Radiofrequency ablation of hepatocellular carcinoma: pros and cons

Abstract

Among locoregional treatments for hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) has been accepted as the most popular alternative to curative transplantation or resection, and it shows an excellent local tumor control rate and acceptable morbidity. The benefits of RFA have been universally validated by the practice guidelines of international societies of hepatology. The main advantages of RFA include 1) it is minimally invasive with acceptable morbidity, 2) it enables excellent local tumor control, 3) it has promising long-term survival, and 4) it is a multimodal approach. Based on these pros, RFA will play an important role in managing the patient with early HCC (smaller than 3 cm with fewer than four tumors). The main limitations of current RFA technology in hepatic ablation include 1) limitation of ablation volume, 2) technically infeasible in some tumors due to conspicuity and dangerous location, and 3) the heat-sink effect. Many technical approaches have been introduced to overcome those limitations, including a novel guiding modality, use of artificial fluid or air, and combined treatment strategies. RFA will continue to play a role as a representative ablative modality in the management of HCC, even in the era of targeted agents.

Keywords: Hepatocellular carcinoma; Image-guided tumor ablation; Loco-regional therapy; Radiofrequency ablation; Thermal ablation.

Fig. 1

Strategy for staging and treatment assignment in patient with hepatocellular carcinoma (HCC) according to the BCLC criteria. BCLC staging system was developed based on the collection of data from several independent studies representing different disease stages and/or treatment modalities. It includes variables related to tumor stage, liver functional status, physical status and cancer related symptoms. The main advantage of the BCLC criteria staging system is that it links staging with treatment modalities and with an estimation of life expectancy that is based on published response rates to the various treatments. Early stage disease includes patients with preserved liver function (Child-Pugh Class A and B) with solitary HCC or up to 3 nodules <3 cm in diameter. These patients can be effectively treated by resection, transplantation, or percutaneous ablation with the possibility for long-term survival ranging from 50% to 75%.