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Review
. 2021 Sep 23:8:1181-1193.
doi: 10.2147/JHC.S268300. eCollection 2021.

Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies

Timothy C Huber  1 , Teodora Bochnakova  1 , Yilun Koethe  1 , Brian Park  1 , Khashayar Farsad  1
Affiliations
Review

Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies

Timothy C Huber et al. J Hepatocell Carcinoma. .

Abstract

Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.

Keywords: ablation; cryoablation; electroporation; hepatocellular carcinoma; microwave; nanoparticles; radiofrequency.

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Conflict of interest statement

Dr Timothy C Huber reports personal fees for speaking on thyroid nodule RFA from Taewoong Medical, outside the submitted work. Dr Brian Park reports non-financial support from VHA Innovation Ecosystem, grants from RSNA, during the conduct of the study; also reports Clinical Advisory Board for Medivis, outside the submitted work. Dr Khashayar Farsad reports grants from Guerbet, LLC, Exelixis, W.L. Gore; grants, personal fees from Boston Scientific, Cook Medical, Neuwave Medical, Eisai, Genentech, Inquis Medical, Dova Pharmaceuticals, founder of and owns equity for Auxetics, Inc, outside the submitted work; In addition, Dr Khashayar Farsad has a patent auxetic stents for managing venous stenosis pending to Oregon Health and Science University. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Microwave ablation of HCC following transarterial chemoembolization (TACE). Augmented reality was used to overlay the post-TACE 3D CT volume within the patient to verify ultrasound location prior to ablation. Red arrow denotes location of <2cm tumor in segment 3 stained with lipiodol. Procedural ultrasound images confirm adequate positioning with the antenna traversing through the center of the tumor.
Figure 2
Figure 2
(A) Example case of antenna orientations and predicted Neuwave PR antenna ablation volumes at 65 W for 10 min. Axes represent pixel locations in isotropic volume. Tips are separated by distance of 15.7 mm with 8.30 degrees acute angle between the antennas. Total calculated ablation volume is 34,512 mm3. Maximum predicted ablation volume for 2 antennas with 0% overlap is 44,296 mm3. As a result, total volumetric overlap of antennas in configuration above is 44.2%. (B) Theoretical modeled ablation zones overlaid on intraprocedural CT scan. Of note, overlapping ablations were predicted to be additive than synergistic.
See this image and copyright information in PMC

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