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World J Gastroenterol. May 7, 2020; 26(17): 2040-2048
Published online May 7, 2020. doi: 10.3748/wjg.v26.i17.2040
Radiofrequency combined with immunomodulation for hepatocellular carcinoma: State of the art and innovations
Adriano Carneiro da Costa, Mikael Sodergren, Kumar Jayant, Fernando Santa Cruz, Duncan Spalding, Madhava Pai, Nagy Habib
Adriano Carneiro da Costa, Mikael Sodergren, Kumar Jayant, Fernando Santa Cruz, Duncan Spalding, Madhava Pai, Nagy Habib, Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London W12 0NN, United Kingdom
Author contributions: da Costa AC performed the majority of the writing; Sodergren M, Jayant K and Santa Cruz F performed data accusation and writing; Spalding D provided the input in writing the paper; Pai M and Habib N designed the outline and coordinated the writing of the paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nagy Habib, FRCS (Gen Surg), Chairman, Professor, Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, 1st Floor B Block, Du Cane Road, London W12 0NN, United Kingdom. nagy.habib@imperial.ac.uk
Received: February 9, 2020
Peer-review started: February 9, 2020
First decision: February 27, 2020
Revised: March 25, 2020
Accepted: April 15, 2020
Article in press: April 15, 2020
Published online: May 7, 2020
Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver tumor and has been considered a very immunogenic tumor. The treatment with radiofrequency ablation (RFA) has been established as the standard ablative therapy for early HCC, and is currently recognized as the main ablative tool for HCC tumors < 5 cm in size; however, progression and local recurrence remain the main disadvantages of this approach. To solve this clinical problem, recent efforts were concentrated on multimodal treatment, combining different strategies, including the combination of RFA and immunotherapy. This article reviewed the combination treatment of RFA with immunotherapy and found that this treatment strategy leads to an increased response of anti-tumor T cells, significantly reduces the risk of recurrence and improves survival rates compared to RFA alone. This review highlighted scientific evidence that supports the current recommendations for pre-clinical studies, and discuss the need for further research on this topic.

Keywords: Hepatocellular carcinoma, Radiofrequency ablation, Immunotherapy, Liver cancer, Combined modality therapy, State-of-the-art review

Core tip: Radiofrequency ablation (RFA) is a well-established surgical approach to treat hepatocellular carcinoma (HCC). However, it has the inconvenience of being related to tumor recurrence. The combination of RFA and immunotherapy has emerged as a promising approach to activate and potentialize local and systemic immune responses. It has potential to reinstate anti-tumor immunity in HCC through increase in antitumor T cell response. The approach seems quite pragmatic in limiting the recurrence and improving survival rates compared to RFA alone for HCC patients. Currently, there are only eight articles in the literature that studied the combination of RFA and immunotherapy.