Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article

 

 Permissions and Reprints

Abstract

Purpose The locoregional interventional oncological treatment approach is an accepted modality for liver neoplasms, especially for hepatocellular carcinoma (HCC) and oligonodular liver metastases.

Materials and Methods The main aim of ablation therapies like microwave ablation (MWA) is to eradicate all malignant cells in a minimally invasive technique under imaging guidance while preserving the healthy tissue with a sufficient safety margin (at least 5 mm) surrounding the ablated lesion.

Results Ablation therapy can be performed via a percutaneous, laparoscopic or intraoperative approach under ultrasound, MRI or CT guidance for adequate localization and monitoring of the ablation process.

Conclusion Ablation is the method of choice for oligonodular HCCs ≤ 3 cm. The technical success rate varies from 88 % to 98 % and progression-free survival (PFS) at 3 years from 27 % to 91.7 %. The same criteria apply to the therapy of liver metastases.

Key Points 

• Careful selection of patients proves to be essential for optimum results of MWA

• Interventionists should be familiar with all aspects of complication and rapid assessment of imaging methods in order to evaluate induced damage by thermal ablation

• MWA seems to have some advantages over radiofrequency ablation, like shorter ablation time, less pain, less heat sink effect; however, scientific proof is needed

Citation Format

• Vogl TJ, Nour-Eldin A, Hammerstingl RM et al. Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article. Fortschr Röntgenstr 2017; 189: 1055 – 1066

Zusammenfassung

Hintergrund Der lokoregionale interventionelle onkologische Behandlungsansatz ist eine anerkannte Behandlungsoption bei Lebermalignomen, insbesondere beim hepatozellulären Karzinom (HCC) und oligonodulären Lebermetastasen.

Material und Methode Das Hauptziel der Ablationstherapie wie Mikrowellenablation (MWA) ist es, alle Tumorzellen mittels minimal invasiver Technik unter Bildsteuerung abzutragen, während das umgebende gesunde Gewebe unter Einhaltung eines entsprechenden Sicherheitssaumes (mindestens 5 mm) geschont wird.

Ergebnisse Die Ablationstherapie erfolgt über einen perkutanen, laparoskopischen oder intraoperativen Zugang, und die Läsion wird mittels Ultraschall, MRT oder CT-Steuerung lokalisiert und überwacht.

Schlussfolgerung Ablation ist die Methode der Wahl bei oligonodulären HCC ≤ 3 cm. Die technische Erfolgsrate variiert von 88 bis 98 %; das progressionsfreie Überleben nach 3 Jahren liegt zwischen 27 und 91,7 %. Für die Ablation von Lebermetastasen gelten die gleichen Kriterien.

Kernaussagen 

• Für optimale Ergebnisse zur MWA von Lebertumoren ist die exakte Selektion von Patienten wichtig.

• Interventionisten sollten vertraut sein mit allen Aspekten von möglichen Komplikationen und deren Therapien.

• Die MWA von Lebermalignomen scheint Vorteile gegenüber der RF-Ablation zu haben, wie z.B. kürzere Interventionszeit, weniger Schmerzen und weniger „heat sink effect“. Es fehlen jedoch Daten randomisierter Studien.

