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World J Hepatol. Apr 27, 2023; 15(4): 515-524
Published online Apr 27, 2023. doi: 10.4254/wjh.v15.i4.515
Ablative strategies for recurrent hepatocellular carcinoma
Lin Wang, Bao-Xian Liu, Hai-Yi Long, Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
ORCID number: Bao-Xian Liu (0000-0002-6841-1637); Hai-Yi Long (0000-0001-5158-5879).
Author contributions: Wang L was involved in the review design and drafting of the manuscript; Liu BX were involved in the critical revision of the manuscript; Long HY was involved in the review design and critical revision of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Yi Long, MD, Doctor, Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou 510080, Guangdong Province, China. longhy9@mail.sysu.edu.cn
Received: October 26, 2022
Peer-review started: October 26, 2022
First decision: November 26, 2022
Revised: February 14, 2023
Accepted: March 29, 2023
Article in press: March 29, 2023
Published online: April 27, 2023

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the fifth leading cause of cancer death worldwide and the third leading cause of all diseases worldwide. Liver transplantation, surgical resection and ablation are the three main curative treatments for HCC. Liver transplantation is the optimal treatment option for HCC, but its usage is limited by the shortage of liver sources. Surgical resection is considered the first choice for early-stage HCC, but it does not apply to patients with poor liver function. Therefore, more and more doctors choose ablation for HCC. However, intrahepatic recurrence occurs in up to 70% patients within 5 years after initial treatment. For patients with oligo recurrence after primary treatment, repeated resection and local ablation are both alternative. Only 20% patients with recurrent HCC (rHCC) indicate repeated surgical resection because of limitations in liver function, tumor location and intraperitoneal adhesions. Local ablation has become an option for the waiting period when liver transplantation is unavailable. For patients with intrahepatic recurrence after liver transplantation, local ablation can reduce the tumor burden and prepare them for liver transplantation. This review systematically describes the various ablation treatments for rHCC, including radiofrequency ablation, microwave ablation, laser ablation, high-intensity focused ultrasound ablation, cryablation, irreversible electroporation, percutaneous ethanol injection, and the combination of ablation and other treatment modalities.

Key Words: Hepatocellular carcinoma, Recurrence, Ablative therapy, Thermal ablation

Core Tip: Despite the tremendous efforts in the fight against hepatocellular carcinoma, there is still no way to prevent its recurrence. Intrahepatic recurrence can be treated by repeated resection and ablation, and there are many studies showing the advantages and disadvantages of each treatment method. For tumors ≤ 3 cm in diameter, there is no significant difference between surgery resection and radiofrequency/microwave ablation treatment. Non-thermal ablation treatment has clearer borders but a higher postoperative recurrence rate. Percutaneous ethanol injection has comparable efficacy to radiofrequency ablation for small tumors. Multiple recurrences require combined systemic therapy.



INTRODUCTION

Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third leading cause of cancer death worldwide[1]. Up to 20% of HCC patients relapse within 2 years after liver transplantation and 1/3 of post liver transplantation patients with recurrent HCC (rHCC) experienced late recurrence (> 5 years after liver transplantation)[2]. Nearly half of patients with early-stage HCC experienced recurrence after Hepatic resection[3]. The local recurrence rate in patients with HCC treated radiofrequency ablation (RFA) varied between 18.2% and 46.6%[4].The incidence of intrahepatic and extrahepatic recurrence had been reported to be approximately 70% eventually[5,6]. Thus, the treatment and management of HCC recurrence is very important.

rHCC can be divided into two types: Oligo recurrence and disseminated recurrence[7,8]. Patients with oligo recurrence were consider for radical treatment, including surgery and RFA[9]. Whereas patients with disseminated recurrence received palliative treatment or supportive care only[9]. The curative approaches for intrahepatic rHCC include salvage liver transplantation, repeat resection and RFA. Salvage liver transplantation has been proposed to be the optimal option but have precluded its extensive application because of the shortage of organ donors and the strict selection criteria for patients[10-12]. In addition, because of progressive liver dysfunction, the presence of multiple tumors, various tumor sites, and intraperitoneal adhesions, only 20% patients with recurrence are eligible for repeated resection[13,14].

Ablation has the advantages of minimal invasiveness, fewer complications and good repeatability[15]. Ablative therapy is a locoregional treatment that can be used alone or in combination with other treatment modalities[16]. Monotherapy includes RFA, microwave ablation (MWA), laser ablation (LA), high-intensity focused ultrasound (HIFU) ablation, cryoablation (CRA), irreversible electroporation (IRE), and percutaneous ethanol injection (PEI). Combination therapy includes RFA/MWA-transcatheter arterial chemoembolization (TACE) and RFA-PEI.

