Abdominal Imaging

, Volume 36, Issue 6, pp 635–647 | Cite as

The current role of minimally invasive therapies in the management of liver tumors

  • Hansjörg Rempp
  • Andreas Boss
  • Thomas Helmberger
  • Philippe Pereira


This is a review of minimally invasive therapy options for liver tumors, such as highly focused ultrasound, microwave ablation, and irreversible electroporation, as well as new aspects of radiofrequency ablation. Radiofrequency ablation is recommended for patients with early-stage HCC with up to 3 lesions with a tumor diameter within 3 cm and for patients with non-resectable liver metastasis. Indications and contraindications to treatment are designated, and different modalities for image-based therapy guidance are compared. Options for therapy monitoring and controlling are reviewed, namely intraprocedural tools, imaging and functional parameters and their evolution during therapy. Prevention and control of local recurrences is discussed. We also present a short review of current clinical results in treating liver metastasis and primary liver tumors.

Key words

Ablative therapies Microwave ablation Radiofrequency ablation Highly focused ultrasound Irreversible electroporation MR functional imaging MR thermometry Hepatocellular carcinoma Liver metastasis 


  1. 1.
    Calle EE, Teras LR, Thun MJ (2005) Obesity and mortality. N Engl J Med 353:2197–2199PubMedCrossRefGoogle Scholar
  2. 2.
    Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917PubMedCrossRefGoogle Scholar
  3. 3.
    O’Dwyer PJ, Stevenson JP, Haller DG, et al. (2001) Follow-up of stage B and C colorectal cancer in the United States and France. Semin Oncol 28:45–49PubMedGoogle Scholar
  4. 4.
    Iyer RB, Silverman PM, DuBrow RA, et al. (2002) Imaging in the diagnosis, staging, and follow-up of colorectal cancer. AJR Am J Roentgenol 179:3–13PubMedGoogle Scholar
  5. 5.
    Johns LE, Houlston RS (2001) A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol 96:2992–3003PubMedCrossRefGoogle Scholar
  6. 6.
    Ruers TJ, Joosten J, Jager GJ, et al. (2001) Long-term results of treating hepatic colorectal metastases with cryosurgery. Br J Surg 88:844–849PubMedCrossRefGoogle Scholar
  7. 7.
    Jessup JM, McGinnis LS, Steele GDJr, et al. (1996) The National Cancer Data Base. Report on colon cancer. Cancer 78:918–926PubMedCrossRefGoogle Scholar
  8. 8.
    Yoon SS, Tanabe KK (1998) Multidisciplinary management of metastatic colorectal cancer. Surg Oncol 7:197–207PubMedCrossRefGoogle Scholar
  9. 9.
    Wanebo HJ, Semoglou C, Attiyeh F, et al. (1978) Surgical management of patients with primary operable colorectal cancer and synchronous liver metastases. Am J Surg 135:81–85PubMedCrossRefGoogle Scholar
  10. 10.
    Wilson SM, Adson MA (1976) Surgical treatment of hepatic metastases from colorectal cancers. Arch Surg 111:330–334PubMedGoogle Scholar
  11. 11.
    Wagner JS, Adson MA, Van Heerden JA, et al. (1984) The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 199:502–508PubMedCrossRefGoogle Scholar
  12. 12.
    Scheele J, Stangl R, Altendorf-Hofmann A (1990) Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 77:1241–1246PubMedCrossRefGoogle Scholar
  13. 13.
    Lee WS, Yun SH, Chun HK, et al. (2008) Clinical outcomes of hepatic resection and radiofrequency ablation in patients with solitary colorectal liver metastasis. J Clin Gastroenterol 42:945–949PubMedCrossRefGoogle Scholar
  14. 14.
    Aloia TA, Vauthey JN, Loyer EM, et al. (2006) Solitary colorectal liver metastasis: resection determines outcome. Arch Surg 141:460–466 (discussion 466–467)PubMedCrossRefGoogle Scholar
  15. 15.
    Simmonds PC, Primrose JN, Colquitt JL, et al. (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999PubMedCrossRefGoogle Scholar
  16. 16.
    de Baere T, Elias D, Dromain C, et al. (2000) Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. AJR Am J Roentgenol 175:1619–1625PubMedGoogle Scholar
  17. 17.
