We read with interest the article by Bruix et al1 on currently available treatment options for hepatocellular carcinoma (HCC). Radiofrequency ablation (RFA) is now the first-line technique for HCC ablation. RFA produces tumour necrosis in situ through temperature modification. Compared with RFA, microwave ablation (MWA) is one relatively recent advancement of thermoablative technology, which shows multiple theoretical advantages over RFA.2–4 We wish to report the results of a phase III randomised controlled trial (RCT) by comparing ultrasound-guided percutaneous cooled-probe MWA and RFA in ≤5 cm HCC (NCT 02539212).

From October 2008 to June 2015, 203 (265 nodules) subjects were randomised to MWA and 200 (251 nodules) were randomised to RFA. The indications were as follows: tumour size ≤5 cm in diameter, tumour number ≤3, Child–Pugh class A or B classification, no evidence of extrahepatic metastasis, vein or bile duct tumour embolus, lesions visible on ultrasound with an acceptable puncture path, an Eastern Cooperative Oncology Group performance status of 0–1, and no any other anticancer treatment previously. All the patients were percutaneously treated by a …