RADIOFREQUENCY ABLATION

RFA generates 400-500 kHz radiofrequency current through the distal end of the uninsulated part of the puncture needle, which causes high-frequency friction of water molecules in the tumor tissue and local high temperature, leading to co-degeneration necrosis and protein degeneration in the tumor tissue[4,17,18]. RFA is one of the curative treatment modalities for early-stage HCC with advantages of safety, tolerability, ease of operation, and cost-effectiveness[4]. Previous study has demonstrated that RFA provided similar long-term survival rates for isolated HCC of 5 cm or less, regardless of whether the treatment was initial or salvage therapy[19]. Indications of RFA for rHCC are the same as those for initial HCC, including single nodule < 5 cm in diameter or less than 3 nodules with the largest diameter < 3 cm, and without vascular invasion nor extrahepatic metastasis[15].

There were no significant differences in overall survival (OS), re-recurrence rate, distant progression-free survival rate, local progression-free survival rate, nor complications between RFA and repeated resection in early-staged rHCC[16,20]. Another recent randomized controlled trial showed no statistically significant difference in OS and repeat recurrence–free survival (RFS) between repeated resection and RFA in early-staged rHCC[21]. Additionally, in patients with rHCC diameter greater than 3 cm or alpha-fetoprotein level greater than 200 ng/mL, local disease control and long-term survival may be better with repeated resection[21]. Moreover, thermal ablation is superior to repeated resection in safety, such as significantly shorter average hospital stay, less risk of intraoperative blood transfusion, and less invasive[16,22,23].

The main contraindications of RFA are severe bleeding diathesis (platelet count less than 50000/μL), hemostatic compromise, decompensated ascites, jaundice and the presence of metallic devices such as pacemakers[24]. Relative contraindications are lesions near the gastrointestinal tract, biliary system and heart. RFA should also be avoided for tumors within 1 cm proximal to the hepatic portal tract[24].

MICROWAVE ABLATION

MWA causes cell death by increasing the temperature of tumor tissue caused by electromagnetic energy deposition in the tumor[25]. The advantages of MWA over RFA are as follows: (1) MWA uses electromagnetic wave energy without grounding poles, so it does not cause skin burns and has no taboos to metals[26]; (2) The electromagnetic field of the MWA causes rapid and uniform heating of the tissue, creating a more uniform and predictable ablation zone with less time; and (3) MWA provides faster heating and higher temperature, so MWA is suitable for perivascular, subcapsular lesions and those adjacent to bile duct[27-29]. Previous study has demonstrated no significant difference in OS nor disease-free survival (DFS) between MWA and surgical resection[30]. Meanwhile, the meta-analysis demonstrated that MWA was associated with shorter operation time, less amount of blood loss in operation, and less complications when compared to surgical resection[30].

The complications of MWA and RFA are similar, such as bleeding, liver abscess, hemothorax, colon perforation and bile duct stenosis[31].

LASER ABLATION

LA is a procedure based on laser devices that convert heat energy into light energy and generate heat with tissues to cause cell death[32] and was firstly described in 1983 for the treatment of liver tumors[33].

A randomized controlled trial confirmed LA should be considered a viable treatment option for HCC ≤ 20 mm, given lower incidence of complications than the RFA group and comparable primary technique efficacy rate and RFS rate[34]. Traditional thermal ablation techniques (RFA and MWA) are considered less effective than TACE in obtaining a complete response for solitary large HCC ≥ 40 mm[35-37]. A recently published retrospective case-control study indicated that multifiber LA approach was more effective than TACE by achieving a complete tumor ablation and reducing the recurrence rates[38]. However, LA is rarely used and has been superseded by MWA or RFA in many centers partly because LA requires a high level of equipment and its results need to be confirmed by randomized controlled trials[39].

HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION

HIFU ablation is a non-invasive ablation mode using an ultrasound frequency of 0.8-3.5 MHz focused through intact skin on a distant therapeutic transducer[40,41]. Compared with RFA, HIFU has the following advantages: (1) HIFU is an ex vivo conformal therapy without invasiveness; (2) Tumor seeding is unlikely to occur in HIFU; and (3) No direct puncture of target tumor[42].

