CIO 2022-7 Irreversible Electroporation versus Microwave Ablation as a Treatment Option in Hepatocellular Carcinoma

Purpose: In the United States, hepatocellular carcinoma (HCC) has an incidence of 7.7 per 100,000 and is the most common cause of primary liver cancer worldwide. The gold-standard treatment for patients with early-stage HCC is surgical resection; however, when patients are not candidates for surgery, the treatment of choice is percutaneous ablation, with microwave ablation (MWA) being a popular choice. Irreversible electroporation (IRE) is a newer ablation technology that uses a form of low-energy DC at a high voltage to disrupt the cell membrane of the HCC lesion by creating nanopores. This process disrupts the homeostasis of the lesion, leading to apoptosis and eventual cell death. Currently, IRE is only used when thermal ablation techniques are not viable treatment options. The purpose of this research is to compare the 12-month local recurrence–free survival (LRFS), complete ablation rate (CA), and major adverse event rate (MAE) of IRE and MWA to determine if IRE could replace MWA as a gold-standard ablation technique for patients with HCC.

Materials and Methods: A literature review was done using the PubMed database to compare the 12-month LRFS, TSR, and MAE of IRE with MWA using a 95% confidence interval. MAE was defined as complications that were life threatening or resulted in hospitalization. CA was defined by complete ablation of the treated HCC lesion. Four studies were used in this review, with their results compiled and reviewed. Among the four studies, a total of 624 cases were compared and reviewed. Of these cases, 105 received IRE, and 519 received MWA.

Results: MWA had a significantly higher LRFS of 93.9% compared with 76.9% of lesions treated with IRE (P < 0.00001). IRE had an MAE percentage of 1.9% compared with 20% of MWA-treated lesions, which had no statistical significance (P = 0.32218). MWA had a significantly better CA of 98.11% compared with 92.04% for IRE-treated lesions (P = 0.0278).

Conclusions: This review indicates that MWA is significantly better at ablating the entire lesion and results in significantly better 12-month LRFS. However, there is no significant difference in the safety of the two procedures. Based on these results, we conclude that IRE should remain as a treatment option only when MWA is not a viable treatment. Because IRE is a relatively new technology, more research needs to be done to determine its long-term effectiveness and safety.