Digestive Diseases and Sciences

, Volume 64, Issue 4, pp 951–958 | Cite as

Current State of Tumor Ablation Therapies

  • Christopher W. BaileyEmail author
  • Malcolm K. SydnorJr.


The most common primary liver malignancy, hepatocellular carcinoma (HCC), has a high likelihood of mortality, and much effort into early detection and treatment has occurred. Multiple staging systems have surfaced of which some guide treatment. Curative intent is a goal of early-staged HCC treatment, and this can be achieved with surgical resection, liver transplantation, and minimally invasive percutaneous therapies such as tumor ablation. Many of the newer ablation techniques have evolved from shortcomings of prior methods which have resulted in an expanded number of applications for tumor ablation. Our review focuses on current mainstream image-guided percutaneous ablation modalities which are commonly performed as an alternative to surgery.


Hepatocellular Carcinoma HCC RFA Microwave ablation Liver neoplasm Ablation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conlict of interest.


  1. 1.
    Global Burden of Disease Liver Cancer Collaboration, Akinyemiju T, Abera S, et al. The burden of primary liver cancer and underlying etiologies from, to 2015 at the global, regional, and national level: results from the global burden of disease study 2015. JAMA Oncol. 1990;2017:1683–1691.Google Scholar
  2. 2.
    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–E386.CrossRefGoogle Scholar
  3. 3.
    Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma; The BCLC staging classification. Semin Liver Dis. 1999;19:329–338.CrossRefGoogle Scholar
  4. 4.
    Forner A, Reig M, Rodriguez de Lope C, Bruix J. Current strategy for staging and treatment: The BCLC update and future prospects. Semin Liver Dis. 2010;30:61–74.CrossRefGoogle Scholar
  5. 5.
    Habib A, Desai K, Hickey R, et al. Locoregional therapy of hepatocellular carcinoma. Clin Liver Dis. 2015;19:401–420.CrossRefGoogle Scholar
  6. 6.
    Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358–380.CrossRefGoogle Scholar
  7. 7.
    Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–1022.CrossRefGoogle Scholar
  8. 8.
    Livraghi T, Bolondi L, Lazzaroni S, et al. Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis: A study on 207 patients. Cancer. 1992;69:925–929.CrossRefGoogle Scholar
  9. 9.
    Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: Long-term results of percutaneous ethanol injection. Radiology. 1995;197:101–108.CrossRefGoogle Scholar
  10. 10.
    Dodd GD, Soulen MC, Kane RA, et al. Minimally invasive treatment of malignant hepatic tumors: At the threshold of a major breakthrough. Radiographics. 2000;20:9–27.CrossRefGoogle Scholar
  11. 11.
    Lencioni R, Crocetti L, Della Pina C, Cioni D. Image-Guided Ablation of Hepatocellular Carcinoma. In: Geschwind JFH, Soulen MC, eds. Interventional Oncology, Principle and Practice. New York, NY: Cambridge University Press; 2008:145–159.CrossRefGoogle Scholar
  12. 12.
    Koda M, Murawaki Y, Mitsuda A, et al. Predictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma. Cancer. 2000;88:529–537.CrossRefGoogle Scholar
  13. 13.
    Lencioni R, Bartolozzi C, Caramella D, et al. Treatment of small hepatocellular carcinoma with percutaneous ethanol injection: Analysis of prognostic factors in 105 western patients. Cancer. 1995;76:1737–1746.CrossRefGoogle Scholar
  14. 14.
    McWilliams JP, Yamamoto S, Raman SS, et al. Percutaneous ablation of hepatocellular carcinoma: Current status. J Vasc Interv Radiol. 2010;21:S204–S213.CrossRefGoogle Scholar
  15. 15.
    Lencioni RA, Allgaier HP, Cioni D, et al. Small hepatocellular carcinoma in cirrhosis: Randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology. 2003;228:235–240.CrossRefGoogle Scholar
  16. 16.
    McGahan J, Browning PD, Brock JM, Tesluk H. Hepatic ablation using radiofrequency electrocautery. Invest Radiol. 1990;25:267–270.CrossRefGoogle Scholar
  17. 17.
    Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: A unified approach to underlying principles, techniques, and diagnostic imaging guidance. Am J Roentgenol. 2000;174:323–331.CrossRefGoogle Scholar
  18. 18.
