Local ablation therapy for hepatocellular carcinoma: current status and future perspectives

Abstract

along with results in Japan and the evidence-based viewpoint of local ablation therapy in the treatment of hepatocellular carcinoma. Indications and contraindications Percutaneous ethanol injection therapy (PEIT)This therapeutic method was developed by Sugihara and colleagues in Japan in 1982, and has been widely used as an effective therapy for unresectable small hepatocellular carcinoma worldwide, not only in Japan but also in Italy, Spain, and Taiwan, and its usefulness has been well supported. [1][2][3][4] The indications for PEIT were basically patients with three or fewer tumor lesions with a diameter smaller than 3 cm, because tumors larger than 3 cm in diameter frequently invade extracapsular regions, and therefore require extraordinary technique for sufficient therapy, especially for the region around the tumor. 5 In those cases, a large amount of ethanol is required to be injected repeatedly. Moreover, it is very likely to result in a high frequency of residual viable cancer, 5 due to incomplete necrosis, leading to a later cancer recurrence. With regard to this point, the results of PEIT vary markedly depending on the enthusiastic effort and skill of physicians, unlike resection. If ethanol injection is performed with a very advanced technique and enthusiastic effort, this indication can be expanded, not limited to lesions 3 cm or smaller and three lesions or fewer. Actually, application to tumors exceeding 3 cm in diameter obtained good results in some reports. 2,5-7 However, PEIT is not curative therapy for such liver cancers larger than 3 cm in diameter, and it is performed as a palliative therapy for mass reduction in most of the cases.Although the indication criteria for PEIT have been tentatively set at 3 cm or smaller and three lesions or fewer, there has been no obvious evidence for whether

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

“…Okusaka et al (19) reported that, of the 149 resected specimens, 28 (19%) exhibited satellite lesions, which were located ≤0.5 cm from the main tumor in 8 (33%), 0.6-1.0 cm in 12 (50%), 1.1-1.5 cm in 1 (4%) and 1.6-2.0 cm in 3 (13%) of the cases. A safe margin was considered to be ≥5 mm (25). The present study also demonstrated significantly lower local recurrence rates for nodules ablated with wide safety margins (Fig.…”

Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?

“…6,7 Radiofrequency ablation (RFA) is currently considered the most effective PAT, [8][9][10][11] and 2 recent randomized trials failed to reveal significant differences between the survival rates associated with resective surgery and RFA in patients with early HCC. 12,13 These considerations have led some centers to adopt RFA as first-line treatment for single HCC nodules less than 3.0 cm in diameter, [14][15][16][17] opening the debate over the best therapeutic option for these small tumors.To clarify this issue, we conducted a multicenter study that included a consecutive series of patients with single HCC 2.0 cm or less in diameter accompanying cirrhosis …”

Treatment of hepatocellular carcinoma: Steps forward but still a long way to go

“…For the RFA procedure to be considered technically successful, the tumor and at least a 5 mm safety margin must be included in the ablation zone [38] . Kudo et al [39] reported that the local recurrence rate at 2 years after RFA was 2.6% in HCC patients with a ≥ 5 mm safety margin, as opposed to 20.8% in HCC patients without such a safety margin (P = 0.01).…”