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Ablation of Hepatocellular Carcinoma

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Liver Diseases

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Abstract

Ablation is an effective alternative to resection for very early and early stages of hepatocellular carcinoma (HCC) according to the criteria of the Barcelona Clinic Liver Cancer Staging System. There is a wide range of ablation techniques, including mono- and multipolar radiofrequency ablation, microwave ablation and irreversible electroporation. In contrast to the other techniques, irreversible electroporation is not temperature-based and can therefore be used in the vicinity of large bile ducts and vessels. For HCC larger than 3 cm, ablation should be combined with transarterial chemoembolization. In recent years, technical developments have contributed to the efficient and curative treatment of at-risk-location and large HCCs, which were previously regarded as “non-ablatable”. Percutaneous ablation can also be successfully used as a bridging technique for liver transplant patients.

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Author information

Authors and Affiliations

  1. Department of Radiology, University Hospital Regensburg, Regensburg, Germany

    Lukas Beyer & Lukas Luerken

Authors
  1. Lukas Beyer
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  2. Lukas Luerken
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Corresponding author

Correspondence to Lukas Beyer .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self-Study

Self-Study

1.1 Questions

  1. 1.

    Which statement is correct:

    1. (a)

      According to the EASL guidelines for HCC, ablation should primarily be performed in patients with intermediate HCC stage BCLC B.

    2. (b)

      Subcapsular HCC should not be treated by ablation because of the high risk of tumor seeding.

    3. (c)

      HCC immediately adjacent to a central bile duct can be safely treated using microwave ablation, but not radiofrequency ablation.

    4. (d)

      Hydrodissection can be used to safely treat HCC adjacent to the colon or stomach.

  2. 2.

    Which statement is correct:

    1. (a)

      MWA is independent of the transmission of an electric current in the surrounding tissue.

    2. (b)

      IRE is especially suitable for large HCC > 5 cm because multiple electrodes can be placed surrounding the tumor.

    3. (c)

      For HCC > 3 cm, ablation should be combined with systemic treatment.

    4. (d)

      Resection improves overall survival compared to ablation for HCC < 2 cm.

1.2 Answers

  1. 1.

    Which statement is correct:

    1. (a)

      Ablation is one of three curative options for patients with HCLC BCLC 0 and A. TACE is the treatment of choice for patients with HCC BCLC B.

    2. (b)

      Recent data suggests subcapsular location of HCC is not an unfavourable prognostic factor. Techniques such as indirect puncture and needle tract coagulation or “no-touch” ablation using multiple probes can be used to avoid tumour seeding.

    3. (c)

      All thermodestructive ablation techniques such as RFA and MWA are considered contraindicated next to major central bile ducts. Alternatively, irreversible electroporation can be used.

    4. (d)

      Hydrodissection uses artificial ascites to protect thermosensitive structures such as the stomach or colon during thermal ablation. Alternatively, CO2-dissection or irreversible electroporation can be used. CORRECT

  2. 2.

    Which statement is correct:

    1. (a)

      MWA is based on the emission of electromagnetic waves and not electric current. CORRECT

    2. (b)

      The main limitation of IRE is the tumor diameter with high local recurrence rates for tumors exceeding 3 cm. For large tumors multi-probe RFA or MWA are the technique of choice.

    3. (c)

      The STORM trial failed show improved recurrence-free survival for a combination of resection or ablation and sorafenib. However, several meta-analysis showed improved recurrence-free and overall survival for the combination of TACE and ablation in patients with HCC > 3 cm.

    4. (d)

      A large systematic meta-analysis (8420 patients) showed that patients with very early HCC treated by RFA have a comparable life expectancy to patients after resection

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Beyer, L., Luerken, L. (2020). Ablation of Hepatocellular Carcinoma. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_61

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  • DOI: https://doi.org/10.1007/978-3-030-24432-3_61

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  • Online ISBN: 978-3-030-24432-3

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