• References

• 1 Boyle P, Levin B. (eds) Liver Cancer World Cancer Report. IACR Press; 2008: 350-357
  PubMedGoogle Scholar
• 2 Liu LX, Zhang WH, Jiang HC. Current treatment for liver metastases from colorectal cancer. World J Gastroenterol 2003; 9: 193-200
  CrossrefPubMedGoogle Scholar
• 3 Vogl TJ, Panahi B, Fischer S. et al. Interventional therapy of lung and liver metastases. Onkologe, Springer-Verlag. Berlin Heidelberg: 2014
  PubMedGoogle Scholar
• 4 Ahmed M. Image-Guided Tumor Ablation: Standardization of Terminology and Reporting Criteria – A 10-Year Update. RSNA 2014. J Vasc Interv Radiol 2014; 25: 1706-1708
  CrossrefPubMedGoogle Scholar
• 5 Lahat E, Eshkenazy R, Zendel A. et al. Complications of ablation of liver tumors: a systematic review. Hepatobiliary Surgery and Nutrition 2014; 3: 317-323
  PubMedGoogle Scholar
• 6 Tabuse K, Katsumi M, Kobayashi Y. et al. Microwave surgery: hepatectomy using a microwave tissue coagulator. World J Surg 1985; 9: 136-143
  CrossrefPubMedGoogle Scholar
• 7 Liang P, Wang Y. Microwave ablation of hepatocellular carcinoma. Oncology Suppl 2007; 72 (Suppl. 01) 124-131
  PubMedGoogle Scholar
• 8 Facciorusso A, Di Maso M, Muscatiello N. Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis. Int J Hyperthermia 2016; 32: 339-344
  CrossrefPubMedGoogle Scholar
• 9 Yi Y, Zhang Y, Wei Q. et al. Radiofrequency ablation or microwave ablation combined with transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma by comparing with radiofrequency ablation alone. Chin J Cancer Res 2014; 26: 112-8
  PubMedGoogle Scholar
• 10 Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. Am J Roentgenol 2000; 174: 323-331
  CrossrefPubMedGoogle Scholar
• 11 Sun Y, Cheng Z, Dong L. et al. Comparison of temperature curve and ablation zone between 915- and 2450-MHz cooled-shaft microwave antenna: results in ex vivo porcine livers. European Journal of Radiology 2012; 81: 553-557
  CrossrefPubMedGoogle Scholar
• 12 Yang D, Converse MC, Mahvi DM. et al. Measurement and Analysis of Tissue Temperature During Microwave Liver Ablation. IEEE Trans Biomed Eng 2007; 54: 150-155
  CrossrefPubMedGoogle Scholar
• 13 Liang P, Wang Y, Yu X. et al. Malignant liver tumors: treatment with per-cutaneous microwave ablation-complications among cohort of 1136 patients. Radiology 2009; 251: 933-940
  CrossrefPubMedGoogle Scholar
• 14 Itoh S, Ikeda Y, Kawanaka H. et al. Efficacy of surgical microwave therapy in patients with unresectable hepatocellular carcinoma. Ann Surg Oncol 2011; 18: 3650-3656
  CrossrefPubMedGoogle Scholar
• 15 Li X, Zhang L, Fan W. et al. Comparison of microwave ablation and multipolar radiofrequency ablation, both using a pair of internally cooled interstitial applicators: results in ex vivo porcine livers. Int J Hyperthermia 2011; 27: 240-248
  CrossrefPubMedGoogle Scholar
• 16 Poulou LS, Botsa E, Thanou I. et al. Percutaneous microwave ablation vs. radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol 2015; 7: 1054-1063
  CrossrefPubMedGoogle Scholar
• 17 Yu NC, Lu DS, Raman SS. et al. Hepatocellular carcinoma: microwave ablation with multiple straight and loop antenna clusters – pilot comparison with pathologic findings. Radiology 2006; 239: 269-275
  CrossrefPubMedGoogle Scholar
• 18 Ping Liang, Jie Yu, Ming-De Lu. et al. Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy. World J Gastroenterol 2013; 19: 5430-5438
  CrossrefPubMedGoogle Scholar
• 19 Foltz G. Image-guided percutaneous ablation of hepatic malignancies. Semin Intervent Radiol 2014; 31: 180-186
  Article in Thieme ConnectPubMedGoogle Scholar
