J Korean Med Assoc.  2013 Nov;56(11):964-971. 10.5124/jkma.2013.56.11.964.

Recent advance of local ablation for hepatocellular carcinoma

• Rhim H

• KMID: 2193468
• DOI: http://doi.org/10.5124/jkma.2013.56.11.964

Abstract

Local ablation has been accepted in many treatment guidelines as a good alternative to curative resection or transplantation for patients with unresectable hepatocellular carcinoma (HCC). The main advantage of local ablative therapy is minimal invasiveness, guaranteeing low morbidity even for the patient with poor hepatic reserve. Furthermore, the therapeutic efficacy of local ablation, especially radiofrequency ablation (RFA), has been shown to be as effective as surgical resection for early-stage (smaller than 3 cm, less than 4 in number) HCC. The long-term outcome after radiofrequency ablation for HCC reported in large series studies were overall survival of 50% to 60% at 5 years and 27 to 32% at 10 years. Major complication rates are 0% to 2.4%. However, controversy remains regarding whether local ablation can replace surgical resection because many retrospective comparative studies have produced conflicting results. Only a well-designed randomized study will be able to clearly answer this long-standing question. During the past decade, many technical advancements in local ablation have been reported, including novel electrodes, thermal protection (i.e., artificial ascites), fusion image guidance, Sonazoid-enhanced ultrasound guidance, and emerging energy sources (i.e., microwaves, High internsity focused ultrasound, Irreversible electroporation). Local ablation is still an evolving technique in the era of minimally invasive treatment for HCC. Many more technical advances are ongoing to enhance the therapeutic efficacy of local ablation. In summary, local ablation will remain a mainstay of non-surgical treatment early stage HCC and play an important role in multidisciplinary approach for HCC management.

Keyword

Hepatocellular carcinoma; Local ablation; Radiofrequency ablation; Minimally invasive therapy; Microwave ablation

MeSH Terms

Carcinoma, Hepatocellular*
Electrodes
Humans
Microwaves
Retrospective Studies
Transplantation
Transplants
Ultrasonography

Figure

• 

  Figure 1 Radiofrequency ablation with assistance of Sonazoid enhanced ultrasound (US) and fusion image guidance with magnetic resonance (MR) imaging. (A) MR scan obtained during hepatic arterial phase shows 1.1 cm-sized-hypervascular mass (arrow) in segment V before radiofrequency ablation. (B) Planning ultrasonography (US, left image) with fusion image (MR, right image) guidance before radiofrequency ablation shows a very inconspicuous tumor (arrow) on gray scale image. Sonazoid enhanced US demonstrates arterial hypervascular mass (C, arrow) on vascular phase and hypoechoic lesion (D) in the corresponding area on Kupffer phase (10 minutes delay) representing hepatocellular carcinoma. It helps to insert radiofreqeuncy electrode into target lesion confidently due to enhancement of tumor conspicuity. (E) During RF ablation, the hypoechoic index tumor changes into hyperechoic area (arrowhead) due to microbubbles from vaporization of tumors. (F) Axial computed tomography scan obtained during portal phase obtained immediately after radiofrequency ablation shows complete ablation with an enough ablative margin (arrow).

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