Role of local ablative therapy for hepatocellular carcinoma

Abstract

Percutaneous local ablation (PLA) techniques are currently considered as the best treatment option for patients with early-stage hepatocellular carcinoma (HCC) who are not candidates for surgical resection. They are safe, minimally invasive, efficacious and cost-effective. Radiofrequency ablation (RFA) is considered as the first line treatment in some centers, though most of the guidelines recommend it for small HCCs, where surgical resection is not feasible. In developing countries percutaneous ethanol injection (PEI) and percutaneous acetic acid injection (PAI) may be used instead of RFA. For large HCCs, advances in electrode designs and newer techniques of ablation, including microwave ablation, are increasingly been used. Combination treatment modalities have shown promising results as compared to single modality for large tumors. The selection of the most appropriate modality depends on the size, number of lesions, the liver function status, patient's financial resources, availability of a particular technique and the expertise available.

Keywords: AFP, alpha feto protein; CT, computed tomography; HCC, hepatocellular carcinoma; HR, hepatic resection; PEI, percutaneous ethanol injection; PLA, percutaneous local ablation; RFA, radiofrequency ablation; USG, ultrasonography; hepatocellular carcinoma (HCC); percutaneous liver ablation (PLA); radiofrequency ablation (RFA).

Figure 1

Small HCC treated by RFA. A & B: Pre-RFA CT scan, C: Schematic diagram of RFA. D & E: Post-RFA CT scan.

Figure 2

HCC treated by percutaneous ethanol ablation. A: Pre-ablation CT scan, B: Ablation being done with a needle, C: Post-ablation CT scan.