    Gazelle GS, Goldberg SN, Solbiati L, Livraghi T. Tumor ablation with radio-frequency energy. Radiology. 2000;217:633–646.CrossRefGoogle Scholar
  19. 19.
    Okusaka T, Okada S, Ueno H, et al. Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features. Cancer. 2002;95:1931–1937.CrossRefGoogle Scholar
  20. 20.
    Salmi A, Turrini R, Lanzani G, Savio A, Anglani L. Efficacy of radiofrequency ablation of hepatocellular carcinoma associated with chronic liver disease without cirrhosis. Int J Med Sci. 2008;5:327–332.CrossRefGoogle Scholar
  21. 21.
    Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the milan criteria. Ann Surg. 2010;252:903–912.CrossRefGoogle Scholar
  22. 22.
    Lee HW, Lee JM, Yoon JH, et al. A prospective randomized study comparing radiofrequency ablation and hepatic resection for hepatocellular carcinoma. Ann Surg Treat Res. 2018;94:74–82.CrossRefGoogle Scholar
  23. 23.
    Fang Y, Chen W, Liang X, et al. Comparison of long-term effectiveness and complications of radiofrequency ablation with hepatectomy for small hepatocellular carcinoma. J Gastroenterol Hepatol. 2014;29:193–200.CrossRefGoogle Scholar
  24. 24.
    Livraghi T, Goldberg SN, Lazzaroni S, et al. Hepatocellular carcinoma: Radio-frequency ablation of medium and large lesions. Radiology. 2000;214:761–768.CrossRefGoogle Scholar
  25. 25.
    Huffman SD, Huffman NP, Lewandowski RJ, Brown DB. Radiofrequency ablation complicated by skin burn. Semin Intervent Radiol. 2011;28:179–182.CrossRefGoogle Scholar
  26. 26.
    Goldberg SN, Solbiati L, Halpern EF, Gazelle GS. Variables affecting proper system grounding for radiofrequency ablation in an animal model. J Vasc Intervent Radiol. 2000;11:1069–1075.CrossRefGoogle Scholar
  27. 27.
    Patterson EJ, Scudamore CH, Owen DA, Nagy AG, Buckowski AK. Radiofrequency ablation of porcine liver in vivo effects of blood flow and treatment time on lesion size. Ann Surg. 1998;227:559–565.CrossRefGoogle Scholar
  28. 28.
    Bhardwaj N, Strickland AD, Ahmad F, Ataneysan L, West K, Lloyd DM. A comparative histological evaluation of the ablations produced by microwave, cryotherapy and radiofrequency in the liver. Pathology. 2009;41:168–172.CrossRefGoogle Scholar
  29. 29.
    Wright AS, Sampson LA, Warner TF, Mahvi DM, Lee FT Jr. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology. 2005;236:132–139.CrossRefGoogle Scholar
  30. 30.
    Tabuse K. A new operative procedure of hepatic surgery using a microwave tissue coagulator. Arch Jap Chir. 1979;48:160–172.Google Scholar
  31. 31.
    Murakami R, Yoshimatsu S, Yamashita Y, Matsukawa T, Takahashi M, Sagara K. Treatment of hepatocellular carcinoma: Value of percutaneous microwave coagulation. Am J Roentgenol. 1995;164:1159–1164.CrossRefGoogle Scholar
  32. 32.
    Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: Principles and applications. RadioGraphics. 2005;25:S69–S83.CrossRefGoogle Scholar
  33. 33.
    Wells SA, Hinshaw JL, Lubner MG, Ziemlewicz TJ, Brace CL, Lee FT Jr. Liver ablation: Best practice. Radiol Clin N Am. 2015;53:933–971.CrossRefGoogle Scholar
  34. 34.
    Wright SW, Lee FT Jr, Mahvi DM. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol. 2003;10:275–283.CrossRefGoogle Scholar
  35. 35.
    Yin XY, Xie XY, Lu MD, et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma long-term outcome and prognostic factors. Cancer. 2009;115:1914–1923.CrossRefGoogle Scholar
  36. 36.
    Llang P, Dong B, Yu X, et al. Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation. Radiology. 2005;235:299–307.CrossRefGoogle Scholar
  37. 37.
    Dong B, Liang P, Yu X, et al. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: Results in 234 patients. Am J Roentgenol. 2003;180:1547–1555.CrossRefGoogle Scholar
  38. 38.
    Xu L-F, Sun H-L, Chen Y-T, et al. Large primary hepatocellular carcinoma: Transarterial chemoembolization monotherapy versus combined transarterial chemoembolization-percutaneous microwave coagulation therapy. J Gastroenterol Hepatol. 2013;28:456–463.CrossRefGoogle Scholar
  39. 39.
    Zhang R, Shen L, Zhao L, Guan Z, Chen Q, Li W. Combined transarterial chemoembolization and microwave ablation versus transarterial chemoembolization in BCLC stage B hepatocellular carcinoma. Diagn Interv Radiol. 2018;24:219–224.CrossRefGoogle Scholar
