Radiofrequency Thermoablation Research Articles

Ambulatory surgery for chronic venous insufficiency using radiofrequency thermoablation: quality and satisfaction

Ambulatory surgery for chronic venous insufficiency using radiofrequency thermoablation: quality and satisfaction

Thermoablative Treatment of Papillary Microcarcinomas of Thyroid.

Recently, locoregional treatment with ultrasound-guided radiofrequency has been proposed as a new, effective, and safe procedure for low-risk papillary thyroid microcarcinoma (PTC < 1 cm), not eligible or recruitable for surgery. Until now, the gold standard has been the surgery and then the active surveillance. The aim of the study is to present our experience of ultrasound-guidedthermoablation, a procedure performed before demolitive surgery and post-active surveillance. It is a non-invasive treatment that does not require general anesthesia, with a low risk of complications, hypothyroidism, and hypoparathyroidism. All nodules described on ultrasound showed a volumetric increase (follow-up from 12 to 36 months). The cytological examination in all cases showed TIR 4b and TIR 5 papillary microcarcinoma. All the patients were offered the possibility of radiofrequency thermoablation; they were all informed and gave their consent. 18G active tip electrode needles 7 or 10 mm (Amica Gen HS) were used with the moving shot method under local anesthesia in a day hospital setting. No severe complications were reported. Contrast-Enhanced Ultrasonography (CEUS) with SonoVue (CEUS Sonovue) was performed post-procedure and then at 1, 3, 6, and 12 months, which documented complete revascularization and progressive volumetric reduction of the treated area. Our experience has confirmed that radiofrequency ablation can effectively eliminate small papillary thyroid carcinomas with fewer complications. In our opinion, it is a valid alternative for the treatment of low-risk and indolent papillary thyroid microcarcinomas, even in the absence of surgical contraindications.

Chronic Low Back Pain Management: Comparison of Facet Denervation with Radiofrequency Thermoablation and Facet Joint Injection

Chronic Low Back Pain Management: Comparison of Facet Denervation with Radiofrequency Thermoablation and Facet Joint Injection

Ambulatory surgery for chronic venous insufficiency using radiofrequency thermoablation: quality and satisfaction.

Chronic venous disease is a frequent and prevalent pathology. Its surgical treatment has been shown to be cost-effective. Thermal endoablation performed as major outpatient surgery (MAS) is the technique of choice. To know the satisfaction of patients after MAS and the quality of care provided. Observational, descriptive, cross-sectional study, carried out between January 2019 and March 2020. A survey was carried out on patients who underwent endovascular radiofrequency thermoablation in two hospitals in Spain, consisting of two questionnaires: one ad hoc and one another of satisfaction (SERCAL). Quality indices for MAS were measured. We analyzed 156 episodes. 145 interventions were carried out. We found 4 (2.8%) unscheduled admissions. 3 patients (2.1%) attended the emergency department. There was a 99.3% success rate. 100% of the patients had pre-surgical recommendations and informed consent. We obtained 48 surveys (response rate: 33.1%). All the patients gave a rating greater ≥ 8 in quality of care (x = 9.83) and would recommend this procedure to their relatives (x = 9.71). Endovascular radiofrequency thermoablation performed in MAS has a high success rate and a very low rate of admission and visit to the emergency room. Patient satisfaction is high.

Synchronous Treatment of Breast Cancer Hepatic Metastases by Transarterial Radioembolization and Radiofrequency Thermoablation: A Case Report.

In a 51-year-old woman affected by breast cancer, hepatic recurrence of disease was managed by concurrent 90 Y-labeled glass microsphere embolization (transarterial radioembolization) and radiofrequency thermoablation. Intention-to-treat target, candidate to radioembolization, was in the IV hepatic segment; another lesion, managed with radiofrequency thermoablation, was in the VI-VII hepatic segment. Concomitant correction of a duodenocephalopancreatic shunting was performed as well. Thermoablation did not interfere with distribution of 99m Tc-macroaggregated albumin and 90 Y-labeled microspheres to the target and healthy liver. At our knowledge, this is the first report that combines 2 locoregional procedures in different hepatic segments on the same day.

