title: Microwave ablation versus transarterial chemoembolization in large hepatocellular carcinoma: prospective analysis.
abstract: OBJECTIVE
  Limited therapies are offered for large hepatocellular carcinoma (HCC). It carries dismal prognosis and efforts tried changing its management from a palliative to a curative mode. Transarterial chemoembolization (TACE) is a palliative procedure that may have survival benefit if compared to non-management of large lesions. Microwave ablation (MWA) has emerged as a relatively new technique with promise of larger and faster ablation. We aim to evaluate the efficacy and safety of percutaneous MWA versus TACE for large tumors (5-7 cm) and to assess their effects on local tumor progression and survival.
  
  
  METHODS
  Sixty-four patients with large lesions are managed in our multidisciplinary HCC clinic and were divided into two groups treated either by MWA or TACE. Complete response rate, local recurrence, de novo lesions, and overall survival analysis are compared between both procedures.
  
  
  RESULTS
  Both groups were comparable as regards the demographic and ultrasonographic features. MWA showed higher rates of complete ablation (75%) with fewer sessions, lower incidence of tumor recurrence (p = 0.02), development of de novo lesions (p = 0.03), occurrence of post-treatment ascites (p = 0.003), and higher survival rates (p = 0.04). The mean survival of the microwave group was 21.7 months with actuarial probability of survival at 12 and 18 months 78.2% and 68.4%, respectively. The mean survival of the TACE group was 13.7 months with actuarial probability of survival at 12 and 18 months being 52.4% and 28.6%, respectively.
  
  
  CONCLUSIONS
  MWA showed better results than TACE in the management of large HCC lesions.
authors.affiliation: Endemic Medicine and Hepatogastroenterology Department, Cairo University , Cairo , Egypt.
authors.forename: Ashraf Omar
authors.initials: AO
authors.lastname: Abdelaziz
authors.forename: Mohamed Mahmoud
authors.initials: MM
authors.lastname: Nabeel
authors.forename: Tamer Mahmoud
authors.initials: TM
authors.lastname: Elbaz
authors.forename: Hend Ibrahim
authors.initials: HI
authors.lastname: Shousha
authors.forename: Eman Medhat
authors.initials: EM
authors.lastname: Hassan
authors.forename: Sherif Hamdy
authors.initials: SH
authors.lastname: Mahmoud
authors.forename: Noha Ali
authors.initials: NA
authors.lastname: Rashed
authors.forename: Mostafa Mohamed
authors.initials: MM
authors.lastname: Ibrahim
authors.forename: Ahmed Hosni
authors.initials: AH
authors.lastname: Abdelmaksoud
mesh_terms: D001201:Ascites / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000209:etiology; D011446:Prospective Studies; D015996:Survival Rate; D047368:Tumor Burden
keywords: hepatocellular carcinoma; microwave ablation; survival; transarterial chemoembolization.