Aim: to evaluate long-term outcomes in patients with CRLM treated with RFA and systemic therapy with intention analysis to treat
Study data: 99 patients with 202 lesions; unresectable lesions or refused surgery Conclusions: 5- and 10-year survivals were 47.8% and 18%, respectively; overall, addition of RFA to chemotherapy achieved local control in large majority of metachronous CRLM
Aim: to compare QOLAS between HR and RFA for HCCs <5 cm in diameter Study data: Markov model generated data from multiple studies Conclusions: HR provides better QOLAS as RFA is associated with increased rate of recurrence that requires multiple sessions; however, for older people, RFA appears to be the best therapeutic option; if the probability of ablation for recurrent disease is equal in the 2 arms, survival benefits of RFA are similar to HR
Aim: to evaluate risks and benefits of RFA in patients with recurrence after HR Study data: 35 patients with 61 tumors Conclusions: RFA is safe and effective in patients with tumors after previous HR; complete ablation was achieved in 88.5% and the 3-year survival was 45%
Aim: to compare rates of recurrence and OS in patients with <5 cm HCC treated with HR versus RFA Study data: 44 patients; 40 patients with metastatic lesions and 10 patients with HCC Conclusions: IRE is safe for treating hepatic tumors that are in proximity to vital structures, initial success achieved in 100% of patients; recurrence free survival at 12 months was 59.5%
Aim: to compare results of HR versus TA in patients with early HCC Study data: 105 patients; 114 lesions, randomly divided into HR and RFA Conclusions: TA is cheap, minimally invasive and easily accessible; it also achieves equivalent local therapeutic effectiveness and 3-year survival outcome when compared to HR
Aim: to compare long-term outcomes in patients treated with HR versus RFA for small HCC meeting the Milan criteria Study data: 278 patients, divided in three groups: HR, percutaneous RFA, and surgical RFA Conclusions: in patients with small HCCs within the Milan criteria, HR is better in patients with a single tumor and well-preserved liver function. RFA should be chosen for patients with an unresectable single tumor or those with multinodular tumors, regardless of the grade of liver damage; surgical RFA provides better long-term oncological control
Aim: to compare RFA with HR for HCC conforming to Milan criteria Study data: 230 patients; divided into 2 groups and followed over 5 years Conclusions: HR provides better OS and RFS and has lower recurrence rates than RFA for patients with HCC meeting the Milan criteria
Aim: to evaluate the outcomes in HCC down-staged patients after locoregional treatments Study data: 161 patients; 48 TAE, 7 PEI, 24 RFA, 15 HR, and 34 combination treatments Conclusions: locoregional treatments can successfully downstage patients; these down staged patients show excellent tumor-free and OS rates after transplantation
Aim: to review evidence for and against the use of RFA for resectable CRLM Study data: multiple studies Conclusions: for tumors ≤3 cm, local control after RFA is equivalent to that of HR, especially if applied by experienced physicians to nonperivascular tumors
Aim: to evaluate long-term survival data for patients with CRLM treated with RFA Study data: 309 patients; 617 sessions, 5-year follow-up Conclusions: in selected patients, RFA achieves 5-year survival rate of 24–33%, which is superior to chemotherapy and equivalent to that achieved with HR
Aim: to evaluate efficacy and utility of RFA in treating CRLM Study data: multiple studies Conclusions: there is a wide variability in the 5-year survival rate (14% to 55%) and local tumor recurrence rate (3.6% to 60%); further studies are therefore needed to better define the role of RFA in patients with CRLM
Aim: to evaluate the benefits of RFA in treating nonresectable CRLM Study data: 119 patients divided into two groups; 59 systemic treatment only and 60 systemic treatment + RFA Conclusions: RFA plus systemic treatment resulted in significant longer PFS in patients with nonresectable CRLM, effect on OS is uncertain
Aim: to systematically review the role of RFA in the treatment of CRLM Study data: 1144 records; 18 studies, 1 RCT Conclusions: the PFS was significantly higher in the group that received RFA; however, there was not conclusive information regarding OS