Survival in People Living with HIV with or without Recurrence of Hepatocellular Carcinoma after Invasive Therapy

To address the overall survival (OS) and recurrence (RE) in people living with HIV (PLWH) treated with invasive therapy (IT) for hepatocellular carcinoma (HCC). This is a retrospective cohort study on 41 PLWH with HCC receiving IT, defined as liver resection (LR), orthotopic liver transplantation (OLT), radiofrequency thermo-ablation (RFTA) trans arterial chemo, or radioembolization (CRE). OS and RE were investigated by Kaplan-Meier curves. The Cox proportional hazard regression model was used for multivariate analyses. Recurrence occurred in 46.3% PLWH; in 36.7% of participants at 2 years and in 52% at 5 years from HCC diagnosis; it was less frequent in males, p = 0.036. Overall, 2- and 5-year survival after HCC diagnosis was 72% and 48%, respectively. Two-and five-year survival was 100% and 90.9%, respectively, in PLWH receiving OLT, compared to other IT (60.9% and 30.6%, respectively) log-rank p = 0.0006. Two- and five-year survival in participants with no-RE was 70.5% and 54.6%, respectively, and 73.7% and 42.1% among RE, respectively, log-rank p = 0.7772. By multivariate analysis, AFP at values < 28.8 ng/mL, at HCC diagnosis, was the only factor predicting survival. Fifty percent of PLWH survived five years after HCC diagnosis; 90.9% among OLT patients. Recurrence after IT was observed in 46% of HCC/PLWH. AFP cut-off levels of 28.8 ng/mL were the only independent variable associated with survival.

Retrospective Analysis of Clinical Feature in Trigeminal Neuralgia

BACKGROUND: Trigeminal neuralgia (TN) is usually established using characteristic clinical features such as sudden, severe, and unilateral facial pain. Studies about diverse clinical features and epidemiologic data of TN have been reported previously; however, most of the previous studies have evaluated in and focused on Caucasian and Western populations. OBJECTIVES: The purpose of this study was to evaluate diverse clinical features, currently applied types of treatment, and brain imaging studies in patients with TN in a Korean population. STUDY DESIGN: Retrospective analysis. SETTING: An interventional pain management practice in South Korea. METHODS: Patients with a primary diagnosis of TN were identified using Clinical Data Warehouse v 2.5 (CDW, Planit Healthcare, Seoul, Korea) using the key words “trigeminal neuralgia and G50.0 (International classification of disease 10 code).” RESULTS: TN occurred predominantly between the fifth and seventh decades of life, with female predominance. The V3 division and unilateral right-side involvement were the most common affected region. An electric shock like sensation and the intraoral side (teeth and gingiva) were the most common pain description and location, respectively. Normal brain imaging studies and vascular compression on the trigeminal nerve were observed in 92 (64.7%) and 36 (25%) patients, respectively. The superior cerebellar artery was the most common offending vessel (19;13.3%). Monotherapy with carbamazepine alone was the most common (91;37.7%), whereas radiofrequency thermoablation was the most common invasive treatment. LIMITATIONS: The results of this study were based on data on TN patients from a single center. The generalizability of the findings to the Korean population is thus limited. CONCLUSION: There is little difference between Korean and other Asian patients with TN in their demographic and clinical characteristics. KEY WORDS: Brain imaging, clinical feature, electric shock-like sensation, intraoral side, trigeminal neuralgia, vascular compression

Radiofrequency thermoablation (RFA) in kidney cancer patients

The aim: to evaluate the own direct results of the RFA of kidney tumors in A.V. Vishnevsky National Medical Research Center of Surgery.Materials and methods. The study included the results of examination and treatment of 22 patients with kidney tumors treated at A.V. Vishnevsky National Medical Center of Surgery (16 men and 6 women aged 40 to 81, mean age 61.5 years). All patients underwent preoperative ultrasound, MSCT with contrast enhancement., Patients underwent RFA of kidney tumors using the Radionics Cool-Tip ® Ablation System (USA) at various stages of treatment In the postoperative period, all patients underwent MSCT monitoring with contrast enhancement and ultrasound with duplex scanning, as well as ultrasound with contrast enhancement – in 7 patients and MRI with contrast enhancement on the first day after the intervention – in 5 patients. Dynamic follow-up was performed in the postoperative period from 3 to 60 months (median 17.8 months).Results. Depending on the surgical tactics, the patients were divided into two groups: the first (16 patients) – RFA was performed as the first independent stage of treatment; the second (6 patients) – RFA was performed as a staged treatment for kidney resection.The tumor was solitary in 19 patients of both groups, multiple – in 3. In tumors of the first group, with sizes exceeding 30.0 mm in diameter, a positive effect was obtained from the manipulation: no progression of the tumor was detected during dynamic observation. These patients underwent 2 to 3 RFA sessions. In tumors of the second group, the size did not exceed 30.0 mm, 2 to 4 sessions (on average 3 sessions) of RFA were performed, which was due to multiple lesions in 3 cases.The use of RFA in the treatment of patients with small kidney cancer in patients with concomitant diseases that do not allow for radical treatment, made it possible to obtain a relapse-free period of an average of 16.5 months. The use of RFA, as a stage in the treatment of primary multiple kidney cancer, showed a relapse-free period of an average of 21.2 months.Conclusion. The use of radiofrequency ablation in the treatment of kidney cancer patients can significantly expand the scope of surgical care, both in the case of patients with concomitant diseases that do not allow a significant amount of surgical intervention, and in the treatment of patients with primary multiple cancer of both kidneys as a stage treatment.

