Abstract
SummaryMinimally invasive thermal ablation techniques are an integral part of international treatment guidelines in hepatocellular carcinoma (HCC). Due to highly effective local tumor control in nonresectable liver tumors with a relatively low rate of morbidity and mortality, thermal ablation even challenges the surgical approach as the first-line treatment in selected patients. Ablation outcome is largely dependent on the size and location of the HCC as well as on the applied ablation technique and image guidance. The creation of a sufficient ablation margin (A0 ablation in analogy to R0 resection) is prerequisite to assure low recurrence rates. In large tumors, tumor-free margins can be achieved only by overlapping ablation zones, which can be accomplished using stereotactic multiprobe ablation techniques (stereotactic radiofrequency ablation [SRFA], stereotactic microwave ablation [SMWA], stereotactic irreversible electroporation [SIRE]) in combination with 3D trajectory planning and image fusion for intraoperative evaluation of treatment results.
Highlights
Due to satisfactory local tumor control and survival rates thermal ablation has been included in international guidelines as a minimally invasive local curative procedure for the treatment of hepatocellular carcinoma (HCC) [1,2,3]
Technical effectiveness of the procedure depends on the safety margin of the ablation zone, which is directly proportional to the tumor recurrence rate [13]
One included 180 HCC patients who were prospectively randomized to Radiofrequency ablation (RFA) or surgery, with 1, 2, 3- and 4-year overall survival rates of 95.8%, 82.1%, 71.4% and 67.9% vs. 93.3%, 82.3%, 73.4% and 64%, respectively [37]
Summary
Keywords Radiofrequency ablation · Local tumor treatment · Percutaneous thermal ablation · Interventional oncology · Minimally invasive surgery · Stereotaxy Due to satisfactory local tumor control and survival rates thermal ablation has been included in international guidelines as a minimally invasive local curative procedure for the treatment of hepatocellular carcinoma (HCC) [1,2,3]. MWA and RFA have achieved comparable results in clinical HCC trials regarding local recurrence and complication rates [6, 7].
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