Aim: to evaluate clinical outcomes in patients treated with LITT for hepatic metastasis Study data: 705 patients; 1981 lesions treated with 7148 treatment applications over 7 years Conclusions: LITT achieves local tumor destruction using minimally invasive techniques in outpatient setting; the 5-year survival rate is 30%; overall, it results in improved clinical outcomes and survival rates and can be considered a potential alternative to HR
Aim: to evaluate safety and efficacy of MR guided LITT in patients with CRLM Study data: 85 patients; 163 nonresectable lesions Conclusions: after 12 months, the local tumor control was 69.4% and median survival was 23 months; overall, LITT was found to be safe and effective for nonresectable CRLM
Aim: to evaluate long-term outcomes with LITT in patients with nonresectable CRLM Study data: 66 patients; 117 nonresectable lesions Conclusions: after 36 months, the survival was 56% in selected patients; overall, LITT has low complication rate and achieves longer survival when compared to patients treated with systemic treatment alone
Aim: to evaluate benefits and adverse effects of TOCE + LITT in patients with HCC Study data: 105 patients divided into two groups; 54 in TOCE + LITT and 51 in TOCE + PEI Conclusions: after 24 months, the survival was significantly better in TOCE + LITT (79.6% versus 60. 8%); overall, TOCE + LITT has low complication rate and achieves good therapeutic effects in patients with HCC
Aim: to evaluate long-term outcomes in patients with CRLM treated with LITT Study data: 594 patients Conclusions: median survival was 25 months; 5-year survival rate was 7.8% and 5-year PFS was 22.3%; overall, LITT is effective, but prognosis is dependent on initial lymph node status, size, and number of hepatic tumors
Aim: to evaluate outcome in patients with unresectable HCC treated with HIFU Study data: 594 patients Conclusions: the technique effectiveness rate was 79.5%, which increased with experience; the 3-year survival rate was 62.4%; overall, HIFU is an effective treatment modality for unresectable HCC with a high technique effectiveness rate and favorable survival outcome
Aim: to evaluate efficacy and complication rate of HIFU treatment in patients with HCC Study data: 145 patients; single institution Conclusions: symptoms improved in 84.8% patients; the 2-year survival rate was 80% in patients with stage IB, 51.4% in stage IIA, and 46.5% in stage IIIA; overall, HIFU is safe and improves quality of life survival
Aim: to evaluate and compare treatment with HIFU with RFA in patients with HCC Study data: 103 patients; 27 treated with HIFU and 76 with RFA Conclusions: 3-year DFS rate was 18.5% in HIFU versus 26.5% in RFA group; 3-year OS was 69.8% in HIFU versus 64.2% in RFA (); overall, HIFU has promising results in patients with recurrent HCC, but further evidence is required
Aim: to evaluate HIFU ablation as an effective bridging therapy for patients with HCC Study data: 49 consecutive patients listed for liver transplant based on UCSF criteria Conclusions: 90% patients in HIFU group versus 3% in the TACE group had complete response; 7 patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list (); overall, HIFU has promising results as a bridging therapy and reduces the drop-out rate of liver transplant candidates
Aim: to evaluate safety and efficacy of MWA in HCC Study data: 19 patients with unresectable HCC Conclusions: 73.7% patients achieved potentially curative treatment; overall, MWA is safe, efficacious, and potentially curable in patients with HCC, with advanced liver cirrhosis and multifocal or central tumors
Aim: to evaluate the efficacy of MWA in unresectable HCC Study data: 60 patients; 15 patients with initial HCC and 45 with recurrent HCC Conclusions: 3-year RFS in initial HCC was 36.7% and recurrent HCC was 8.8%; 5-year OS for all patients was 43.1%; overall, MWA is an effective method for treating initial or recurrent unresectable HCC