    Ott R, Wein A, Hohenberger W (2001) Liver metastases—primary or multimodal therapy? Chirurg 72:887–897PubMedCrossRefGoogle Scholar
  18. 18.
    Mulier S, Ni Y, Jamart J, et al. (2008) Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol 15:144–157PubMedCrossRefGoogle Scholar
  19. 19.
    Llovet JM (2005) Updated treatment approach to hepatocellular carcinoma. J Gastroenterol 40:225–235PubMedCrossRefGoogle Scholar
  20. 20.
    Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236PubMedCrossRefGoogle Scholar
  21. 21.
    Kudo M, Okanoue T (2007) Management of hepatocellular carcinoma in Japan: consensus-based clinical practice manual proposed by the Japan Society of Hepatology. Oncology 72(suppl 1):2–15PubMedCrossRefGoogle Scholar
  22. 22.
    Kudo M (2010) Radiofrequency ablation for hepatocellular carcinoma: updated review in 2010. Oncology 78(suppl 1):113–124PubMedCrossRefGoogle Scholar
  23. 23.
    Ryder SD (2003) Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut 52(suppl 3):iii1–iii8PubMedGoogle Scholar
  24. 24.
    Bruix J, Sherman M, Llovet JM, et al. (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430PubMedCrossRefGoogle Scholar
  25. 25.
    Lin SM, Lin CJ, Lin CC, et al. (2004) Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology 127:1714–1723PubMedCrossRefGoogle Scholar
  26. 26.
    Lin SM, Lin CJ, Lin CC, et al. (2005) Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 54:1151–1156PubMedCrossRefGoogle Scholar
  27. 27.
    Shiina S, Teratani T, Obi S, et al. (2005) A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 129:122–130PubMedCrossRefGoogle Scholar
  28. 28.
    Orlando A, Leandro G, Olivo M, et al. (2009) Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials. Am J Gastroenterol 104:514–524PubMedCrossRefGoogle Scholar
  29. 29.
    Brunello F, Veltri A, Carucci P, et al. (2008) Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: a randomized controlled trial. Scand J Gastroenterol 43:727–735PubMedCrossRefGoogle Scholar
  30. 30.
    Cho YK, Kim JK, Kim MY, et al. (2009) Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology 49:453–459PubMedCrossRefGoogle Scholar
  31. 31.
    Bouza C, Lopez-Cuadrado T, Alcazar R, et al. (2009) Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol 9:31PubMedCrossRefGoogle Scholar
  32. 32.
    ter Haar G, Rivens I, Chen L, et al. (1991) High intensity focused ultrasound for the treatment of rat tumours. Phys Med Biol 36:1495–1501PubMedCrossRefGoogle Scholar
  33. 33.
    Chen L, Rivens I, ter Haar G, et al. (1993) Histological changes in rat liver tumours treated with high-intensity focused ultrasound. Ultrasound Med Biol 19:67–74PubMedCrossRefGoogle Scholar
  34. 34.
    McDannold N, Tempany CM, Fennessy FM, et al. (2006) Uterine leiomyomas: MR imaging-based thermometry and thermal dosimetry during focused ultrasound thermal ablation. Radiology 240:263–272PubMedCrossRefGoogle Scholar
  35. 35.
    Madersbacher S, Schatzl G, Djavan B, et al. (2000) Long-term outcome of transrectal high-intensity focused ultrasound therapy for benign prostatic hyperplasia. Eur Urol 37:687–694PubMedCrossRefGoogle Scholar
  36. 36.
    Gelet A, Chapelon JY, Bouvier R, et al. (1996) Treatment of prostate cancer with transrectal focused ultrasound: early clinical experience. Eur Urol 29:174–183PubMedGoogle Scholar
  37. 37.
    Wu F, Wang ZB, Chen WZ, et al. (2005) Advanced hepatocellular carcinoma: treatment with high-intensity focused ultrasound ablation combined with transcatheter arterial embolization. Radiology 235:659–667PubMedCrossRefGoogle Scholar
  38. 38.
