State of the ablation nation: a review of ablative therapies for cure in the treatment of hepatocellular carcinoma

Abstract

Primary liver cancer, mainly hepatocellular carcinoma, is one of the most common malignancies worldwide. Surgical management, either resection or transplantation, is considered definitive treatment, however, less than 20% of patients are ultimately candidates. Thermal ablation modalities such as radiofrequency ablation and microwave ablation have evolved such that these modalities have been applied with curative intent. Moreover, thermal ablation has demonstrated efficacy in treating early-stage tumors and can be offered as first-line treatment in patients with uncomplicated disease. Attributing to refinements in technology and techniques, recent studies evaluating stereotactic ablative body radiotherapy have shown promising results, while irreversible electroporation, an emerging modality, may further expand the role of ablative therapy in treating potentially resectable hepatocellular carcinoma.

Videolaparoscopic microwave ablation in patients with HCC at a European high‐volume center: Results of 815 procedures

“…[4][5][6][7] Radiofrequency ablation (RFA) has been the most widely tested treatment worldwide, but microwave ablation (MWA) has recently been used more and more and applied to different types of tumor. MWA seems to offer all the benefits of RFA, as well as some substantial advantages, such as faster heating and higher temperatures, with the potential for achieving a larger volume 8 of cellular necrosis with shorter procedures, and an attenuated heat sink effect. On the other hand, some reported drawbacks of MWA include greater potential for bile duct damage and a greater risk associated with the higher power delivered.…”

Chemotherapeutic Nanoparticle-Based Liposomes Enhance the Efficiency of Mild Microwave Ablation in Hepatocellular Carcinoma Therapy

“…There have been tremendous improvements in HCC therapy during the last two decades, especially in the use of minimal interventional therapies (Facciorusso et al, 2016;Salati et al, 2017;Shiina et al, 2018). Microwave ablation is one such method that has shown promising outcomes for HCC treatment, due to the rapid temperature increase and larger ablation compared with other modalities (Zhang et al, 2019).…”

“…Rapid temperature, a larger ablation zone, and low susceptibility to the heat-sink effect are advantages that confer superiority to MWA for HCC therapy compared with other thermal modalities, (Facciorusso et al, 2016) particularly for early-stage HCC (Salati et al, 2017). These advantages overcome several challenges, including how the size of HCC can severely affect MWA efficacy, which may result in postsurgical recurrence or the development of unwanted lesions near important blood vessels and collateral biliary ducts that are difficult to ablate completely (Yu et al, 2017).…”

Thermal Therapy Modalities for Cancer Treatment: A Review and Future Perspectives

“…Due to the nature of the used energy which is an EM radiation, the MWA can generate more uniform and larger ablation zones. It resolves some of the RFA limitations especially the increasing impedance that reduces the efficacy of the RFA [55,67]. Indeed, the heat generated by the MWA is a result of the kinetic energy of the tissue molecules after an EM excitation.…”