Percutaneous treatment of chest wall chondroid hamartomas: the experience of a single center

BackgroundThoracic mesenchymal hamartomas are rare benign lesions. Rarely symptomatic, they may compress pulmonary parenchyma, leading to respiratory distress. Although spontaneous regression has been documented, the more common outcome is progressive growth. The treatment of choice is en bloc excision of the involved portion of the chest wall, frequently leading to significant deformity.ObjectiveThe aim of our study was to describe percutaneous techniques to treat these lesions.Materials and methodsWe collected data of children with thoracic mesenchymal hamartomas who were treated at our institution from 2005 to 2020 using various percutaneous techniques. Techniques included radiofrequency thermoablation, microwave thermoablation (microwave thermoablation) and cryoablation.ResultsFive children were treated for chest wall hamartomas; one child showed bilateral localization of the mass. Two children underwent microwave thermoablation, one radiofrequency thermoablation and two cryoablation; one child treated with cryoablation also had radiofrequency thermoablation because mass volume increased after the cryoablation procedure. The median reduction of tumor volume was 69.6% (24.0–96.5%). One child treated with microwave thermoablation showed volumetric increase of the mass and underwent surgical removal of the tumor. No major complication was reported.ConclusionPercutaneous ablation is technically feasible for expert radiologists and might represent a valid and less invasive treatment for chest wall chondroid hamartoma, avoiding skeletal deformities.

Radiofrequency thermoablation of the peripheral branches of trigeminal nerve versus the Gasserian ganglion for treating idiopathic trigeminal neuralgia: A systematic review and meta-analysis

BackgroundTrigeminal neuralgia is characterized by pain at the distribution of one or more of the trigeminal nerve branches and is usually treated with anti-epileptic medication. When first line treatment fails, patients receive other treatment modalities including radiofrequency thermoablation (RFT) of the Gasserian ganglion and peripheral branches of the trigeminal nerve. The aim of this study is to compare RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve in terms of efficacy and rate of complications. MethodsThis was a systematic review and meta-analysis that searched Medline, Cochrane Central Register of Controlled Trials, and Embase using Medical Subject Headings and the references of the enrolled studies with no restriction on date. We included only RCTs that compared the RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve with one of the following outcomes: pain scales, immediate effective rate, recurrence rate, and complications. ResultsFive articles were eligible for our review and showed that there was no difference between RFT of the peripheral nerves and the Gasserian ganglion in terms of pain scores. There was a non-significant trend for RFT of the peripheral nerve to have higher immediate effect rates and higher recurrence rates. RFT of the Gasserian ganglion group was associated with masticatory weakness, while the other group was associated with facial swelling and numbness of V2. ConclusionRFT of the peripheral branches is a safe and effective method to treat idiopathic trigeminal neuralgia but leads to a higher recurrence rate when compared with RFT of the Gasserian ganglion.

Colorectal cancer liver metastases: current state of the problem, priority treatment approaches

The review is devoted to the world trends in epidemiology of colorectal cancer and treatment of colorectal cancer liver metastases. The authors analyze the effectiveness of traditional (resection) and modern minimally invasive methods of local destruction (radiofrequency thermoablation, microwave ablation, cryoablation), stereotactic radiotherapy, radiosurgery, targeted therapy and endovascular techniques (chemoinfusion, chemoembolization, radioembolization). It was emphasized that searching for new chemotherapeutic and targeted drugs is one of the reserve ways to improve treatment outcomes in patients with potentially resectable colorectal cancer liver metastases. The possibilities and prospects of liver transplantation as a priority treatment strategy for patients with unresectable bilobar colorectal cancer liver metastases are highlighted.

