title: Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma.
abstract: OBJECTIVE
  To retrospectively compare the initial response, local recurrence, and complication rates of radiofrequency ablation (RFA) vs microwave ablation (MWA) when combined with neoadjuvant bland transarterial embolization (TAE) or drug-eluting microsphere chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 35 subjects with Barcelona Clinic Liver Cancer (BCLC) very early and early-stage HCC (range: 1.2-4.1cm) underwent TAE (23) or TACE (12) with RFA (15) or microwave ablation (MWA) (20) from January 2009 to June 2015 as either definitive therapy or a bridge to transplant. TAE and TACE were performed with 40-400μm particles and 30-100μm plus either doxorubicin- or epirubicin-eluting microspheres, respectively. Initial response and local progression were evaluated using modified response evaluation criteria in solid tumors. Complications were graded using common terminology criteria for adverse events version 5.0.
  
  
  RESULTS
  Complete response rates were 80% (12/15) for RFA + TAE/TACE and 95% (19/20) for MWA + TAE/TACE (P = 0.29). Local recurrence rate was 30% (4/12) for RFA + TAE/TACE and 0% (0/19) for MWA + TAE/TACE. Durability of response, defined as local disease control for duration of the study, demonstrated a significant difference in favor of MWA (P = 0.0091). There was no statistical difference in complication rates (3 vs 2).
  
  
  CONCLUSIONS
  MWA and RFA when combined with neoadjuvant TAE or TACE have similar safety and efficacy in the treatment of early-stage HCC. MWA provided more durable disease control in this study; however, prospective data remain necessary to evaluate superiority of either modality.
authors.affiliation: Department of Radiology, University of Florida College of Medicine, Gainesville, FL. Electronic address: thorlm@radiology.ufl.edu.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Thornton
authors.affiliation: Section of Hepatobiliary Diseases, Department of Medicine, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Roniel
authors.initials: R
authors.lastname: Cabrera
authors.affiliation: Department of Transplant Surgery, University of Florida at Shands, Gainesville, FL.
authors.forename: Melissa
authors.initials: M
authors.lastname: Kapp
authors.affiliation: Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Michael
authors.initials: M
authors.lastname: Lazarowicz
authors.affiliation: Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Vogel
authors.affiliation: Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Beau B
authors.initials: BB
authors.lastname: Toskich
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008872:Microwaves; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome