Ablation for hepatocellular carcinoma: beyond the standard indications

Challenges Facing Percutaneous Ablation in the Treatment of Hepatocellular Carcinoma: Extension of Ablation Criteria

“…7 However, according to a large number of prospective and retrospective studies and clinical application results published in recent years, the application of percutaneous ablation in the treatment of HCC has exceeded the recommendations of Barcelona Clinic Liver Cancer (BCLC) staging system and treatment strategy, and has also achieved effective local tumor control. 18,[20][21][22]27,28,30 By analyzing the clinical research data obtained in recent years, we revised the indications for ablative modalities in the treatment of HCC and divided them into "absolute indications" and "relative indications". "Absolute indications" are HCC cases recommended to be treated with percutaneous ablation in the guidelines.…”

“…"Relative indications" include HCC cases with tumor diameter ≥3 cm or tumor number ≥3 that were recommended to receive TACE treatment by the guidelines, and HCC cases with tumor locations previously considered unsuitable for percutaneous ablation treatments (such as tumors close to the pericardium, diaphragm, gallbladder, caudate lobe of liver, central bile duct, large vessels, lymph node metastasis of HCC, or porta hepatis). 18,27,28,[33][34][35] These cases were previously considered to be the "forbidden zone", "non-standard indications", or HCC cases with "highrisk locations" for ablative modalities. Safe and effective treatment of these cases requires a wealth of experience in ablation therapy and the use of advanced image guidance technologies (such as fusion imaging and enhanced ultrasound) and assistive technologies (such as artificial ascites, artificial hydrothorax, and multiple overlapping ablations).…”

“…13,14 However, in recent years, with the continuous progress and innovation of percutaneous ablation technologies, more and more patients who were previously considered unsuitable for ablation treatments are receiving percutaneous ablation. 15,16 Obviously, percutaneous ablation can reduce the risk of palliative cares, 17,18 which are associated with poor patient prognosis. 7,[19][20][21] Therefore, when conditions permit, all potential curative treatments for HCC (such as percutaneous ablation, surgical resection, and liver transplantation) should be used as first-line treatments.…”

“…This obviously helps to improve the clinical outcomes and safety of the treatment methods, which in turn leads to the expanded application of percutaneous ablation in the treatment of HCC. 18,[27][28][29] It is challenging, but also necessary, to keep abreast of these developments. The correct use of assistive technologies, equipment and image guidance methods under different ablative modalities will be essential for the optimal treatment results.…”

Impact of Real-Time Contrast-Enhanced Ultrasound-Guided Radiofrequency Ablation on Progression-Free Survival in Patients with Hepatocellular Carcinoma: a Retrospective Case-Control Study

“…Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide, and the incidence is especially high in China [1,2]. Owing to the development of screening programs for patients at high risk, patients are being increasingly diagnosed with small HCC lesions (maximum diameter of tumor ≤ 3.0 cm) [3]. However, some patients are still diagnosed with intermediate (3.1~5.0 cm in diameter) or large (> 5.0 cm in diameter) lesions at presentation.…”