Thermal Ablation of Liver Tumours: How the Scenario Has Changed in the Last Decade

Abstract

Surgical resection has long been considered the gold standard for the local treatment of primary and secondary liver tumours. Until recent years, percutaneous thermal ablation (PTA), in particular radiofrequency ablation (RFA), was not accepted as a first-line option for the treatment of liver tumours and was reserved for patients who were unsuitable for surgery. However, in the last decade the scenario has changed: interesting technical developments and innovations have improved the performance of RFA and broadened the availability of other ablative technologies, such as microwave ablation (MWA) and laser ablation (LA). The latest generation of MWA systems can achieve larger ablation areas than RFA and LA, with a multifibre technique that uses very thin needles, allowing physicians to treat nodules in at-risk locations with high flexibility and a very low risk ofcomplications. Nowadays, there is an increasingly accepted consensus on the role of PTA as a first-line option for the treatment of liver tumours <2 cm in size, as well as in patients potentially eligible for surgery, and it is likely that in the near future the 2 cm barrier could also be surpassed and extended to at least 3 cm. PTA is becoming more effective and important in the treatment of primary and secondary liver tumours, and, in the well-established scenario of a multimodal tailoredtreatment, it plays and will continue to play a central role. The aim of this paper is to examine the current role of PTA in such a scenario, focussing on advantages and limitations of the three available ablative techniques: RFA, MWA, and LA.