• 20 de Baere T, Tselikas L, Yevich S. et al. The role of image-guided therapy in the management of colorectal cancer metastatic disease. Eur J Cancer 2017; 23: 231-242
  PubMedGoogle Scholar
• 21 Barral M, Auperin A, Hakime A. et al. Percutaneous Thermal Ablation of Breast Cancer Metastases in Oligometastatic Patients. Cardiovasc Intervent Radiol 2016; 39: 885-893
  CrossrefPubMedGoogle Scholar
• 22 Alexander ES, Wolf FJ, Machan JT. et al. Microwave ablation of focal hepatic malignancies regardless of size: A 9-year retrospective study of 64 patients. Eur J Radiol 2015; 84: 1083-1090
  CrossrefPubMedGoogle Scholar
• 23 Shibata T, Niinobu T, Ogata N. et al. Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer 2000; 89: 276-284
  CrossrefPubMedGoogle Scholar
• 24 Ziemlewicz TJ, Hinshaw JL, Lubner MG. 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: 62-68
  CrossrefPubMedGoogle Scholar
• 25 Vogl TJ, Zegelman A, Bechstein WO. et al. Treatment of liver metastases of colorectal carcinoma: overview of hyperthermal ablation methods. Dtsch Med Wochenschr 2013; 138: 792-798
  Article in Thieme ConnectPubMedGoogle Scholar
• 26 Moreland AJ, Lubner MG, Ziemlewicz TJ. et al. Evaluation of a Thermoprotective Gel for Hydrodissection During Percutaneous Microwave Ablation: In Vivo Results. Cardiovasc Intervent Radiol 2014 2015; 38: 722-730
  CrossrefPubMedGoogle Scholar
• 27 Chen EA, Neeman Z, Lee FT. et al. Thermal protection with 5% dextrose solution blanket during radiofrequency ablation. Cardiovasc Interv Radiol 2006; 29: 1093-1096
  CrossrefPubMedGoogle Scholar
• 28 Yamakado K, Nakatsuka A, Akeboshi M. et al. Percutaneous radiofrequency ablation of liver neoplasms adjacent to the gastrointestinal tract after balloon catheter interposition. J Vasc Interv Radiol 2003; 14: 1183-1186
  CrossrefPubMedGoogle Scholar
• 29 Park BK, Kim CK. Using an electrode as a lever to increase the distance between renal cell carcinoma and bowel during CT-guided radiofrequency ablation. Eur Radiol 2008; 18: 743-746
  CrossrefPubMedGoogle Scholar
• 30 Zhang M, Liang P, Cheng ZG. et al. Efficacy and safety of artificial ascites in assisting percutaneous microwave ablation of hepatic tumors adjacent to the gastrointestinal tract. Int J Hyperthermia 2014; 30: 134-41
  CrossrefPubMedGoogle Scholar
• 31 Stone MJ, Wood BJ. Emerging local ablation techniques. Semin Intervent Radiol 2006; 23: 85-98
  Article in Thieme ConnectPubMedGoogle Scholar
• 32 Sainani NI, Gervais DA, Mueller PR. et al. Imaging after percutaneous radiofrequency ablation of hepatic tumors. I. Normal findings. Am J Roentgenol 2013; 200: 184-193
  CrossrefPubMedGoogle Scholar
• 33 Wang X, Sofocleous CT, Erinjeri JP. et al. Margin size is an independent predictor of local tumor progression after ablation of colon cancer liver metastases. Cardiovasc Intervent Radiol 2013; 36: 166-175
  CrossrefPubMedGoogle Scholar
• 34 Kim YS, Lee WJ, Rhim H. et al. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (<2 and <5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. Am J Roentgenol 2010; 195: 758-765
  CrossrefPubMedGoogle Scholar
• 35 Sacks D, McClenny TE, Cardella JF. et al. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14: S199-S202
  CrossrefPubMedGoogle Scholar
• 36 Davis CR. Interventional radiological treatment of hepatocellular carcinoma. Cancer Control 2010; 17: 87-99
  CrossrefPubMedGoogle Scholar
• 37 Huo YR, Eslick GD. Microwave Ablation Compared to Radiofrequency Ablation for Hepatic Lesions: A Meta-Analysis. J Vasc Interv Radiol 2015; 26: 1139-1146
  CrossrefPubMedGoogle Scholar