    Li YY, Sha WH, Zhou YJ, et al. (2007) Short and long term efficacy of high intensity focused ultrasound therapy for advanced hepatocellular carcinoma. J Gastroenterol Hepatol 22:2148–2154PubMedCrossRefGoogle Scholar
  39. 39.
    Zhang L, Zhu H, Jin C, et al. (2009) High-intensity focused ultrasound (HIFU): effective and safe therapy for hepatocellular carcinoma adjacent to major hepatic veins. Eur Radiol 19:437–445PubMedCrossRefGoogle Scholar
  40. 40.
    Dong B, Liang P, Yu X, et al. (2003) Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: results in 234 patients. AJR Am J Roentgenol 180:1547–1555PubMedGoogle Scholar
  41. 41.
    Shibata T, Iimuro Y, Yamamoto Y, et al. (2002) Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 223:331–337PubMedCrossRefGoogle Scholar
  42. 42.
    Martin RC, Scoggins CR, McMasters KM (2010) Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol 17:171–178PubMedCrossRefGoogle Scholar
  43. 43.
    Liang P, Wang Y, Yu X, et al. (2009) Malignant liver tumors: treatment with percutaneous microwave ablation—complications among cohort of 1136 patients. Radiology 251:933–940PubMedCrossRefGoogle Scholar
  44. 44.
    Dohi M, Harada J, Mogami T, et al. (2003) MR-guided percutaneous cryotherapy of malignant liver tumor under horizontal-magnetic open system: initial experience. J Hepatobiliary Pancreat Surg 10:360–365PubMedCrossRefGoogle Scholar
  45. 45.
    Vogl TJ, Straub R, Eichler K, et al. (2002) Malignant liver tumors treated with MR imaging-guided laser-induced thermotherapy: experience with complications in 899 patients (2, 520 lesions). Radiology 225:367–377PubMedCrossRefGoogle Scholar
  46. 46.
    Silverman SG, Tuncali K, Adams DF, et al. (2000) MR imaging-guided percutaneous cryotherapy of liver tumors: initial experience. Radiology 217:657–664PubMedGoogle Scholar
  47. 47.
    Silverman SG, Tuncali K, Adams DF (2000) MR imaging-guided percutaneous cryotherapy of liver tumors: initial experience. Radiology 217:654–667Google Scholar
  48. 48.
    McCarthy T, Kuhn JA (1998) Cryotherapy for liver tumours. Oncology 12:979–993Google Scholar
  49. 49.
    Davalos RV, Mir IL, Rubinsky B (2005) Tissue ablation with irreversible electroporation. Ann Biomed Eng 33:223–231PubMedCrossRefGoogle Scholar
  50. 50.
    Miller L, Leor J, Rubinsky B (2005) Cancer cells ablation with irreversible electroporation. Technol Cancer Res Treat 4:699–705PubMedGoogle Scholar
  51. 51.
    Edd JF, Horowitz L, Davalos RV, et al. (2006) In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Trans Biomed Eng 53:1409–1415PubMedCrossRefGoogle Scholar
  52. 52.
    Lee EW, Loh CT, Kee ST (2007) Imaging guided percutaneous irreversible electroporation: ultrasound and immunohistological correlation. Technol Cancer Res Treat 6:287–294PubMedGoogle Scholar
  53. 53.
    Onik G, Mikus P, Rubinsky B (2007) Irreversible electroporation: implications for prostate ablation. Technol Cancer Res Treat 6:295–300PubMedGoogle Scholar
  54. 54.
    Mali B, Jarm T, Corovic S, et al. (2008) The effect of electroporation pulses on functioning of the heart. Med Biol Eng Comput 46:745–757PubMedCrossRefGoogle Scholar
  55. 55.
    Pereira PL, Trubenbach J, Schenk M, et al. (2004) Radiofrequency ablation: in vivo comparison of four commercially available devices in pig livers. Radiology 232:482–490PubMedCrossRefGoogle Scholar
  56. 56.
    Clasen S, Schmidt D, Boss A, et al. (2006) Multipolar radiofrequency ablation with internally cooled electrodes: experimental study in ex vivo bovine liver with mathematic modeling. Radiology 238:881–890PubMedCrossRefGoogle Scholar
  57. 57.
