate zu anderen ablativen Methoden.

Schlüsselwörter

Abdomen - Ultraschall - Mikrowellen - Ablation - Karzinom - hepatisch - Metastasen

Key words

abdominal - ultrasound - microwaves - ablation techniques - carcinoma - hepatocellular - neoplasm metastasis

• References

• 1 Ahmed M, Brace CL, Lee FT et al. Principles of and advances in percutaneous Ablation. Radiology 2011; 258: 351-369 DOI: 10.1148/radiol.10081634.
• 2 Ding J, Jing X, Liu J et al. Complications of thermal ablation of hepatic tumours: comparison of radiofrequency and microwave ablative techniques. Clin Radiol 2013; 68: 608-615 DOI: 10.1016/j.crad.2012.12.008.
• 3 Koda M, Murawaki Y, Hirooka Y et al. Complications of radiofrequency ablation for hepatocellular carcinoma in a multicenter study: an analysis of 16346 treated nodules in 13283 patients. Hepatol Res 2012; 42: 1058-1064 DOI: 10.1111/j.1872-034X.2012.01025.x.
• 4 Di Vece F, Tombesi P, Ermili F et al. Coagulation areas produced by cool-tip radiofrequency ablation and microwave ablation using a device to decrease back-heating effects: a prospective pilot study. Cardiovasc Intervent Radiol 2014; 37: 723-729 DOI: 10.1007/s00270-013-0733-9.
• 5 Groeschl RT, Pilgrim CHC, Hanna EM et al. Microwave ablation for hepatic malignancies: a multiinstitutional analysis. Ann Surg 2014; 259: 1195-2000 DOI: 10.1097/SLA.0000000000000234.
• 6 Ding J, Jing X, Liu J et al. Comparison of two different thermal techniques for the treatment of hepatocellular carcinoma. Eur J Radiol 2013; 82: 1379-1384 DOI: 10.1016/j.ejrad.2013.04.025.
• 7 Liu Y, Zheng Y, Li S et al. Percutaneous microwave ablation of larger hepatocellular carcinoma. Clin Radiol 2013; 68: 21-26 DOI: 10.1016/j.crad.2012.05.007.
• 8 Lorentzen T, Skjoldbye BO, Nolsoe CP. Microwave ablation of liver metastases guided by contrast-enhanced ultrasound: experience with 125 metastases in 39 patients. Ultraschall in Med 2011; 32: 492-496 DOI: 10.1055/s-0029-1246002.
• 9 Martin RCG, Scoggins CR, McMasters KM. Microwave hepatic ablation: initial experience of safety and efficacy. J Surg Oncol 2007; 96: 481-486 DOI: 10.1002/jso.20750.
• 10 Lam VW, Ng KK, Chok KSH et al. Incomplete ablation after radiofrequency ablation of hepatocellular carcinoma: analysis of risk factors and prognostic factors. Ann Surg Oncol 2008; 15: 782-790 DOI: 10.1245/s10434-007-9733-9.
• 11 Chiang J, Hynes K, Brace CL. Flow-dependent vascular heat transfer during microwave thermal ablation. Conf Proc IEEE Eng Med Biol Soc 2012; 2012: 5582-5585 DOI: 10.1109/EMBC.2012.6347259.
• 12 Longo I, Gentili GB, Cerretelli M et al. A coaxial antenna with miniaturized choke for minimally invasive interstitial heating. IEEE Trans Biomed Eng 2003; 50: 82-88 DOI: 12617527.
• 13 Brace CL, Laeseke PF, Sampson LA et al. Microwave ablation with a single small-gauge triaxial antenna: in vivo porcine liver model. Radiology 2007; 242: 435-440 DOI: PMC1945245.
• 14 Brace CL, Sampson LA, Hinshaw JL et al. Radiofrequency ablation: simultaneous application of multiple electrodes via switching creates larger, more confluent ablations than sequential application in a large animal model. J Vasc Interv Radiol 2009; 20: 118-124 DOI: 10.1016/j.jvir.2008.09.021.
• 15 Bhardwaj N, Strickland AD, Ahmad F et al. Microwave ablation for unresectable hepatic tumours: clinical results using a novel microwave probe and generator. Eur J Surg Oncol 2010; 36: 264-268 DOI: 10.1016/j.ejso.2009.10.006.
• 16 Iannitti DA, Martin RCG, Simon CJ et al. Hepatic tumor ablation with clustered microwave antennae: the US Phase II Trial. HPB (Oxford) 2007; 9: 120-124 DOI: 10.1080/13651820701222677.
• 17 Livraghi T, Goldberg SN, Lazzaroni S et al. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 2000; 214: 761-768
• 18 Cavagnaro M, Amabile C, Bernardi P et al. A minimally invasive antenna for microwave ablation therapies: design, performances, and experimental assessment. IEEE Trans Biomed Eng 2011; 58: 949-959 DOI: 10.1109/TBME.2010.2099657.
• 19 Meloni MF, Andreano A, Bovo G et al. Acute portal venous injury after microwave ablation in an in vivo porcine model: a rare possible complication. J Vasc Interv Radiol 2011; 22: 947-951 DOI: 10.1016/j.jvir.2011.03.012.
• 20 Ahmed M. Technology Assessment Committee of the Society of Interventional Radiology. Image-guided tumor ablation: standardization of terminology and reporting criteria – a 10-year update: supplement to the consensus document. J Vasc Interv Radiol 2014; 25: 1706-1708 DOI: 10.1016/j.jvir.2014.09.005.
