Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery

Abstract

Image-guided percutaneous ablation is considered best in the treatment of early-stage hepatocellular carcinoma (HCC). Ablation is potentially curative, minimally invasive, and easily repeatable for recurrence. Ethanol injection used to be the standard in ablation. However, radiofrequency ablation has recently been the most prevailing ablation method for HCC. Many investigators have reported that radiofrequency ablation is superior to ethanol injection, from the viewpoints of treatment response, local tumor curativity, and overall survival. New-generation microwave ablation can create a larger ablation volume in a shorter time period. Further comparison studies are, however, mandatory between radiofrequency ablation and microwave ablation, especially in terms of complications and long-term survival. Irreversible electroporation, which is a non-thermal ablation method that delivers short electric pulses to induce cell death due to apoptosis, requires further studies, especially in terms of long-term outcomes. It is considerably difficult to compare outcomes in ablation with those in surgical resection. However, radiofrequency ablation seems to be a satisfactory alternative to resection for HCC 3 cm or smaller in Child-Pugh class A or B cirrhosis. Furthermore, radiofrequency ablation may be a first-line treatment in HCC 2 cm or smaller in Child-Pugh class A or B cirrhosis. Various innovations would further improve outcomes in ablation. Training programs may be effective in providing an excellent opportunity to understand basic concepts and learn cardinal skills for successful ablation. Sophisticated ablation would be more than an adequate alternative of surgery for small- and possibly middle-sized HCC.

Short term treatment results of local ablation with water‑cooled microwave antenna for liver cancer: Comparison with radiofrequency ablation

“…smaller sizes. MWA and RFA have high local tumor control abilities and result in low levels of invasion and are therefore recommended as the most appropriate treatment options of early-HCC (13,14). Previous studies had reported that first-generation MWA is a useful treatment for small HCC tumors (15,16), and in several reports, MWA and RFA have been reported to yield equivalent results in terms of therapeutic effects and complications (17,18).…”

Safety and technical feasibility of percutaneous ablation for lymph node metastases of hepatocellular carcinoma

“…RFA is considered the standard of care for treatment of HCC of 3 cm or smaller [30]. Compared with RFA, MWA is associated with increased ablation temperatures, increased ablation zones, and a reduction in the heat-sink effect for HCC [31,32]. Besides, MWA is reported to induce lower risk of unintended injury for lesions abutting visceral organs [33].…”

Dihydroartemisinin promotes CHAC1 transcription to induce ferroptosis in primary liver cancer cells: activation of unfolded protein responses

“…The major risk factors of PLCs include chronic infection of hepatitis B/C viruses, excess alcohol consumption, non-alcoholic fatty liver disease, and a atoxin exposure [3,4]. Although current treatments, including percutaneous local ablation, surgical resection, and liver transplantation, improve the survival of patients with PLCs, PLC-correlated mortality still increases owing to population growth and high recurrence [1,5,6]. Therefore, to develop novel therapies for PLCs based on molecular studies is urgently needed.…”