Radiofrequency Thermoablation and Hypofractionated Radiotherapy Combined Treatment for Bone Metastases: A Retrospective Study

Introduction: Bone metastases (BMs) are the common cause of cancer-related pain, as approximately 45% of cancer patients suffer from bone pain (BP). Radiotherapy (RT) is well established as BP treatment strategy; also, other approaches have been shown to be effective in this setting. Radiofrequency thermoablation (RFA) in a combined strategy with RT appears to be feasible and effective in the treatment of metastatic BP ensuring a better quality of life. Aim of this retrospective study was to describe a case series of patients with painful osteolytic lesions at risk of fracture treated with the RFA-RT combined approach, analyzing local control and pain control as outcomes. Methods: Data of all patients with BM treated with combined approach in our center from April 2016 to June 2020 were retrospectively analyzed. Patients underwent RFA followed by cementoplasty on the same day and RT in a second phase. RT dose ranged between 30 and 37.5 Gy in 5/10 fractions. BP was evaluated according to the numeric rating scale (NRS), at the beginning of treatment and at 1, 2, 3, 6, 9, and 12 months from the end of combined treatment. Results: A total of 27 patients were treated from April 2016 to June 2020 with RFA-RT combined approach. The large majority of patients underwent stereotactic body radiotherapy (SBRT) (23/27). All patients experienced an NRS value decrease >2 at 1 month and between the first and second months. NRS mean value reached 0 at 3, 6, 9, and 12 months’ evaluations. Discussion/Conclusion: The results of this retrospective analysis of patients treated with RFA-RT combined approach for BP support its safety and efficacy in terms of pain reduction. SBRT role in this combined approach has to be investigated in randomized trials.

Osteoblastoma: When the Treatment Is Not Minimally Invasive, an Overview.

Background: osteoblastoma is a bone-forming tumor accounting for about 1% of all primary bone tumors and 3% of benign bone tumors. The gold-standard treatment is surgical excision; nevertheless, minimally invasive radiological techniques such as thermoablation and, more recently, high intensity focused ultrasound are gaining more importance. The aim of the present paper is to analyze surgical indications based on our experience and on the evidences in the literature. Methods: all patients affected by osteoblastoma who underwent surgical excision in January 2009 and December 2018 were reviewed; eleven patients were enrolled in the study. The epidemiological aspects, size of the disease and site of onset, symptoms, surgery type, indications, and results are reported for every case. Results: all treatments were based on a preoperative diagnosis; pain was constant in all cases. Intralesional surgeries were performed in 9 out of 11 cases; the remaining 2 cases underwent wide resection. No early or late complications occurred after the surgical procedure. The indications for surgery were lesions very close to nerves or joints, unclear diagnosis, risk of fracture, lesion too large for radiofrequency thermoablation, or failure of minimally invasive treatments. At a medium follow-up of 88 months, no local recurrences were verified. Conclusions: osteoblastoma is a rare tumor with difficult diagnosis. Identification is based on symptoms, imaging, and histology. When possible, minimally invasive techniques is preferred for treatment but surgery is still considered the gold standard.

Magnetic Resonance-guided Focused Ultrasound Ablation:Techniques and Neurological Applications

Magnetic resonance(MR)-guided focused ultrasound ablation(FUS)is a minimally invasive technique for targeted tissue thermo-ablation and is promising for neuromodulation in various neurological disorders. The effectiveness and safety of this technique have been recognized worldwide. In Japan, the applications of FUS for the treatment of essential tremors and Parkinson's disease have recently been covered under health insurance. The FUS system is composed of a phased-array transducer with 1024 elements, with a beam of ultrasound emerging from each element. The phase and amplitude of the beam are computed and controlled to focus on the target with the calculation of computed tomography(CT)profiles, resulting in optimal thermo-ablation. To utilize FUS safely and effectively, a deep understanding of the physics of this technology is necessary. Furthermore, the technique should be compared with other options including deep brain stimulation(DBS)and radiofrequency thermo-ablation. Although FUS has received attention because of minimally invasive characteristics and a possibility of procedural target refinement, DBS has some advantages on bilateral implantation, a potential of postoperative adjustment, and control of head/leg tremors. In this article, we first reviewed the physics of FUS and demonstrated the typical treatment protocols. Second, we reviewed the outcomes from the existing literature, and revealed the advantages and disadvantages of this procedure, with the evaluation of the optimal condition for FUS.

Radiofrequency thermoablation (RFA) and radiotherapy (RT) combined treatment for bone metastases: a systematic review.