    Rhim H, Goldberg SN, Dodd GD 3rd, et al. (2001) Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. Radiographics 21(Spec No):S17–S35 (discussion S36–19)PubMedGoogle Scholar
  58. 58.
    McGahan JP, Gu WZ, Brock JM, et al. (1996) Hepatic ablation using bipolar radiofrequency electrocautery. Acad Radiol 3:418–422PubMedCrossRefGoogle Scholar
  59. 59.
    Clasen S, Schmidt D, Dietz K, et al. (2007) Bipolar radiofrequency ablation using internally cooled electrodes in ex vivo bovine liver: prediction of coagulation volume from applied energy. Invest Radiol 42:29–36PubMedCrossRefGoogle Scholar
  60. 60.
    de Baere T, Denys A, Wood BJ, et al. (2001) Radiofrequency liver ablation: experimental comparative study of water-cooled versus expandable systems. AJR Am J Roentgenol 176:187–192PubMedGoogle Scholar
  61. 61.
    Goldberg SN, Gazelle GS, Dawson SL, et al. (1995) Tissue ablation with radiofrequency using multiprobe arrays. Acad Radiol 2:670–674PubMedCrossRefGoogle Scholar
  62. 62.
    Solazzo SA, Ahmed M, Liu Z, et al. (2007) High-power generator for radiofrequency ablation: larger electrodes and pulsing algorithms in bovine ex vivo and porcine in vivo settings. Radiology 242:743–750PubMedCrossRefGoogle Scholar
  63. 63.
    Goldberg SN, Stein MC, Gazelle GS, et al. (1999) Percutaneous radiofrequency tissue ablation: optimization of pulsed-radiofrequency technique to increase coagulation necrosis. J Vasc Interv Radiol 10:907–916PubMedCrossRefGoogle Scholar
  64. 64.
    Schmidt D, Trubenbach J, Brieger J, et al. (2003) Automated saline-enhanced radiofrequency thermal ablation: initial results in ex vivo bovine livers. AJR Am J Roentgenol 180:163–165PubMedGoogle Scholar
  65. 65.
    Livraghi T, Goldberg SN, Monti F, et al. (1997) Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases. Radiology 202:205–210PubMedGoogle Scholar
  66. 66.
    Goldberg SN, Ahmed M, Gazelle GS, et al. (2001) Radio-frequency thermal ablation with NaCl solution injection: effect of electrical conductivity on tissue heating and coagulation-phantom and porcine liver study. Radiology 219:157–165PubMedGoogle Scholar
  67. 67.
    Goldberg SN, Solbiati L, Hahn PF, et al. (1998) Large-volume tissue ablation with radio frequency by using a clustered, internally cooled electrode technique: laboratory and clinical experience in liver metastases. Radiology 209:371–379PubMedGoogle Scholar
  68. 68.
    Lorentzen T (1996) A cooled needle electrode for radiofrequency tissue ablation: thermodynamic aspects of improved performance compared with conventional needle design. Acad Radiol 3:556–563PubMedCrossRefGoogle Scholar
  69. 69.
    Rempp H, Voigtländer M, Clasen S, et al. (2009) Increased ablation zones using a cryo-based internally cooled bipolar RF applicator in ex vivo bovine liver. Invest Radiol 44:763–768PubMedCrossRefGoogle Scholar
  70. 70.
    Hines-Peralta A, Hollander CY, Solazzo S, et al. (2004) Hybrid radiofrequency and cryoablation device: preliminary results in an animal model. J Vasc Interv Radiol 15:1111–1120PubMedGoogle Scholar
  71. 71.
    Leyendecker JR, Dodd GD 3rd, Halff GA, et al. (2002) Sonographically observed echogenic response during intraoperative radiofrequency ablation of cirrhotic livers: pathologic correlation. AJR Am J Roentgenol 178:1147–1151PubMedGoogle Scholar
  72. 72.
    Choi D, Lim HK, Kim SH, et al. (2000) Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: usefulness of power Doppler US with a microbubble contrast agent in evaluating therapeutic response-preliminary results. Radiology 217:558–563PubMedGoogle Scholar
  73. 73.
