Liver Cancers pp 109-122 | Cite as

The Role of Interventional Radiology and Image-Guided Ablation in Primary Liver Cancer

  • Jen-Jou Wong
  • Nabil Kibriya


Percutaneous image-guided ablation is now an established treatment in the control of hepatocellular carcinoma (HCC). While liver transplantation remains the definitive treatment, a lack of donors worldwide excludes this treatment as a realistic possibility for most sufferers. Surgical resection provides the opportunity for cure; however, stringent patient selection criteria employed to avoid complications often means many patients are not eligible for surgery. Thus percutaneous ablation is often an ideal choice for the minimally invasive treatment of early-stage patients who are ineligible for surgery, which can be curative in itself or be utilised as a bridge to future transplantation. With a number of ablation technologies available in the interventional radiologist’s armamentarium, there are few lesions which cannot be treated percutaneously—it is therefore paramount that referral for image-guided ablation is considered in patients who cannot be treated surgically.


Interventional oncology Interventional radiology Ablation IRE Microwave Radiofrequency 


  1. 1.
    Montalto G, Cervello M, Giannitrapani L, Dantona F, Terranova A, Castagnetta LA. Epidemiology, risk factors, and natural history of hepatocellular carcinoma. Ann N Y Acad Sci. 2002;963:13–20.CrossRefGoogle Scholar
  2. 2.
    Belghiti J, Kianmanesh R. Surgical treatment of hepatocellular carcinoma. HPB (Oxford). 2005;7(1):42–9.CrossRefGoogle Scholar
  3. 3.
    Nagase N, Yuki H, Hamada T, Hirose S, Kawashima R, Inokuchi K. The natural history of hepatocellular carcinoma. A study of 100 untreated cases. Cancer. 1984;54(7):1461–5.CrossRefGoogle Scholar
  4. 4.
    Llovet JM, Fuster J, Buix J. The Barcelona approach; diagnosis, staging and treatment of hepatocellular carcinoma. Liver Transpl. 2004;10:115–20.CrossRefGoogle Scholar
  5. 5.
    Pompili M, Francica G, Ponziani FR, Iezzi R, Avolio AW. Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation. World J Gastroenterol. 2013;19(43):7515–30.CrossRefGoogle Scholar
  6. 6.
    Weis S, Franke A, Mössner J, Jakobsen JC, Schoppmeyer K. Radiofrequency (thermal) ablation versus no intervention or other interventions for hepatocellular carcinoma. Cochrane Database Syst Rev. 2013;12:CD003046.Google Scholar
  7. 7.
    Bhatia S, et al. Is antibiotic prophylaxis for percutaneous radiofrequency ablation (RFA) of primary liver tumors necessary? Results from a single-center experience. Cardiovasc Intervent Radiol. 2015;38(4):922–8.CrossRefGoogle Scholar
  8. 8.
    Llovet JM, Vilana R, Brú C, et al. Barcelona Clínic Liver Cancer (BCLC) Group Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001;33(5):1124–9.CrossRefGoogle Scholar
  9. 9.
    Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev. 2007;33(5):437–47.CrossRefGoogle Scholar
  10. 10.
    Mulier S, Mulier P, Ni Y, et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg. 2002;89(10):1206–22.CrossRefGoogle Scholar
  11. 11.
    Wang T, et al. Microwave ablation of hepatocellular carcinoma as first-line treatment: long term outcomes and prognostic factors in 221 patients. Sci Rep. 2016;6:32728.CrossRefGoogle Scholar
  12. 12.
    Brace C. Microwave ablation technology: What every user should know. Curr Probl Diagn Radiol. 2009;38(2):61–7.CrossRefGoogle Scholar
  13. 13.
    Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics. 2005;25(Suppl 1):S69–83.CrossRefGoogle Scholar
  14. 14.
    Wright AS, Sampson LA, Warner TF, Mahvi DM, Lee FT Jr. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology. 2005;236(1):132–9.CrossRefGoogle Scholar
  15. 15.
    Facciorusso A, Di Maso M, Muscatiello N. Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperth. 2016;32(3):339–44.CrossRefGoogle Scholar
  16. 16.
    Wang C, et al. Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma. Hepatology. 2015;61(5):1579–90.CrossRefGoogle Scholar
  17. 17.
    Rong G, et al. Long-term outcomes of percutaneous cryoablation for patients with hepatocellular carcinoma within Milan criteria. PLoS One. 2015;10(4):e0123065.CrossRefGoogle Scholar
  18. 18.
    Wu S, Hou J, Ding Y, Wu F, Hu Y, Jiang Q, Mao P, Yang Y. Cryoablation versus radiofrequency ablation for hepatic malignancies. Medicine (Baltimore). 2015;94(49):e2252.CrossRefGoogle Scholar
  19. 19.
    Chakravorty E, et al. Anaesthetic management of radiofrequency tumour ablation: or experience. Indian J Anaesth. 2006;50:123–7.Google Scholar
  20. 20.
    Wang Y, Luo Q, Li Y, Deng S, Wei S, Li X. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials. PLoS One. 2014;9(1):e84484.CrossRefGoogle Scholar
  21. 21.
    Shiina S, et al. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol. 2012;107(4):569–77.CrossRefGoogle Scholar
  22. 22.
    Xu Y, et al. Microwave ablation for the treatment of hepatocellular carcinoma that met up-to-seven criteria: feasibility, local efficacy and long-term outcomes. Eur Radiol. 2017;27(9):3877–87.CrossRefGoogle Scholar
  23. 23.
    Liang P, et al. Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation. Radiology. 2005;235(1):299–307.CrossRefGoogle Scholar
  24. 24.
    Xu Y, et al. Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma. Chin J Cancer. 2017;36(1):14.CrossRefGoogle Scholar
  25. 25.
    Chinnaratha MA, Chuang MY, Fraser RJ, Woodman RJ, Wigg AJ. Percutaneous thermal ablation for primary hepatocellular carcinoma: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31(2):294–301.CrossRefGoogle Scholar
  26. 26.
    Sutter O, 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(3):877–86.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jen-Jou Wong
    • 1
  • Nabil Kibriya
    • 2
  1. 1.Department of Interventional RadiologyThe Royal Liverpool University HospitalLiverpoolUK
  2. 2.Kings College HospitalLondonUK

Personalised recommendations