Approximately 50% of cancer patients develop bone metastases in their natural disease history. The management of metastatic bone disease requires a multidisciplinary approach. Both radiofrequency ablation (RFA) and radiation therapy (RT) were safe and effective in the management of painful metastases, even if they rely on totally different action mechanisms. A synergistic combination of RT and RFA seems to result in a better pain control. A systematic review was performed to describe the feasibility and effectiveness of the association between RFA and RT in the treatment of metastatic bone pain in oligo-metastatic patients, evaluating its role in alleviating bone pain, reducing the risk of fractures, and consequently ensuring a better quality of life. A systematic database search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review included studies that reported populations meeting the following inclusion criteria: (I) confirmed bone metastases in adult patients; (II)active bone metastases pain; (III) patients treated with combined RFA-RT; (IV) Original studies. Three papers that evaluated the combined treatment with doses ranging from moderately hypofractionated three-dimensional conformal RT (3D-CRT) and stereotactic body radiation therapy (SBRT) schedules were selected. The RFA-RT combined strategy appears to be promising in terms of efficiency and safety with adequate pain control and quality of life improvement. Positive effects on time to local failure and overall survival increase were also observed.Further prospective studies are needed to better delineate RFA-RT treatment benefits.

Computed tomography-guided percutaneous radiofrequency and laser ablation for the treatment of osteoid osteoma - long-term follow-up from 5 to 10 years.

PurposeThe impact of computed tomography (CT)-guided, percutaneous radiofrequency ablation and interstitial laser ablation (ILA) on the management of patients with osteoid osteoma was studied. This was carried out by assessing immediate and long-term clinical outcomes, the complication rate, and repeat therapy effectiveness in recurrent patients who have already experienced percutaneous ablation.Material and methodsConsecutive patients with osteoid osteoma were assessed before the interventional treatment in a single centre from 2010 to 2015. Patient demographics, complications, and recurrence were recorded. The pain was evaluated with Visual Analogue Scale (VAS). Percutaneous procedures were performed by means of radiofrequency thermoablation or ILA. Epidural or regional anaesthesia in the CT suite was applied in all procedures. Success, whether primary or secondary, was measured as complete pain relief without evidence of recurrence after the first or second procedure, respectively. Osteoid osteoma characteristics, procedure overview, and technical success were looked for in pre-procedural and procedural scans.ResultsEighty-three per cent of osteoid osteomas were located in lower extremities, 56% of tumours were intracortical, and 83% of osteoid osteomas were extra-articular. The mean pre-procedure VAS score was 8.5 ± 0.8, while the overall primary success rate of radiofrequency thermoablation and ILA was 87.5%. No major complications were noted. The mean follow-up period for patients in was 7.5 years (5.0-10.2 years).ConclusionsPercutaneous, CT-guided thermoablation proved to be effective and should become the method of choice in osteoid osteoma treatment because of its minimal invasiveness. Our results show that there is no risk of very late recurrence after achieving primary and secondary treatment success.

Characterization of the ablation zones produced by three commercially available systems from a single vendor for radiofrequency thermoablation in an ex vivo swine liver model.

BackgroundRadiofrequency Ablation (RFA) is rarely performed in veterinary medicine. A rationale exists for its use in selected cases of canine liver tumours. RFA induces ablation zones of variable size and geometry depending on the technique used and on the impedance of the targeted organ.Objectives(a) to describe the geometry and reproducibility of the ablation zones produced by three commercially available systems from a single company, using isolated swine liver parenchyma as a model for future veterinary applications in vivo; (b) to study the effects of local saline perfusion into the ablated parenchyma through the electrode tip and of single versus double passage of the electrode on size, geometry and reproducibility of the ablation zones produced.MethodsSize, and geometry of ablation zones reproduced in six livers with one cooled and perfused (saline) and two cooled and non‐perfused systems, after single or double passage (n = 6/condition), were assessed macroscopically on digitalized images by a blinded operator. Longitudinal and transverse diameters, equivalent diameter, estimated volume and roundness index were measured. Reproducibility was assessed as coefficient of variation.Results and ConclusionsAblation zone reproducibility was higher when expressed in terms of ablation zone diameters than estimated volume. Local saline perfusion of the parenchyma through the electrode tip during RFA increased the ablation zone longitudinal diameter. Ablation zone estimated volume increased with saline perfusion only when double passage was performed. These data may provide useful information for those clinicians who intend to include RFA as an additive tool in veterinary interventional radiology.

Radiofrequency Thermal Ablation of Benign Thyroid Nodules: The Correlation Between Ultrasound Nodule Characteristics and Results.

