Page 246 - Read Online

Commentary

Comment on “Preliminary outcome of microwave ablation

of hepatocellular carcinoma: breaking the 3-cm barrier?”

Paola Tombesi, Francesca Di Vece, Francesca Ermili, Sergio Sartori
Section of Interventional Ultrasound, St. Anna Hospital, 44100 Ferrara, Italy.
Dr. Paola Tombesi was born on April 27, 1976, and graduated cum laude in 2001. She is specialist in
Internal Medicine and is dealing with interventional ultrasonography from 2003. She is working in the
Section of Interventional Ultrasound, St. Anna Hospital, Ferrara, Italy, from 2006, and is author of 61
scientific papers.

Corresponding Author:
Dr. Paola Tombesi, Section of Interventional Ultrasound, St. Anna Hospital, 44100 Ferrara, Italy. E-mail: p.tombesi@ospfe.it
Received: 13-07-2016; Accepted: 20-07-2016

Thamtorawat S, Hicks R, Yu J, Siripongsakun S, Lin WC, Raman S, experienced thermal ablation technique, but its efficacy is
McWilliams JP, Douek M, Bahrami S, Lu DSK. Preliminary well known to decrease in presence of tumors larger than
outcome of Microwave ablation of hepatocellular carcinoma: 2-3 cm. Last generation microwave ablation (MWA) systems
breaking the 3-cm barrier? J Vasc Interv Radiol 2016;27:623-30. offer some advantages compared with RFA, such as greater
intratumoral temperature, deeper penetration of energy,
Nowadays, surgical resection represents the gold standard propagation across the poorly conductive tissues, less
for the treatment of hepatocellular carcinoma (HCC) in sensitivity to the heat-sink effect, and larger ablation volume.
eligible patients, and liver transplantation is considered the These peculiarities could enable to treat larger tumors than
best option for selected patients with HCC. However, in the RFA with adequate safety margin. So to date the question
last years the role of thermal ablation therapies is becoming is: is it time to break the 3-cm barrier for thermal ablation?
more and more relevant. Their effectiveness and safety have
widely been proven, and they play a key role in the treatment To the best of our knowledge, no previous studies compared
of HCC patients who are not eligible or poor candidates for the efficacy of MWA in nodules up to 5 cm with respect to
[8]
[1-4]
surgery, or who refuse surgery. Moreover, they can also be nodules up to 3 cm. Thamtorawat et al. recently published
used as a bridge to liver transplantation. an interesting retrospective study including 129 patients
with 173 HCCs up to 5 cm treated with MWA: 118 nodules
In the Barcelona Clinic Liver Cancer (BCLC) guidelines were ≤ 3 cm in size, whereas 55 nodules were from 3.1 to
for treatment of HCC, tumors up to 3 cm in diameter are 5 cm in size. The reported overall technical success rate of
considered eligible for radiofrequency ablation (RFA) with MWA was 96.5%. Local tumor progression occurred in 20/173
curative intent in non-surgical candidates. Moreover, recent tumors (11.6%), and recurrences were successfully retreated
[5]
studies showed that RFA of very early HCC is as effective as by additional thermal ablation session. The mean follow-up
surgical resection in terms of overall survival and recurrence- period was 11.8 ± 9.8 months. The 1-year and 2-year overall
free survival rates. On the basis of these reports and their survival rates for nodules ≤ 3 cm and for nodules from 3.1 to
[6,7]
own experience, most skilled interventional oncologists 5 cm were 91.3% and 81.7%, respectively. Eighteen patients
and radiologists are advocating an update of the current out of 129 (13.9%) were bridged to liver transplantation.
guidelines, as it is time to consider RFA at least equivalent Interestingly, there was no statistically significant
to surgical resection in the treatment of HCC up to 2 cm, in difference in local progression rates between the two
particular when the liver tumor is centrally located. groups of HCC, with a 2-year local tumor control of 83.9%
RFA represents the “historical”, best established and and 82.1%, respectively.
This is an open access article distributed under the terms of the Creative
Access this article online Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
Quick Response Code others to remix, tweak, and build upon the work non-commercially, as long as the
Website: author is credited and the new creations are licensed under the identical terms.
www.hrjournal.net/ For reprints contact: service@oaepublish.com

How to cite this article: Tombesi P, Di Vece F, Ermili F, Sartori
DOI: S. Comment on “Preliminary outcome of microwave ablation of
10.20517/2394-5079.2016.30 hepatocellular carcinoma: breaking the 3-cm barrier?” Hepatoma
Res 2016;2:237-8.
© 2016 Hepatoma Research | Published by OAE Publishing Inc. 237