Image-Guided Ablation Therapies for Extrahepatic Metastases from Hepatocellular Carcinoma: A Review

Abstract

The most common sites of extrahepatic metastases from hepatocellular carcinoma (HCC) are the lungs, intra-abdominal lymph nodes, bones, and adrenal glands, in that order. Although systemic therapies are a common treatment for patients with extrahepatic metastases, local ablative therapies for the extrahepatic metastatic lesions can be performed in selected patients. In this article, the literature on image-guided thermal ablation for metastasis to each organ was reviewed to summarize the current evidence. Radiofrequency ablation was the most commonly evaluated technique, and microwave ablation, cryoablation, and percutaneous ethanol injection were also utilized. The local control rate of thermal ablation therapy was relatively favorable, at approximately 70–90% in various organs. The survival outcomes varied among the studies, and several studies reported that the absence of viable intrahepatic lesions was associated with improved survival rates. Since only retrospective data from relatively small studies has been available thus far, more robust studies with prospective designs and larger cohorts are desired to prove the usefulness of thermal ablation for extrahepatic metastases from HCC.

Ultrasound‐guided percutaneous high‐frequency irreversible electroporation in porcine livers using four electrode needles: A feasibility and safety study

“…Image-guided ablation is an effective standard treatment for patients with primary and metastatic liver tumors. 1 Currently, thermal tissue destruction using microwave and radiofrequency ablation (MWA/RFA) is the most widely used ablation strategy, both of which are recommended to achieve curative effects in small and isolated liver malignancies. 2,3 However, traditional thermal ablation therapies have difficulties in achieving uniform temperatures and inevitably generate heat sink effects, which can lead to incomplete ablation of the tumor.…”