Background. The aim of this observational study was to investigate for which nodules a better response to radiofrequency thermoablation (RFA) for nonfunctioning benign thyroid nodules is likely. Methods. Aesthetic score, compressive score, and volume of 32 benign nodules from 32 patients were registered during follow-up at baseline, 1, 3, 6, and 12 months. Results. A volume reduction rate (VRR) of 72.56% at 12 months after the procedure (P = .009) was registered. A significant (P < .001) improvement in the compressive and aesthetic scores was observed. Nodules with a baseline volume <20 mL had VRRs at 3 and 6 months that were significantly greater than those with volume >20 mL (P = .037). Conclusions. RFA was shown to be a safe and effective procedure for the management of benign thyroid nodules and that there is a correlation between the initial size of the nodule and the response to treatment.

Surgical management and prognostic factors in liver metastases from kidney cancer

Aim. To evaluate short- and long-term results of surgical treatment of the liver metastases from kidney cancer, to identify prognostic factors.Materials and methods. The retrospective study included 67 patients who underwent surgical treatment for liver metastases from kidney cancer from 1990 to 2019. A total of 71 operations on the liver were performed (53 economical resections, 15 extensive resections, 3 radiofrequency thermoablation). Four of them were repeated for the development of metastases in the liver remant.Results. Postoperative morbidity was 30%. There was one (1,5%) intraoperative death. Within 90 days after surgery, all patients were alive. The 5-year overall survival was 64%, median was 73 months. Univariate analysis revealed factors that significantly worsened overall survival: stage III and IV kidney cancer at the time of nephrectomy; nonclear cell histological type of metastases; synchronous liver metastases; intraoperative blood loss more than 2000 ml. Gender, age (≥ 65 years) at the time of surgery, number of metastases, maximum diameter of the metastases, presence of extrahepatic disease and major liver resection did not have a statistically significant impact on overall survival.Conclusions. Surgical treatment allows to achieve long-term overall survival of patients with liver metastases from kidney cancer. Higher indicators of overall survival were noted in the clear-cell variant of kidney cancer, stage I–II, and the metachronic nature of hepatic metastases. Patients with large (≥4 cm) and multiple resectable liver metastases, having solitary and single metastases in other organs, provided that they are radically removed, can also be considered as candidates for surgical treatment.

Criteria for Selecting the Optimal Method of Treating Hepatic Hemangiomas.

The aim of the study was to develop criteria for optimal tactics of treating hepatic hemangiomas of various sizes and localization including endovascular, percutaneous puncture ablative, and open resection interventions.Materials and MethodsThe results of treating 95 patients (65 women and 30 men aged 26–65 years) with hepatic hemangiomas have been analyzed. Tumor diagnosis was based on the data of echosonoscopy, MRI, multispiral computed tomography with intravenously injected contrasting medium, US dopplerography, and puncture biopsy. 78 patients were operated on, 63 of them underwent isolated surgery, whereas 15 patients were treated with a combination of methods. In 17 cases, the decision was made not to use operative treatment.ResultsAfter open resection operations (n=34), complications in the form of bilomas were observed in 3 patients in the postoperative period, in 1 patient the tumor growth continued two months after the resection of liver segment IV. Sclerotherapy of hepatic hemangiomas with ethanol (n=13) resulted in the recovery of 10 patients, massive intravascular hemolysis has developed in one patient, two patients died. After radiofrequency thermoablation of hepatic hemangiomas less than 5 cm in diameter (n=4), recovery was achieved. Echosonoscopy showed the reduction of blood flow and absence of tumor growth in 12 patients after isolated endovascular embolization of the vessel nourishing hepatic hemangioma. The combined treatment according to the method developed by us resulted in clinical recovery of all 15 patients.ConclusionSclerotherapy of hepatic hemangiomas with ethanol, especially those being large in size, may cause unpredictable complications and individual pathological reactions with severe outcomes. Surgical treatment is not required if morphologically verified hepatic hemangiomas are less than 3 cm in diameter without evident clinical manifestations and growth. When the diameter of hepatic hemangiomas is in the range of 3–5 cm with a tendency to growth, radiofrequency thermoablation is preferred. Hemangiomas of the left liver lobe more than 5 cm in size should be treated by resection methods. Our combined method is designed to treat hemangiomas of the right liver lobe exceeding the size of 5 cm. If the right lobe tumor is more than 10 cm, it is advisable to make a decision in favor of open operation.