• 38 Vogl TJ, Farshid P, Naguib NNN. et al. Ablation therapy of hepatocellular carcinoma: a comparative study between radiofrequency and microwave ablation. Abdominal Imaging 2015; 40: 1829-1837
  CrossrefPubMedGoogle Scholar
• 39 Zhang L, Wang N, Shen Q. et al. Therapeutic efficacy of percutaneous radiofrequency ablation versus microwave ablation for hepatocellular carcinoma. PLoS One 2013; 8: e76119
  CrossrefPubMedGoogle Scholar
• 40 Liu F, Yu X, Liang P. et al. Contrast-enhanced ultrasound-guided microwave ablation for hepatocellular carcinoma inconspicuous on conventional ultrasound. Int J Hyperthermia 2011; 27: 555-562
  CrossrefPubMedGoogle Scholar
• 41 Abdelaziz AO, Nabeel MM, Elbaz TM. et al. Microwave ablation versus transarterial chemoembolization in large hepatocellular carcinoma: prospective analysis. Scandinavian Journal of Gastroentereology 2015; 50: 479-484
  PubMedGoogle Scholar
• 42 Huang H, Liang P, Yu XL. et al. Safety assessment and therapeutic efficacy of percutaneous microwave ablation therapy combined with percutaneous ethanol injection for hepatocellular carcinoma adjacent to the gallbladder. Int J Hyperthermia 2015; 31: 40-47
  CrossrefPubMedGoogle Scholar
• 43 Ginsburg M, Zivin SP, Wroblewski K. et al. Comparison of Combination Therapies in the Management of Hepatocellular Carcinoma: Transarterial Chemoembolization with Radiofrequency Ablation versus Microwave Ablation. J Vasc Interv Radiol 2015; 26: 330-341
  CrossrefPubMedGoogle Scholar
• 44 Cillo U, Gringeri E, Feltracco P. et al. Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy. Ann Surg Oncol 2015; 22: 2787-2788 doi: 10.1245/s10434-014-4353-7
  CrossrefPubMedGoogle Scholar
• 45 Ai-Xue Sun, Zhi-Li Cheng, Pan-Pan Wu. et al. Clinical outcome of medium-sized hepatocellular carcinoma treated with microwave ablation. World J Gastroenterol  2015; 21: 2997-3004
  CrossrefPubMedGoogle Scholar
• 46 Medhat E, Abdel AzizA, Nabeel M. et al. Value of Microwave Ablation in Treatment of large lesions of Hepatocellular Carcinoma. J Dig Dis 2015; 16: 456-463
  CrossrefPubMedGoogle Scholar
• 47 Ohmoto K, Yoshioka N, Tomiyama Y. et al. Radiofrequency ablation versus percutaneous microwave coagulation therapy for small hepatocellular carcinomas: a retrospective comparative study. Hepatogastroenterology 2007; 54: 985-989
  PubMedGoogle Scholar
• 48 Dong B, Liang P, Yu X. et al. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: results in 234 patients. Am J Roentgenol 2003; 180: 1547-1555
  CrossrefPubMedGoogle Scholar
• 49 Eng OS, Tsang AT, Moore D. et al. Outcomes of Microwave Ablation for Colorectal Cancer Liver Metastases: A Single Center Experience. Journal of Surgical Oncology 2015; 111: 410-413
  CrossrefPubMedGoogle Scholar
• 50 Wang XH, Yu J, Liang P. et al. Percutaneous cooled-tip microwave ablation under ultrasound guidance for primary liver cancer: analysis of major complications in 693 patients. Zhonghua Zhong Liu ZaZhi 2012; 34: 945-949
  PubMedGoogle Scholar
• 51 Li M, Yu XL, Liang P. et al. Percutaneous microwave ablation for liver cancer adjacent to the diaphragm. Int J Hyperthermia 2012; 28: 218-226
  CrossrefPubMedGoogle Scholar
• 52 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
  CrossrefPubMedGoogle Scholar
• 53 Lu MD, Xu HX, Xie XY. et al. Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a retrospective comparative study. J Gastroenterol 2005; 40: 1054-1060
  CrossrefPubMedGoogle Scholar
• 54 Groeschl RT, Pilgrim CH, Hanna EM. et al. Microwave ablation for hepatic malignancies: a multiinstitutional analysis. Ann Surg 2014; 259: 1195-1200
  CrossrefPubMedGoogle Scholar