Combined Treatments in Liver Ablations

Abstract

Percutaneous ablation is a curative treatment indicated in very early and early hepatocellular carcinoma (HCC). Procedural success remains disappointing in lesions ≥3.0 cm and located in subcapsular and perivascular areas. To overcome these limitations, combination treatments have been proposed. The combination of ablation and transarterial chemoembolization (TACE) is widely adopted in clinical practice and may improve survival, particularly in patients with single nodules 3 to 5 cm in size. However, technical issues and clinical indications are still debated. Radiofrequency ablation (RFA) may also be combined with percutaneous ethanol injection to improve local tumor control; limited data show safety and efficacy of this option. The combination of ablation and systemic treatments is still debated. Intravenous injection of thermosensitive liposomal doxorubicin in association with prolonged RFA is under investigation in patients with single lesions < 7 cm. While there is no indication for the use of systemic drugs (specifically sorafenib) in the adjuvant setting, the observation that RFA is able to activate inflammatory reactions has raised interest in the possibility of combining RFA with the new immuno-oncology drugs, for local and distant tumor control. Thus ablation would no longer be reserved only to early HCC but could be exploited also in more advanced stages.