High-power microwave ablation with preablation transarterial chemoembolization enhances ablation zone stability in patients with liver malignancies.

PURPOSE: We aim to assess whether high-power microwave ablation (MWA) in combination with preablation transarterial chemoembolization (TACE) is associated with greater ablation zone stability in patients diagnosed with hepatocellular carcinoma (HCC) or liver metastases. The primary endpoint was the percentage change in ablation zone area from baseline to late follow-up (T1-T3).

METHODS

In this retrospective, non-randomized, single-center study, 45 patients with HCC and 32 patients with liver metastases were analyzed. All patients underwent computed tomography (CT)-guided percutaneous MWA following TACE. Protocols were stratified into a low-power protocol group (initiated at 60 W and limited to ≤ 100 W) and a high-power protocol group (initiated at 80 W and escalated to ≥ 120-150 W). MRI (magnetic resonance imaging) follow-up was performed at 24 h (T1), 3 months (T2) and 6 months (T3), with manual measurement of the ablation zone area at each time point.

RESULTS

In the HCC cohort, high-power MWA was associated with significantly greater ablation zone stability (%ΔT1-T3 = - 32.95 ± 5.82%) compared to low-power protocols (%ΔT1-T3 = - 49.72 ± 6.91%; p < 0.001; Cohen's d = 1.12). In the metastases cohort, high-power MWA also outperformed the low-power group (- 28.4% vs. - 42.1%; p < 0.001, RBC = 0.87; with consistent effect sizes).

CONCLUSION

This retrospective single-center cohort study provides exploratory imaging evidence that higher power settings are associated with greater ablation zone stability following TACE, warranting prospective validation.