Abstract
Owing to surveillance programs for detection of hepatocellular carcinoma (HCC) in patients with cirrhosis, more tumors are being detected at an early, asymptomatic stage. Percutaneous ablation is considered the best treatment option for patients with Child-Pugh class A or B cirrhosis and a single, nodular-type HCC smaller than 5 cm or as many as three HCC lesions, each smaller than 3 cm, when surgical resection or liver transplantation is not suitable. Radiofrequency ablation (RFA) has emerged as the most powerful method for percutaneous treatment of early-stage HCC. Recent studies have shown that RFA can achieve more effective local tumor control than ethanol injection and with fewer treatment sessions. In a randomized trial, local recurrence-free survival rates were significantly higher in patients who received RFA than in those treated by ethanol injection, and treatment allocation was confirmed as an independent prognostic factor by multivariate analysis. Due to advances in radiofrequency technology, RFA also has been used to treat patients with more advanced tumors. Preliminary reports have shown that RFA performed after balloon catheter occlusion of the hepatic artery, transarterial embolization, or chemoembolization results in increased volumes of coagulation necrosis, thus enabling successful destruction of large HCC lesions. This report reviews the current status of percutaneous, image-guided RFA in the therapeutic management of HCC.
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J Bruix M Sherman JM Llovet InstitutionalAuthorNamefor the EASL Panel of Experts on HCC et al. (2001) ArticleTitleClinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver J Hepatol 35 421–430 Occurrence Handle10.1016/S0168-8278(01)00130-1 Occurrence Handle11592607
J Bruix JM Llovet (2002) ArticleTitlePrognostic prediction and treatment strategy in hepatocellular carcinoma Hepatology 35 519–524 Occurrence Handle10.1053/jhep.2002.32089 Occurrence Handle11870363
JM Llovet C Bru J Bruix (1999) ArticleTitlePrognosis of hepatocellular carcinoma: the BCLC staging classification Semin Liver Dis 19 329–338 Occurrence Handle10518312
R Lencioni D Cioni L Crocetti C Bartolozzi (2004) ArticleTitlePercutaneous ablation of hepatocellular carcinoma: state-of-the-art Liver Transpl 10 591–597 Occurrence Handle10.1002/lt.20043
R Lencioni C Bartolozzi D Caramella et al. (1995) ArticleTitleTreatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients Cancer 76 1737–1746 Occurrence Handle8625042
T Livraghi A Giorgio G Marin et al. (1995) ArticleTitleHepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection Radiology 197 101–108 Occurrence Handle7568806
KN Khan H Yatsuhashi K Yamasaki et al. (2000) ArticleTitleProspective analysis of risk factors for early intrahepatic recurrence of hepatocellular carcinoma following ethanol injection J Hepatol 32 269–278 Occurrence Handle10.1016/S0168-8278(00)80072-0 Occurrence Handle10707867
M Koda Y Murawaki A Mitsuda et al. (2000) ArticleTitlePredictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma Cancer 88 529–537 Occurrence Handle10.1002/(SICI)1097-0142(20000201)88:3<529::AID-CNCR6>3.0.CO;2-M Occurrence Handle10649243
SN Goldberg GS Gazelle PR Mueller (2000) ArticleTitleThermal ablation therapy for focal malignancies: a unfied approach to underlyng principles, techniques, and diagnostic imaging guidance AJR 174 323–331 Occurrence Handle10658699
R Lencioni D Cioni C Bartolozzi (2001) ArticleTitlePercutaneous radiofrequency thermal ablation of liver malignancies: techniques, indications, imaging findings, and clinical results Abdom Imaging 26 345–360 Occurrence Handle10.1007/s002610000194 Occurrence Handle11441546
AR Gillams (2003) ArticleTitleRadiofrequency ablation in the management of liver tumors Eur J Surg Oncol 29 9–16 Occurrence Handle10.1053/ejso.2002.1346 Occurrence Handle12559069
JM Llovet MI Real X Montaña et al. (2002) ArticleTitleArterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial Lancet 359 1734–1739 Occurrence Handle10.1016/S0140-6736(02)08649-X Occurrence Handle12049862
JM Llovet A Burroughs J Bruix (2003) ArticleTitleHepatocellular carcinoma Lancet 362 1907–1917 Occurrence Handle14667750
S Rossi F Garbagnati R Lencioni et al. (2000) ArticleTitlePercutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply Radiology 217 119–126 Occurrence Handle11012432
T Yamasaki F Kurokawa H Shirahashi et al. (2002) ArticleTitlePercutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Compar-ison with standard percutaneous radiofrequency ablation therapy Cancer 95 2353–2360 Occurrence Handle10.1002/cncr.10966 Occurrence Handle12436442
K Yamakado A Nakatsuka S Ohmori et al. (2002) ArticleTitleRadiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology J Vasc Interv Radiol 13 1225–1232 Occurrence Handle12471186