    Solbiati L, Goldberg SN, Ierace T, et al. (1999) Radio-frequency ablation of hepatic metastases: postprocedural assessment with a US microbubble contrast agent—early experience. Radiology 211:643–649PubMedGoogle Scholar
  74. 74.
    Kim MJ, Kim JH, Chung JJ, et al. (2003) Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced. MR Imaging 228:719–726Google Scholar
  75. 75.
    Bartolozzi C, Donati F, Cioni D, et al. (2004) Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol 14:14–20PubMedCrossRefGoogle Scholar
  76. 76.
    Kim YK, Lee JM, Kim CS (2004) Gadobenate dimeglumine-enhanced liver MR imaging: value of dynamic and delayed imaging for the characterization and detection of focal liver lesions. Eur Radiol 14:5–13PubMedCrossRefGoogle Scholar
  77. 77.
    Goldberg SN, Grassi CJ, Cardella JF, et al. (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235:728–739PubMedCrossRefGoogle Scholar
  78. 78.
    Graham SJ, Stanisz GJ, Kecojevic A, et al. (1999) Analysis of changes in MR properties of tissues after heat treatment. Magn Reson Med 42:1061–1071PubMedCrossRefGoogle Scholar
  79. 79.
    Kierans AS, Elazzazi M, Braga L, et al. (2010) Thermoablative treatments for malignant liver lesions: 10-year experience of MRI appearances of treatment response. AJR Am J Roentgenol 194:523–529PubMedCrossRefGoogle Scholar
  80. 80.
    Boss A, Graf H, Muller-Bierl B, et al. (2005) Magnetic susceptibility effects on the accuracy of MR temperature monitoring by the proton resonance frequency method. J Magn Reson Imaging 22:813–820PubMedCrossRefGoogle Scholar
  81. 81.
    Quesson B, de Zwart JA, Moonen CT (2000) Magnetic resonance temperature imaging for guidance of thermotherapy. J Magn Reson Imaging 12:525–533PubMedCrossRefGoogle Scholar
  82. 82.
    Lepetit-Coiffe M, Laumonier H, Seror O, et al. (2010) Real-time monitoring of radiofrequency ablation of liver tumors using thermal-dose calculation by MR temperature imaging: initial results in nine patients, including follow-up. Eur Radiol 20:193–201PubMedCrossRefGoogle Scholar
  83. 83.
    Rempp H, Clasen S, Boss A, et al. (2009) Prediction of cell necrosis with sequential temperature mapping after radiofrequency ablation. J Magn Reson Imaging 30:631–639PubMedCrossRefGoogle Scholar
  84. 84.
    Ng KK, Poon RT, Lo CM, et al. (2008) Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg 12:183–191PubMedCrossRefGoogle Scholar
  85. 85.
    Rhim H, Dodd GD 3rd, Chintapalli KN, et al. (2004) Radiofrequency thermal ablation of abdominal tumors: lessons learned from complications. Radiographics 24:41–52PubMedCrossRefGoogle Scholar
  86. 86.
    Llovet JM, Vilana R, Bru C, et al. (2001) Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 33:1124–1129PubMedCrossRefGoogle Scholar
  87. 87.
    Choi H, Loyer EM, DuBrow RA, et al. (2001) Radio-frequency ablation of liver tumors: assessment of therapeutic response and complications. Radiographics 21(Spec No):S41–S54PubMedGoogle Scholar
  88. 88.
    Livraghi T, Solbiati L, Meloni MF, et al. (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226:441–451PubMedCrossRefGoogle Scholar
  89. 89.
    Chen MS, Li JQ, Zheng Y, et al. (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328PubMedCrossRefGoogle Scholar
  90. 90.
    Lu MD, Kuang M, Liang LJ, et al. (2006) Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: a randomized clinical trial. Zhonghua Yi Xue Za Zhi 86:801–805PubMedGoogle Scholar
  91. 91.
    Ogihara M, Wong LL, Machi J (2005) Radiofrequency ablation versus surgical resection for single nodule hepatocellular carcinoma: long-term outcomes. HPB (Oxford) 7:214–221Google Scholar
  92. 92.
