Percutaneous treatment of hepatocellular carcinoma

Abstract

SUMMARYIn early stage hepatocellular carcinoma (HCC), liver transplantation, surgical resection and percutaneous techniques are classified as radical treatments, and may be offered to about 25% of all patients with HCC evaluated in referral centres. The restricted inclusion criteria for surgical resection and the shortage of liver donors for transplantation have stimulated an increasing demand for minimally invasive treatments able to achieve effective and reproducible percutaneous tumour ablation, with less associated morbidity and lower cost than other interventions. Among percutaneous techniques, ethanol injection has proven to be highly effective in single HCC up to 3 cm, with a rate of complete response of 80%, being well tolerated and with a limited risk of minor complication. In larger and⁄or multinodular HCC the efficacy is reduced to 50% of complete response in nodules between 3 and 5 cm, and to lower rate in larger tumours.Alternative options to ethanol injection have been recently proposed, including radiofrequency, microwave and laser thermal ablation, aimed to extend the necrotic area thus improving the rate of complete response. To date, radiofrequency is the most used technique, with a reported rate of complete response of 90-98% in nodules smaller than 3 cm, and with the advantage of fewer sessions, otherwise counteracted by a higher rate of side-effects. Microwave and laser are promising technologies, but only few clinical data are available. Randomized controlled trials are needed in order to assess treatment response, long-term survival, rate of complication and cost-efficacy of newer technologies in comparison to ethanol injection.

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

“…[22][23][24][25] For tumors measuring 2-2.5 cm, the curability of RFA and PMCT is equivalent; 26 however, RFA was superior to PMCT with regard to the number of treatment sessions and complications in many reports. 19,27 Based on the above, RFA is superior to PEIT and PMCT with regard to the results, complications, and numbers of treatment sessions for local ablation aiming for radical cure.…”

“…If this problem is solved, this method will surely become a mainstream local ablation therapy for hepatocellular carcinoma. [12][13][14][15][16][17][18][19][20] RFA uses an expandable or cool-tip electrode needle, and single coagulation is able to necrotize a total area of about 3 cm. Accordingly, curative ablation for a tumor measuring 2.5 cm or less can be completed with a single treatment session.…”

A Floating Sleeve Antenna Yields Localized Hepatic Microwave Ablation

“…The goal of MWA is to destroy the tumor along with a 1 cm margin of normal hepatic tissue. This technology has been used in both intraoperative and percutaneous approaches for primary hepatocellular carcinoma and hepatic metastasis of colorectal carcinoma [1]- [3]. Hepatic tumors are commonly spherically shaped and range in size from less than 1 cm to larger than 10 cm in diameter.…”

Hepatocellular carcinoma: Epidemic and treatment

“…A Cochrane Database Review of randomized clinical trials in 2002 revealed that RFA was not sufficiently studied; one ongoing randomized, controlled trial of more than 100 patients comparing RFA with PEI found neither arm superior with respect to recurrence or survival [48]. RFA has been shown to be more effective for achieving complete necrosis in tumors less than 3 cm and with fewer treatment sessions; however, tumoral seeding from subcapsular lesions has been problematic [49]. Subcapsular lesions and lesions close to hepatic vasculature should be avoided to reduce the risk of tumor seeding and of vascular thrombosis, making these modalities questionable for use in patients with the most need, those with marginally unresectable lesions [49,50].…”

“…RFA has been shown to be more effective for achieving complete necrosis in tumors less than 3 cm and with fewer treatment sessions; however, tumoral seeding from subcapsular lesions has been problematic [49]. Subcapsular lesions and lesions close to hepatic vasculature should be avoided to reduce the risk of tumor seeding and of vascular thrombosis, making these modalities questionable for use in patients with the most need, those with marginally unresectable lesions [49,50].…”