Aim: to evaluate and compare treatment with MWA with HR in patients with CRLM Study data: 30 resectable patients; 14 treated with MWA and 16 with HR Conclusions: 3-year survival was 27 months in MWA versus 25 months in HR (); overall, MWA is equally effective as HR in the treatment of multiple (two to nine) CRLM, whereas its surgical invasiveness is less than that of HR
Aim: to evaluate long-term results of percutaneous MWA in patients with HCC Study data: 234 patients with 339 hepatic lesions Conclusions: posttreatment biopsy showed no tumor in 92.8%; 5-year survival rate was 56.7%; percutaneous MWA resulted in a high percentage of cases without evidence of residual tumor and satisfactory long-term results
Aim: to evaluate survival and prognostic factors in patients with HCC treated with MWA Study data: 288 patients with 477 lesions Conclusions: 5-year cumulative survival rate was 51%; tumor size, number of nodules, and Child-Pugh classification were prognostic for survival; MWA confers long-term survival in patients with a single lesion <4.0 cm or less and Child-Pugh class A cirrhosis
Aim: to evaluate long-term outcomes in patients treated with LMWA for HCC Study data: 68 patients with 71 hepatic lesions Conclusions: 91% effectiveness rate, 5-year survival was 43%; LMWA is a useful modality for treatment of HCC nodules located near the liver surface, and it can be safely performed under direct visual guidance
Aim: to evaluate outcomes from a clinical trial using MWA in hepatic tumors Study data: 87 patients with 224 tumors; 42 treated with open MWA, 7 with laparoscopic MWA, and 45 with percutaneous MWA Conclusions: local recurrence seen in 2.7% tumors, regional recurrence occurred in 43% patients; at follow-up of 19 months, 47% patients were alive with no evidence of disease; overall, MWA is safe, and clustered antennae confer larger ablation volumes
Aim: to evaluate and compare magnetic resonance guided treatment of hepatic tumors with percutaneous and thoracoscopic MWA Study data: 142 patients; 73 treated thoracoscopically and 69 percutaneously Conclusions: both techniques are comparable; however, thoracoscopic MWA is minimally invasive and improves targeting of peridiaphragmatic lesions
Aim: to evaluate therapeutic efficacy of RFA and MWA in treating HCC >3 cm Study data: 109 patients; 58 were treated with ablation first, while 51 were treated after HR Conclusions: complete ablation rate was 92.6%; local recurrence occurred in 22% and distal recurrence in 53.2%; 5-year survival rate was 15.4%; both RFA and MWA are effective and safe in treating HCC >3 cm (3–7 cm), with acceptable local tumor control and long-term outcomes; completeness of ablation, previous history of treatment, and preablation AFP level were significant prognostic factors
Aim: to evaluate long-term outcomes in patients with large HCC (>5 cm) treated with TACE with or without MWA Study data: 136 unresectable patients; 80 treated with TACE and 56 with TACE + MWA Conclusions: 5-year OS rates were 5.0% in the TACE group and 10.0% in the TACE + MWA (); TACE + MWA improves survival in patients with large unresectable HCC
Aim: to evaluate therapeutic efficacy of sorafenib in combination with MWA and TACE in patients with recurrent liver cancer Study data: 90 patients with recurrent HCC; treatment group got sorafenib + MWA + TACE, and the control group received MWA + TACE only Conclusions: treatment group had significant improvement in survival; overall, sorafenib combined with MCT and TACE can improve the disease control rate and prolong the survival in patients with recurrent HCC
Aim: to evaluate the results of HR + MWA versus LDLT for HCC in patients with Child-Pugh class B cirrhosis Study data: 70 resectable patients; 30 treated with HR + MWA and 40 with LDLT Conclusions: 5-year survival after HR + MWA was 70.4%, while it was 72.6% after LDLT; DFS was better after LDLT; overall, in preoperative Milan criteria met-cirrhotic patients with Child-Pugh class B, LDLT was associated with longer DFS and OS than HR + MWA
Aim: to evaluate beneficial and harmful effects of MWA compared with no intervention, other ablation methods or systemic treatments in patients with liver metastases
Study data: 40 patients; one RCT Conclusions: there is insufficient evidence to show whether MWA brings any significant benefit in terms of survival or recurrence compared with conventional surgery for patients with CRLM
