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

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