Microwave ablation in primary and secondary liver tumours: technical and clinical approaches

Figures & data

Table 1. Summary of current literature on treatment of liver malignancies using microwave ablation systems.

						Overall survival rates (%)
Authors (year)	No. of patients	Type of tumour	Follow-up time (months)	Tumour size, cm (range)	LTP rate (%)	1-year	3-year	5-year	Major complication rate (%)
Liang et al., 2012 [26]	1007	HCC	17.3 (3.0–68.9)	2.9 (1.0–18.5)	5.9	91.2	72.5	59.8	2.2
Swan et al., 2013 [28]	54	HCC	11.0 (1.0–33.0)	2.5 (0.5–8.5)	5.2	72.8	58.8	–	7.8
Shi et al., 2014 [29]	117	HCC	37.9 (4.0–99.0)	3.0 (1.0–5.0)	10.2	94	70	52	–
Groeschi et al., 2014 [27]	139	HCC	18.0 (9.0–30.0)	2.6 (0.7–6.0)	9.6	–	38	19	–
Ziemlewicz et al., 2015 [31]	75	HCC	14.0 (1.0–28.0)	2.5 (0.5–7.0)	6.6	76	–	–	0.0
Zhang et al., 2015 [32]	45	HCC	15.0 (3.0–24.0)	3.0 (3.0–8.0)	24.4	95.6	–	–	–
Sun et al., 2015 [33]	182	HCC	17.8 (3.2–37.0)	3.7 (3.0–5.0)	20.3	89	60	–	2.7
Lang et al., 2003 [36]	74	Mets	25.1 (5.0–83.0)	3.1 (0.7–6.8)	13.3	91.4	46.4	29	4.0
Lorentzen et al., 2011 [37]	39	Mets	11.0 (4.0–20.0)	1.5 (0.6–4.0)	9.6	–	–	–	2.5
Liu et al., 2013 [35]	35	Mets	32.2 (–)	2.3 (0.8–5.0)	14.5	82.4	55.8	44	1.1

Figure 1. An 84-year-old woman with a history of cirrhosis and hepatitis C. (A) Contrast-enhanced computed tomography (CECT) image demonstrates an arterial-enhanced lesion in segment IV measuring 4.0 cm (arrow). (B) Lesion was treated with the placement of a single cooled microwave antenna at 40 W for 15 min. (C) A 24-h post-procedural CECT demonstrates the presence of a thick hypervascular peri-ablation halo (triangles). This finding can be seen from the hyperemic reaction that regularly develops around an ablation zone. (D) Four-year follow-up of an arterial-phase (left) and portal-venous phase (right) CECT demonstrates contraction of the ablation zone (arrow) with no evidence of enhancement.

Figure 2. A 67-year-old woman with liver metastasis from colorectal cancer. (A) Pre-ablation MRI (left) of liver lesion (arrow) and CEUS (right) confirming presence of 13 × 14 mm liver lesion (arrow). (B) The lesion was treated with a single water-cooled antenna at 50 W for 6 min (left). Post-ablation image demonstrating hyper-echoic region measuring 34 × 37 mm, representing the ablation zone (right). The goal is to create ablation margins >1 cm beyond tumour boundary. (C) Post-ablation B-mode ultrasound (left) and CEUS (right) showing the ablation zone (anechoic) with the presence of the hypervascular peri-lesional halo. (D) CECT (left) and CEUS (right) demonstrating ablation zones that encompass the entire lesion measuring 32 × 42 mm.

Figure 3. A 79-year-old man with a history of cirrhosis and hepatitis C and prior treatment with surgery and radiofrequency ablation for HCC. (A) CECT (left) and CEUS (right) images demonstrating an arterially enhanced liver lesion (yellow arrows). (B) Ultrasound image showing single gas cooled-antenna (arrowhead) being guided into the HCC (left) and after being treated at 50 W for 5 min (right). This ultrasound image shows progression of treatment via rapid generation of gas inside the liver tissue (arrow). (C) On post-procedural B-mode (left) and CEUS (right) (24 h post-ablation), the image shows presence of a central hypo-echoic area corresponding to the lesion treated, surrounded by a hyper-echoic area which corresponds to the inflammatory region of the ablation zone. (D) A 24-h post-ablation arterial phase CECT (left) and portal-venous phase CECT (right) showing the ablation zone encompassing the lesion (arrows).

Liang P, Yu J, Yu X, Wang X, Wei Q, Yu S, 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;61:1100–1.

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Swan RZ, Sindram D, Martinie JB, Iannitti DA. Operative microwave ablation for hepatocellular carcinoma: complications, recurrence, and long-term outcomes. J Gastrointest Surg 2013;17: 719–29.

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Shi J, Sun Q, Wang Y, Jing X, Ding J, Yuan Q, et al. Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria. J Gastroenterol Hepatol 2014;29:1500–7.

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Groeschl RT, Pilgrim CHC, Hanna EM, Simo KA, Swan RZ, Sindram D, et al. Microwave ablation for hepatic malignancies: a multiinstitutional analysis. Ann Surg 2014;259:1195–200.

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Ziemlewicz TJ, Hinshaw JL, Lubner MG, Brace CL, Alexander ML, Agarwal P, et al. Percutaneous microwave ablation of hepatocellular carcinoma with a gas-cooled system: initial clinical results with 107 tumors. J Vasc Interv Radiol 2015;26:62–8.

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Zhang NN, Lu W, Cheng XJ, Liu JY, Zhou YH, Li F. High-powered microwave ablation of larger hepatocellular carcinoma: evaluation of recurrence rate and factors related to recurrence. Clin Radiol 2015;70:1237–43.

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Sun A-X, Cheng Z-L, Wu P-P, Sheng Y-H, Qu X-J, Lu W, et al. Clinical outcome of medium-sized hepatocellular carcinoma treated with microwave ablation. World J Gastroenterol 2015;21:2997–3004.

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Liang P, Dong B, Yu X, Yang Y, Yu D, Su L, et al. Prognostic factors for percutaneous microwave coagulation therapy of hepatic metastases. Am J Roentgenol 2003;181:1319–25.

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Lorentzen T, Skjoldbye BO, Nolsoe CP. Microwave ablation of liver metastases guided by contrast-enhanced ultrasound: experience with 125 metastases in 39 patients. Ultraschall Med 2011;32:492–6.

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Liu Y, Li S, Wan X, Li Y, Li B, Zhang Y, et al. Efficacy and safety of thermal ablation in patients with liver metastases. Eur J Gastroenterol Hepatol 2013;25:442–6.

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