MWA Versus RFA for Perivascular and Peribiliary CRLM: A Retrospective Patient- and Lesion-Based Analysis of Two Historical Cohorts

• Published in: Cardiovascular and interventional radiology 2016-10, Vol.39 (10), p.1438-1446
• Main Authors: van Tilborg, Aukje A. J. M., Scheffer, Hester J., de Jong, Marcus C., Vroomen, Laurien G. P. H., Nielsen, Karin, van Kuijk, Cornelis, van den Tol, Petrousjka M. P., Meijerink, Martijn R.
• Format: Article
• Language: English
• Subjects: ABLATION; Ablation Techniques - methods; Adult; Aged; Aged, 80 and over; BILE; Bile Ducts - pathology; Bile Ducts - surgery; BILIARY TRACT; Cardiology; Catheter Ablation - methods; Clinical Investigation; Cohort Studies; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; FLUORINE 18; Follow-Up Studies; Humans; Imaging; LIVER; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; METASTASES; MICROWAVE RADIATION; Microwaves - therapeutic use; Middle Aged; MULTIVARIATE ANALYSIS; NEOPLASMS; Nuclear Medicine; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOWAVE RADIATION; REGRESSION ANALYSIS; Retrospective Studies; SAFETY; Treatment Outcome; Ultrasound
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-016-1413-3

Purpose To retrospectively analyse the safety and efficacy of radiofrequency ablation (RFA) versus microwave ablation (MWA) in the treatment of unresectable colorectal liver metastases (CRLM) in proximity to large vessels and/or major bile ducts. Method and Materials A database search was performed to include patients with unresectable histologically proven and/or 18 F–FDG–PET avid CRLM who were treated with RFA or MWA between January 2001 and September 2014 in a single centre. All lesions that were considered to have a peribiliary and/or perivascular location were included. Univariate logistic regression analysis was performed to assess the distribution of patient, tumour and procedure characteristics. Multivariate logistic regression was used to correct for potential confounders. Results Two hundred and forty-three patients with 774 unresectable CRLM were ablated. One hundred and twenty-two patients (78 males; 44 females) had at least one perivascular or peribiliary lesion ( n  = 199). Primary efficacy rate of RFA was superior to MWA after 3 and 12 months of follow-up ( P  = 0.010 and P  = 0.022); however, after multivariate analysis this difference was non-significant at 12 months ( P  = 0.078) and vanished after repeat ablations ( P  = 0.39). More CTCAE grade III complications occurred after MWA versus RFA (18.8 vs. 7.9 %; P  = 0.094); biliary complications were especially common after peribiliary MWA ( P  = 0.002). Conclusion For perivascular CRLM, RFA and MWA are both safe treatment options that appear equally effective. For peribiliary CRLM, MWA has a higher complication rate than RFA, with similar efficacy. Based on these results, it is advised to use RFA for lesions in the proximity of major bile ducts.