Download PDF
Semin intervent Radiol 2020; 37(05): 527-536
DOI: 10.1055/s-0040-1720952
How I Do It

Percutaneous Thermal Ablation for Hepatocellular Carcinoma

Jeffrey L. Weinstein
1   Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
,
Muneeb Ahmed
1   Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Percutaneous thermal ablation is a commonly used treatment for focal hepatocellular carcinoma (HCC), particularly effective for small and early-stage tumors (<3 cm in diameter). When executed expertly in appropriately selected patients, ablation may be curative with survival outcomes similar to surgical resection.[1] [2] [3] In the United States, heat-based modalities such as radiofrequency ablation (RFA) and microwave ablation (MWA) are favored due to the ability to quickly generate coagulation necrosis and help maintain hemostasis. Herein, we will review our recommended patient section parameters, preprocedural management, heat-based ablation techniques for commonly encountered scenarios, and postprocedural management.



Publication History

Article published online:
11 December 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Livraghi T, Meloni F, Di Stasi M. et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?. Hepatology 2008; 47 (01) 82-89
    CrossrefPubMedGoogle Scholar
  • 2 Chen MS, Li JQ, Zheng Y. et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006; 243 (03) 321-328
    CrossrefPubMedGoogle Scholar
  • 3 Feng K, Yan J, Li X. et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol 2012; 57 (04) 794-802
    CrossrefPubMedGoogle Scholar
  • 4 Liao M, Zhong X, Zhang J. et al. Radiofrequency ablation using a 10-mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: a prospective randomized trial. J Surg Oncol 2017; 115 (08) 971-979
    CrossrefPubMedGoogle Scholar
  • 5 Zhang N, Wang L, Chai ZT. et al. Incomplete radiofrequency ablation enhances invasiveness and metastasis of residual cancer of hepatocellular carcinoma cell HCCLM3 via activating β-catenin signaling. PLoS One 2014; 9 (12) e115949
    CrossrefPubMedGoogle Scholar
  • 6 Ganne-Carrié N, Nault JC, Ziol M. et al. Predicting recurrence following radiofrequency percutaneous ablation for hepatocellular carcinoma. Hepat Oncol 2014; 1 (04) 395-408
    CrossrefPubMedGoogle Scholar
  • 7 Lencioni R, Cioni D, Crocetti L. et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 2005; 234 (03) 961-967
    CrossrefPubMedGoogle Scholar
  • 8 Yin XY, Xie XY, Lu MD. et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer 2009; 115 (09) 1914-1923
    CrossrefPubMedGoogle Scholar
  • 9 Ahmed M, Solbiati L, Brace CL. et al; International Working Group on Image-guided Tumor Ablation, Interventional Oncology Sans Frontières Expert Panel, Technology Assessment Committee of the Society of Interventional Radiology, Standard of Practice Committee of the Cardiovascular and Interventional Radiological Society of Europe. Image-guided tumor ablation: standardization of terminology and reporting criteria -- a 10-year update. Radiology 2014; 273 (01) 241-260
    CrossrefPubMedGoogle Scholar
  • 10 Xu Y, Shen Q, Wang N. et al. Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma. Chin J Cancer 2017; 36 (01) 14
    CrossrefPubMedGoogle Scholar
  • 11 Vietti Violi N, Duran R, Guiu B. et al. Efficacy of microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma in patients with chronic liver disease: a randomised controlled phase 2 trial. Lancet Gastroenterol Hepatol 2018; 3 (05) 317-325
    CrossrefPubMedGoogle Scholar
  • 12 Poggi G, Tosoratti N, Montagna B, Picchi C. Microwave ablation of hepatocellular carcinoma. World J Hepatol 2015; 7 (25) 2578-2589
    CrossrefPubMedGoogle Scholar
  • 13 Lucchina N, Tsetis D, Ierardi AM. et al. Current role of microwave ablation in the treatment of small hepatocellular carcinomas. Ann Gastroenterol 2016; 29 (04) 460-465
    PubMedGoogle Scholar
  • 14 Lee TY, Lin JT, Ho HJ, Wu MS, Wu CY. Evaluation of the effect of cumulative operator experience on hepatocellular carcinoma recurrence after primary treatment with radiofrequency ablation. Radiology 2015; 276 (01) 294-301
    CrossrefPubMedGoogle Scholar
  • 15 Crocetti L, Lencioni R. Thermal ablation of hepatocellular carcinoma. Cancer Imaging 2008; 8 (01) 19-26
    CrossrefPubMedGoogle Scholar
  • 16 Thein HH, Isaranuwatchai W, Qiao Y. et al. Cost-effectiveness analysis of potentially curative and combination treatments for hepatocellular carcinoma with person-level data in a Canadian setting. Cancer Med 2017; 6 (09) 2017-2033
    CrossrefPubMedGoogle Scholar
  • 17 Cucchetti A, Piscaglia F, Cescon M. et al. Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma. J Hepatol 2013; 59 (02) 300-307
    CrossrefPubMedGoogle Scholar
  • 18 Kim DG, Lee JG, Joo DJ, Kim SI, Kim MS. Favourable outcome of pathologic downstaging by locoregional treatment for hepatocellular carcinoma in liver transplantation. Sci Rep 2019; 9 (01) 10386
    CrossrefPubMedGoogle Scholar
  • 19 Bauschke A, Altendorf-Hofmann A, Ardelt M, Kissler H, Tautenhahn HM, Settmacher U. Impact of successful local ablative bridging therapy prior to liver transplantation on long-term survival in patients with hepatocellular carcinoma in cirrhosis. J Cancer Res Clin Oncol 2020; 146 (07) 1819-1827
    CrossrefPubMedGoogle Scholar
  • 20 Lu DS, Yu NC, Raman SS. et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology 2005; 234 (03) 954-960
    CrossrefPubMedGoogle Scholar
  • 21 Yamashiki N, Kato T, Bejarano PA. et al. Histopathological changes after microwave coagulation therapy for patients with hepatocellular carcinoma: review of 15 explanted livers. Am J Gastroenterol 2003; 98 (09) 2052-2059
    CrossrefPubMedGoogle Scholar
  • 22 Yu J, Liang P, Yu XL, Cheng ZG, Han ZY, Dong BW. Needle track seeding after percutaneous microwave ablation of malignant liver tumors under ultrasound guidance: analysis of 14-year experience with 1462 patients at a single center. Eur J Radiol 2012; 81 (10) 2495-2499
    CrossrefPubMedGoogle Scholar
  • 23 Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226 (02) 441-451
    CrossrefPubMedGoogle Scholar
  • 24 Rhim H. Complications of radiofrequency ablation in hepatocellular carcinoma. Abdom Imaging 2005; 30 (04) 409-418
    CrossrefPubMedGoogle Scholar
  • 25 Peng ZW, Zhang YJ, Chen MS. et al. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol 2013; 31 (04) 426-432
    CrossrefPubMedGoogle Scholar