Percutaneous Radiofrequency Ablation in the Treatment of Primary Liver Cancers
The development of image-guided percutaneous techniques for local tumor ablation has been one of the major advances in the treatment of liver malignancies. Among these methods, radiofrequency (RF) ablation is currently established as the primary ablative modality at most institutions. In the setting of patients of very early and early-stage hepatocellular carcinoma (HCC) – according to the Barcelona Clinic Liver Cancer (BCLC) staging system image-guided tumor ablation is recommended when patients are excluded from surgical options. The goal of RF ablation is to induce thermal injury to the tissue through electromagnetic energy deposition. One or multiple electrodes have to be inserted directly into the tumor to deliver RF energy current. Electrodes are coupled with RF generators and can be monopolar or bipolar, and they can have different designs (multitined expandable, internally cooled, perfused). Targeting of the lesion can be performed with US, CT, or MR imaging. The guidance system is chosen largely on the basis of operator preference and local availability of dedicated equipment such as fluoro-CT or open MR systems. RF ablation has shown superior anticancer effect and greater survival benefit with respect to the seminal percutaneous technique, ethanol injection, in meta-analyses of randomized controlled trials (RCTs), and is currently established as the standard method for local tumor treatment.
KeywordsThermal Ablation Barcelona Clinic Liver Cancer Complete Tumor Necrosis Heat Sink Effect Local Tumor Ablation
- 37.http://www.clinicaltrial.gov/ct2/show/NCT00617981. Accessed July 2011.