Radiofrequency Ablation of Hepatocellular Carcinoma: Pros and Cons

Abstract

Among locoregional treatments for hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) has been accepted as the most popular alternative to curative transplantation or resection, and it shows an excellent local tumor control rate and acceptable morbidity. The benefits of RFA have been universally validated by the practice guidelines of international societies of hepatology. The main advantages of RFA include 1) it is minimally invasive with acceptable morbidity, 2) it enables excellent local tumor control, 3) it has promising long-term survival, and 4) it is a multimodal approach. Based on these pros, RFA will play an important role in managing the patient with early HCC (smaller than 3 cm with fewer than four tumors). The main limitations of current RFA technology in hepatic ablation include 1) limitation of ablation volume, 2) technically infeasible in some tumors due to conspicuity and dangerous location, and 3) the heat-sink effect. Many technical approaches have been introduced to overcome those limitations, including a novel guiding modality, use of artificial fluid or air, and combined treatment strategies. RFA will continue to play a role as a representative ablative modality in the management of HCC, even in the era of targeted agents. (Gut Liver 2010;4(Suppl. 1):S113-118)

Radiofrequency Ablation of Liver Metastases from Colorectal Cancer: A Literature Review

“…Recently, several local ablative techniques, such as, percutaneous ethanol injection, microwave coagulation therapy, and radiofrequency ablation (RFA) have been reported to be effective in the patients, considered for liver-directed therapies, expanding the pool of patients who can be treated 4-7. RFA, in particular, has resulted in a higher rate of complete necrosis of the metastatic lesions in the liver and required fewer treatment sessions than the other ablation therapies 6-8.…”

Hepatic abscess with hepatobronchial fistula following percutaneous radiofrequency ablation for hepatocellular carcinoma: A case report

“…The criteria used to determine RFA suitability in cases of HCC include the following: A single nodule <5 cm in size, or ≤3 nodules each <3 cm in size; Child-Pugh class A or B; and the absence of portal vein thrombosis or extrahepatic metastases (4). Compared with hepatic resection, RFA has many advantages: i) It is minimally invasive with low risk; ii) it enables excellent local tumor control; iii) it is associated with rapid recovery and promising five-year survival rates; iv) it is a multimodal approach (9). However, RFA may cause certain complications, including peritoneal hemorrhage, bile duct injury, bowel perforation, liver abscess and cancer seeding along the electrode tract, liver infarction, diaphragmatic perforation and hernia (9)(10)(11)(12).…”

“…Compared with hepatic resection, RFA has many advantages: i) It is minimally invasive with low risk; ii) it enables excellent local tumor control; iii) it is associated with rapid recovery and promising five-year survival rates; iv) it is a multimodal approach (9). However, RFA may cause certain complications, including peritoneal hemorrhage, bile duct injury, bowel perforation, liver abscess and cancer seeding along the electrode tract, liver infarction, diaphragmatic perforation and hernia (9)(10)(11)(12). Hepatic abscess with hepatobronchial fistula is an extremely rare complication resulting from hepatic RFA for the treatment of HCC.…”

“…Laboratory test results revealed a white blood cell count of 14.75x10 9 /l (normal range, 3.70-9.20x10 9 /l), red blood cell count of 3.48x10 12 /l (normal range,3.68-5.74x10 12 /l), platelet count of 75x10 9 /l (normal range, 85-320x10 9 /l), and a hemoglobin level of 103 g/l (normal range, 113-172 g/l). Biliary retrograde infection of the hepatic ablation zone was suspected due to the accumulation of gas in this region, observed on B-ultrasound examination.…”

Application of Radiotherapeutic Strategies in the BCLC-defined Stages of Hepatocellular Carcinoma

“…For HCC patients at an early BCLC stage and with an inoperable condition, including those refusing surgery, local ablation such as RFA or percutaneous ethanol injection therapy is recommended. However, the lesions near the hepatic dome or adjacent to the main portal vein can be difficult to target with RFA or may be heated improperly because of the heat sink phenomenon and are also susceptible to procedure-related complications [32]. Empirical use of RT for these lesions has resulted in a substantial response ( fig.…”