Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 18, 2015; 7(8): 1054-1063
Published online May 18, 2015. doi: 10.4254/wjh.v7.i8.1054
Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma
Loukia S Poulou, Evanthia Botsa, Ioanna Thanou, Panayiotis D Ziakas, Loukas Thanos
Loukia S Poulou, Research Unit in Radiology and Medical Imaging, Evgenidion Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
Evanthia Botsa, First Paediatric Clinic, Agia Sofia Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
Ioanna Thanou, Loukas Thanos, Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, 11527 Athens, Greece
Panayiotis D Ziakas, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, United States
Author contributions: All the authors performed the bibliographic search, wrote the paper and approved the final version.
Conflict-of-interest: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Loukas Thanos, MD, Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Mesogeion Av. 152, 11527 Athens, Greece.
Telephone: +30-210-7763362 Fax: +30-210-7707345
Received: August 28, 2014
Peer-review started: August 30, 2014
First decision: September 28, 2014
Revised: October 22, 2014
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 18, 2015

Hepatocellular cancer ranks fifth among cancers and is related to chronic viral hepatitis, alcohol abuse, steatohepatitis and liver autoimmunity. Surgical resection and orthotopic liver transplantation have curative potential, but fewer than 20% of patients are suitable candidates. Interventional treatments are offered to the vast majority of patients. Radiofrequency (RFA) and microwave ablation (MWA) are among the therapeutic modalities, with similar indications which include the presence of up to three lesions, smaller than 3 cm in size, and the absence of extrahepatic disease. The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent (approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival.

Keywords: Microwave, Radiofrequency, Ablation, Hepatocellular carcinoma, Percutaneous

Core tip: Hepatocellular carcinoma (HCC) is a common neoplasia with high morbidity and mortality. Nowadays, technologic progress has led to several diagnostic and therapeutic challenges regarding HCC, including the optimal use of percutaneous ablation methods, defining their indications and assessing the survival impact. Both radiofrequency and microwave ablation are widely used with their respective advantages and may both offer palliation or cure in the context of a multifaceted treatment approach.