    Lupo L, Panzera P, Giannelli G, et al. (2007) Single hepatocellular carcinoma ranging from 3 to 5 cm: radiofrequency ablation or resection? HPB (Oxford) 9:429–434Google Scholar
  93. 93.
    Ueno S, Sakoda M, Kubo F, et al. (2009) Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria. J Hepatobiliary Pancreat Surg 16:359–366PubMedCrossRefGoogle Scholar
  94. 94.
    Molinari M, Helton S (2009) Hepatic resection versus radiofrequency ablation for hepatocellular carcinoma in cirrhotic individuals not candidates for liver transplantation: a Markov model decision analysis. Am J Surg 198:396–406PubMedCrossRefGoogle Scholar
  95. 95.
    Livraghi T, Meloni F, Di Stasi M, et al. (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 47:82–89PubMedCrossRefGoogle Scholar
  96. 96.
    Guglielmi A, Ruzzenente A, Valdegamberi A, et al. (2008) Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis. J Gastrointest Surg 12:192–198PubMedCrossRefGoogle Scholar
  97. 97.
    Ikai I, Arii S, Okazaki M, et al. (2007) Report of the 17th Nationwide Follow-up Survey of Primary Liver Cancer in Japan. Hepatol Res 37:676–691PubMedCrossRefGoogle Scholar
  98. 98.
    Hasegawa K, Makuuchi M, Takayama T, et al. (2008) Surgical resection vs. percutaneous ablation for hepatocellular carcinoma: a preliminary report of the Japanese nationwide survey. J Hepatol 49:589–594PubMedCrossRefGoogle Scholar
  99. 99.
    Lencioni RA, Allgaier HP, Cioni D, et al. (2003) Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 228:235–240PubMedCrossRefGoogle Scholar
  100. 100.
    Camma C, Di Marco V, Orlando A, et al. (2005) Treatment of hepatocellular carcinoma in compensated cirrhosis with radio-frequency thermal ablation (RFTA): a prospective study. J Hepatol 42:535–540PubMedCrossRefGoogle Scholar
  101. 101.
    Lencioni R, Cioni D, Crocetti L, et al. (2005) Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234:961–967PubMedCrossRefGoogle Scholar
  102. 102.
    Lau WY, Leung TW, Yu SC, et al. (2003) Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 237:171–179PubMedGoogle Scholar
  103. 103.
    Berber E, Tsinberg M, Tellioglu G, et al. (2008) Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis. J Gastrointest Surg 12:1967–1972PubMedCrossRefGoogle Scholar
  104. 104.
    Veltri A, Sacchetto P, Tosetti I, et al. (2008) Radiofrequency ablation of colorectal liver metastases: small size favorably predicts technique effectiveness and survival. Cardiovasc Intervent Radiol 31:948–956PubMedCrossRefGoogle Scholar
  105. 105.
    Machi J, Oishi AJ, Sumida K, et al. (2006) Long-term outcome of radiofrequency ablation for unresectable liver metastases from colorectal cancer: evaluation of prognostic factors and effectiveness in first- and second-line management. Cancer J 12:318–326PubMedCrossRefGoogle Scholar
  106. 106.
    Gillams AR, Lees WR (2004) Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol 14:2261–2267PubMedCrossRefGoogle Scholar
  107. 107.
    Mulier S, Ruers T, Jamart J, et al. (2008) Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? An update. Dig Surg 25:445–460PubMedCrossRefGoogle Scholar
  108. 108.
    Mulier S, Ni Y, Jamart J, et al. (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Hansjörg Rempp
    • 1
  • Andreas Boss
    • 2
  • Thomas Helmberger
    • 3
  • Philippe Pereira
    • 4
  1. 1.Department on Diagnostic and Interventional RadiologyEberhard Karls University Hospital of TübingenTübingenGermany
  2. 2.Division of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  3. 3.Institute of Diagnostic and Interventional Radiology and Nuclear MedicineKlinikum BogenhausenMunichGermany
  4. 4.Clinic for Radiology, Minimally Invasive Therapies and Nuclear MedicineSLK-KlinikenHeilbronnGermany

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