The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes

Abstract

The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.

Keywords: Hepatocellular carcinoma; ablative techniques; cryotherapy; interventional radiology; irreversible electroporation; microwave ablation; radiofrequency ablation.

Figure 1

Radiofrequency ablation (RFA) probe with expandable system.

Figure 2

(a) Planning CT for microwave ablation of solitary hepatocellular carcinoma (Archive of Dr Fotiadis, The Royal Marsden Hospital). (b) Microwave ablation of solitary hepatocellular carcinoma (Archive of Dr Fotiadis, The Royal Marsden Hospital). (c) Post-ablation CT (Archive of Dr Fotiadis, The Royal Marsden Hospital).