Percutaneous ablation of hepatocellular carcinoma: State-of-the-art
Open Access
- 30 January 2004
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 10 (S2), S91-S97
- https://doi.org/10.1002/lt.20043
Abstract
Percutaneous ablation is considered the best treatment option for patients with early‐stage hepatocellular carcinoma (HCC) who are not candidates for surgical resection or liver transplantation. Several methods have been developed, including intratumoral injection of ethanol or acetic acid, and thermal ablation with radiofrequency, laser, microwaves, or cryosurgery. Percutaneous ethanol injection (PEI) has been the most widely used technique. Several series have provided indirect evidence that PEI improves the natural history of HCC. Patients with Child‐Pugh class A cirrhosis and either a single tumor smaller than 5 cm or as many as three lesions each smaller than 3 cm may achieve a 5‐year survival of 50%. The major limitation of PEI is the high local recurrence rate, which may reach 33–43%. Radiofrequency (RF) ablation has emerged as the most powerful alternate method for percutaneous ablation. Recent studies have shown that RF ablation can achieve more effective local tumor control than PEI with fewer treatment sessions. In a randomized trial, local recurrence‐free survival rates were significantly higher in patients who received RF ablation than in those treated by PEI, and treatment allocation was confirmed as an independent prognostic factor by multivariate analysis. RF ablation could therefore be considered as the percutaneous treatment of choice for patients with early‐stage tumors. Further investigation is warranted to clarify whether current RF technology could offer improved results in patients with intermediate‐stage HCC. (Liver Transpl 2004;10:S91–S97.)Keywords
This publication has 37 references indexed in Scilit:
- Percutaneous Ablation Therapy Guided by Contrast-Enhanced Sonography for Patients with Hepatocellular CarcinomaAmerican Journal of Roentgenology, 2003
- Prognostic prediction and treatment strategy in hepatocellular carcinomaJournal of Hepatology, 2002
- Radiofrequency Thermal Ablation of Hepatocellular CarcinomaAmerican Journal of Roentgenology, 2001
- Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL ConferenceJournal of Hepatology, 2001
- Percutaneous Radio-frequency Thermal Ablation of Nonresectable Hepatocellular Carcinoma after Occlusion of Tumor Blood SupplyRadiology, 2000
- Hepatocellular Carcinoma: Radio-frequency Ablation of Medium and Large LesionsRadiology, 2000
- Thermal Ablation Therapy for Focal MalignancyAmerican Journal of Roentgenology, 2000
- Small Hepatocellular Carcinoma: Treatment with Radio-frequency Ablation versus Ethanol InjectionRadiology, 1999
- Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.American Journal of Roentgenology, 1998
- Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection.Radiology, 1995