D Cioni R Lencioni S Rossi et al. (2001) ArticleTitleRadiofrequency thermal ablation of hepatocellular carcinoma: using contrast-enhanced harmonic power Doppler sonography to assess treatment outcome AJR 177 783–788 Occurrence Handle11566673
K Numata T Isozaki Y Ozawa et al. (2003) ArticleTitlePercutaneous ablation therapy guided by contrast-enhanced sonography for patients with hepatocellular carcinoma AJR 180 143–149 Occurrence Handle12490493
M Morimoto K Sugimori K Shirato et al. (2002) ArticleTitleTreatment of hepatocellular carcinoma with radiofrequency ablation: radiologic-histologic correlation during follow-up periods Hepatology 35 1467–1475 Occurrence Handle10.1053/jhep.2002.33635 Occurrence Handle12029632
O Catalano R Lobianco N Esposito A Siani (2001) ArticleTitleHepatocellular carcinoma recurrence after percutaneous ablation therapy: helical CT patterns Abdom Imaging 26 375–383 Occurrence Handle10.1007/s002610000199 Occurrence Handle11441549
T Okusaka S Okada H Ueno et al. (2002) ArticleTitleSatellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features Cancer 95 1931–1937 Occurrence Handle10.1002/cncr.10892 Occurrence Handle12404287
S Rossi E Buscarini F Garbagnati et al. (1998) ArticleTitlePercutaneous treatment of small hepatic tumors by an expandable RF electrode needle AJR 170 1015–1022 Occurrence Handle9530052
K Shirato M Morimoto N Tomita et al. (2002) ArticleTitleSmall hepatocellular carcinoma: therapeutic effectiveness of percutaneous radiofrequency ablation therapy with a LeVeen needle electrode J Ultrasound Med 21 67–76 Occurrence Handle11794405
T Livraghi SN Goldberg S Lazzaroni et al. (1999) ArticleTitleSmall hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection Radiology 210 655–661 Occurrence Handle10207464
M Ikeda S Okada H Ueno et al. (2001) ArticleTitleRadiofrequency ablation and percutaneous ethanol injection in patients with small hepatocellular carcinoma: a comparative study Jpn J Clin Oncol 31 322–326 Occurrence Handle10.1093/jjco/hye063 Occurrence Handle11518745
R Lencioni HP Allgaier D Cioni et al. (2003) ArticleTitleSmall hepatocellular carcinoma in cirrhosis: randomized comparison of radiofrequency thermal ablation versus percutaneous ethanol injection Radiology 228 235–240 Occurrence Handle12759473
Lencioni R, Cioni D, Crocetti L, et al. (2005) Early-stage hepatocellular carcinoma in cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology (in press)
V Mazzaferro E Regalia R Doci et al. (1996) ArticleTitleLiver transplantation in the treatment of small hepatocellular carcinomas in patients with cirrhosis N Engl J Med 334 693–699 Occurrence Handle10.1056/NEJM199603143341104 Occurrence Handle8594428
H Bismuth PE Majno R Adam (1999) ArticleTitleLiver transplantation for hepatocellular carcinoma Semin Liver Dis 19 311–322 Occurrence Handle10518310
JM Llovet J Fuster J Bruix (1999) ArticleTitleIntention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation Hepatology 30 1434–1440 Occurrence Handle10.1002/hep.510300629 Occurrence Handle10573522
S Jonas WO Beckstein T Steinmuller et al. (2001) ArticleTitleVascular invasion and histopathologic grading determine outcome after liver transplantion for hepatocellular carcinoma in cirrhosis Hepatology 33 1080–1086 Occurrence Handle10.1053/jhep.2001.23561 Occurrence Handle11343235
Y Fong RL Sun W Jarnagin LH Blumgart (1999) ArticleTitleAn analysis of 412 cases of hepatocellular carcinoma at a Western center Ann Surg 229 790–800 Occurrence Handle10.1097/00000658-199906000-00005 Occurrence Handle10363892
JD Wayne GY Lauwers I Ikai et al. (2002) ArticleTitlePreoperative predictors of survival after resection of small hepatocellular carcinomas Ann Surg 235 722–731 Occurrence Handle10.1097/00000658-200205000-00015 Occurrence Handle11981219
T Livraghi SN Goldberg S Lazzaroni et al. (2000) ArticleTitleHepatocellular carcinoma: radio-frequency ablation of medium and large lesions Radiology 214 761–768 Occurrence Handle10715043
SN Goldberg PF Hahn KK Tanabe et al. (1998) ArticleTitlePercutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol 9 101–115 Occurrence Handle9468403
WR Lees C Schumillian AR Gillams (2000) ArticleTitleHypotensive anesthesia improves the effectiveness of radiofrequency ablation in the liver Radiology 217 IssueIDP 228 Occurrence Handle11012449
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Lencioni, R., Della Pina, C. & Bartolozzi, C. Percutaneous image-guided radiofrequency ablation in the therapeutic management of hepatocellular carcinoma. Abdom Imaging 30, 401–408 (2005). https://doi.org/10.1007/s00261-004-0254-8
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DOI: https://doi.org/10.1007/s00261-004-0254-8