  40. 40.
    Cooper IS. Cryogenic surgery. A new method of destruction or extirpation of benign or malignant tissues. N Engl J Med. 1963;268:743–749.CrossRefGoogle Scholar
  41. 41.
    Ravikumar TS, Kane R, Cady B, Jenkins R, Clouse M, Steele G Jr. A 5-year study of cryosurgery in the treatment of liver tumors. Arch Surg. 1991;126:1520–1524.CrossRefGoogle Scholar
  42. 42.
    Ahmed M, Brace CL, Lee FT Jr, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology. 2011;258:351–369.CrossRefGoogle Scholar
  43. 43.
    Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37:171–186.CrossRefGoogle Scholar
  44. 44.
    Permpongkosol S, Sulman A, Solomon SB, Gong GX, Kavoussi LR. Percutaneous computerized tomography guided renal cryoablation using local anesthesia: Pain assessment. J Urol. 2006;176:915–918.CrossRefGoogle Scholar
  45. 45.
    Allaf ME, Varkarakis IM, Bhayani SB, Inagaki T, Kavoussi LR, Solomon SB. Pain control requirements for percutaneous ablation of renal tumors: Cryoablation versus radiofrequency ablation—initial observations. Radiology. 2005;237:366–370.CrossRefGoogle Scholar
  46. 46.
    Gilbert JC, Onik GM, Hoddick WK, et al. Real time ultrasonic monitoring of hepatic cryosurgery. Cryobiology. 1985;22:319–330.CrossRefGoogle Scholar
  47. 47.
    Lee FT Jr, Chosy SG, Littrup PJ, Warner TF, Kuhlman JE, Mahvi DM. CT-monitored percutaneous cryoablation in a pig liver model: Pilot study. Radiology. 1999;211:687–692.CrossRefGoogle Scholar
  48. 48.
    Silverman SG, Sun MR, Tuncali K, et al. Three-dimensional assessment of MRI-guided percutaneous cryotherapy of liver metastases. Am J Roentgenol. 2004;183:707–712.CrossRefGoogle Scholar
  49. 49.
    Weber SM, Lee FT Jr, Warner TF, Chosy SG, Mahvi DM. Hepatic cryoablation: US monitoring of extent of necrosis in normal pig liver. Radiology. 1998;207:73–77.CrossRefGoogle Scholar
  50. 50.
    Seifert JK, Morris DL. World survey on the complications of hepatic and prostate cryotherapy. World J Surg. 1999;23:109–114.CrossRefGoogle Scholar
  51. 51.
    Xu K-C, Niu L-Z, Zhou Q, et al. Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma. World J Gastroenterol. 2009;15:3664–3669.CrossRefGoogle Scholar
  52. 52.
    Davalos RV, Mir LM, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng. 2005;33:223–231.CrossRefGoogle Scholar
  53. 53.
    Lee EW, Chen C, Prieto VE, Dry SM, Loh CT, Kee ST. Advanced hepatic ablation technique for creating complete cell death: Irreversible electroporation. Radiology. 2010;255:426–433.CrossRefGoogle Scholar
  54. 54.
    Seror O. Ablative therapies: Advantages and disadvantages of radiofrequency, cryotherapy, microwave and electroporation methods, or how to choose the right method for an individual patient? Diagn Interv Imaging. 2015;96:617–624.CrossRefGoogle Scholar
  55. 55.
    Silk MT, Wimmer T, Lee KS, et al. Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Inter Radiol. 2014;25:112–118.CrossRefGoogle Scholar
  56. 56.
    Sutter O, Calvo J, N’Kontchou G, et al. Safety and efficacy of irreversible electroporation for the treatment of hepatocellular carcinoma not amenable to thermal ablation techniques: A retrospective single-center case series. Radiology. 2017;284:877–886.CrossRefGoogle Scholar
  57. 57.
    Cornelis FH, Durack JC, Kimm SY, et al. A comparative study of ablation boundary sharpness after percutaneous radiofrequency, cryo-, microwave, and irreversible electroporation ablation in normal swine liver and kidneys. Cardiovasc Intervent Radiol. 2017;40:1600–1608.CrossRefGoogle Scholar
  58. 58.
    Niessen C, Beyer LP, Pregler B, et al. Percutaneous ablation of hepatic tumors using irreversible electroporation: A prospective safety and midterm efficacy study in 34 patients. J Vasc Inter Radiol. 2016;27:480–486.CrossRefGoogle Scholar
  59. 59.
    Niessen C, Thumann S, Beyer L, et al. Percutaneous irreversible electroporation: Long-term survival analysis of 71 patients with inoperable malignant hepatic tumors. Sci Rep. 2017;7:1–8.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Interventional Radiology, Department of RadiologyVCU Medical Center, Virginia Commonwealth UniversityRichmondUSA

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