• 21 Sacks D, McClenny TE, Cardella JF et al. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14: S199-S202
• 22 Gillams AR, Lees WR. Radiofrequency ablation of colorectal liver metastases. Abdom Imaging 2005; 30: 419-426 DOI: 10.1007/s00261-004-0256-6.
• 23 Meloni MF, Andreano A, Franza E et al. Contrast enhanced ultrasound: should it play a role in immediate evaluation of liver tumors following thermal ablation?. Eur J Radiol 2012; 81: e897-e902 DOI: 10.1016/j.ejrad.2012.05.002.
• 24 Brown LD, Cai TT, DasGupta A. Interval estimation for a binomial proportion. Statist Sci 2001; 16: 101-133 DOI: 10.1214/ss/1009213286.
• 25 Haller B, Schmidt G, Ulm K. Applying competing risks regression models: an overview. Lifetime Data Anal 2013; 19: 33-58 DOI: 10.1007/s10985-012-9230-8.
• 26 Marubini E, Valsecchi MG. Analysing Survival Data from Clinical Trials and Observational Studies. John Wiley & Sons 2004;
• 27 Choi D, Lim HK, Rhim H et al. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol 2007; 17: 684-692 DOI: 10.1007/s00330-006-0461-5.
• 28 Lencioni R, Crocetti L. Local-regional treatment of hepatocellular carcinoma. Radiology 2012; 262: 43-58 DOI: 10.1148/radiol.11110144.
• 29 Liang P, Yu J, Yu X et al. Percutaneous cooled-tip microwave ablation under ultrasound guidance for primary liver cancer: a multicentre analysis of 1363 treatment-naive lesions in 1007 patients in China. Gut 2012; 61: 1100-1101 DOI: 10.1136/gutjnl-2011-300975.
• 30 Cillo U, Noaro G, Vitale A et al. Laparoscopic microwave ablation in patients with hepatocellular carcinoma: a prospective cohort study. HPB (Oxford) 2014; 16: 979-986 DOI: 10.1111/hpb.12264.
• 31 European Association for Study of Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Eur J Cancer 2012; 48: 599-641 DOI: 10.1016/j.ejca.2011.12.021.
• 32 Mulier S, Ni Y, Jamart J et al. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 2005; 242: 158-171 DOI: 00000658-200508000-00003.
• 33 Ahmed M, Liu Z, Humphries S et al. Computer modeling of the combined effects of perfusion, electrical conductivity, and thermal conductivity on tissue heating patterns in radiofrequency tumor ablation. Int J Hyperthermia 2008; 24: 577-588 DOI: 10.1080/02656730802192661.
• 34 Dodd 3rd GD, Dodd NA, Lanctot AC et al. Effect of variation of portal venous blood flow on radiofrequency and microwave ablations in a blood-perfused bovine liver model. Radiology 2013; 267: 129-136 DOI: 10.1148/radiol.12120486.
• 35 Bertot LC, Sato M, Tateishi R et al. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol 2011; 21: 2584-2596 DOI: 10.1007/s00330-011-2222-3.
• 36 Livraghi T, Meloni F, Solbiati L et al. Collaborative Italian Group using AMICA system. Complications of microwave ablation for liver tumors: results of a multicenter study. Cardiovasc Intervent Radiol 2012; 35: 868-874 DOI: 10.1007/s00270-011-0241-8.
• 37 Dietrich CF, Lorentzen T, Sidhu PS et al. An Introduction to the EFSUMB Guidelines on Interventional Ultrasound (INVUS). Ultraschall in Med 2015; 36: 460-463
• 38 Lorentzen T, Nolsoe CP, Ewertsen C et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (long Version). Ultraschall Med 2015; 36: E1-E14
• 39 Lorentzen T, Nolsoe CP, Ewertsen C et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (Short Version). Ultraschall in Med 2015; 36: 464-472
• 40 Sidhu PS, Brabrand K, Cantisani V et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Ultraschall in Med 2015; 36: E15-E35
• 41 Sidhu PS, Brabrand K, Cantisani V et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Ultraschall in Med 2015; 36: 566-580
• 42 Dietrich CF, Lorentzen T, Appelbaum L et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III. Ultraschall in Med 2015;
• 43 Fusaroli P, Jenssen C, Hocke M et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V. Ultraschall in Med 2015;
• 44 Jenssen C, Brkljacic B, Hocke M et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part VI. Ultraschall in Med 2015;
• 45 Jenssen C, Hocke M, Fusaroli P et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version). Ultraschall in Med 2015;
• 46 Dietrich CF. EFSUMB guidelines 2015 on interventional ultrasound. Med Ultrason 2015; 17: 521-527
• 47 Dietrich CF, Cui XW, Appelbaum L et al. Local Ablative Procedures of the liver. Z Gastroenterol 2015; 53: 579-590