HIFU is currently used mainly for palliative treatment of advanced HCC[43]. There was only one retrospective study showed that the OS of HIFU was slightly higher than that of RFA, but the DFS was lower than that of RFA, and the procedure-related morbidity was lower after a median follow-up time of 27.9 mo of patients with rHCC[44]. Notably, this study was retrospective in nature and had a small sample size.

The main limitation to the clinical application of HIFU is the long ablation time required. Other challenges are the difficulty in precise localization and monitoring, and the difficulty in transmitting ultrasonic energy through the covering bone structure to the lesions behind the ribs[45]. The main systemic changes of HIFU are fever, supraventricular tachycardia, hypertension. The local complications are skin burns, pain, mild impairment of hepatic function and mild hematuria[46].

CRYOABLATION

CRA uses extremely low temperatures to directly cause intracellular and extracellular ice crystal formation and lytic agent deformation, leading to cell dehydration and rupture. Vascular injury leads to ischemic hypoxia indirectly destroying tumor tissue. CRA has several potential advantages over RFA: (1) Multiple probes can be used simultaneously to produce a large puck; (2) the size and shape of the puck produced by cryotherapy can be easily seen by intraoperative computed tomography (CT), magnetic resonance imaging, or ultrasound; and (3) relatively painless procedure compared to thermal-based ablation, which can be performed under local anesthesia rather than the general anesthesia required for radiofrequency ablation[47].

The efficacy of CRA for HCC has been demonstrated by a large study cohort including 1595 patients with 2313 tumors[47]. The complete response (CR) rates were 81.2% (1893/2313), 99.4% (780/784), 94.4% (1622/1719), and 45.6% (271/594) in all tumors, tumors < 3 cm, tumors < 5 cm, and tumors > 5 cm, respectively. The CR rate was high than that for RFA that ranged from 50% to 80% in HCCs of 3 to 5cm[48]. At present, the application of CRA in the treatment of rHCC has not been reported.

The most common complications of CRA are postoperative pain, postoperative fever, transient elevations of alanine aminotransferase, hepatic hemorrhage, liver and pleural abscesses and cryoreaction (chills, fever, tachycardia, tachypnea and temporary renal damage, etc.)[49,50]. CRA is recommended as first-line therapy for tumors < 5 cm. For tumors > 5 cm, CRA can reduce tumor burden[47].

IRREVERSIBLE ELECTROPORATION

IRE works by generating high voltage (> 640 V/cm) and high intensity (> 20 A) electrical pulses of short duration (70–100 μs) which render the cellular bilipid membrane of the cells permanently irreversible porous[51,52]. IRE is a good option for patients who cannot undergo surgery, thermal ablation surgery, or whose tumors are close to important structures[51].

A recent meta-analysis reported an OS of 81.3% at 12 mo, 61.5% at 2 years, and 40.9% at 3 years; PFS was reported as 64.2% at 12 mo and 49.1% at 2 years[53]. Since RFA and MWA are preferred in tumors located at “non-risk” locations and IRE is used in “high location”, the efficacy of IRE cannot be directly compared with RFA and MWA in a clinical setting[53].

The major complications are liver abscess, hemorrhage, fever, mild pleural effusion, mild hemoperitoneum, subcapsular hematomas, atrial fibrillation and partial portal vein thrombosis[54-57].

PERCUTANEOUS ETHANOL INJECTION

Injection of ethanol caused dehydration and necrosis of tumor cells accompanied by thrombosis in small vessels to kill tumor tissue[58]. A matched case-control comparative analysis showed that the OS of PEI is comparable to RFA in patients with HCC smaller than 1.5 cm[59]. The major limitation of PEI is significantly higher local recurrence than RFA[60,61]. Interestingly, recent studies have shown that the combination of PEI with RFA in the treatment of HCCs provides comparable OS rates and RFS.

The mechanisms of RFA-PEI are as follows: (1) RFA enhances the ablative effect of ethanol due to its low boiling point (78.3 °C); (2) Ethanol embolizes small vessels to reduce the heat-sink effect; (3) Ethanol distributes to RFA enabled areas (or difficult-to-treat areas); (4) Ethanol diffuses beyond the RFA ablation zone to establish a safety margin; and (5) An ethanol makes the tissue around the electrode less prone to carbonization and further thermal conduction[62-64].

A retrospective study enrolled 271 patients to compare combined RFA-PEI with hepatic resection in the treatment of resectable solitary HCC with 2.1-5.0 cm diameter[65]. RFA-PEI had higher OS rates at 1, 3, and 5 years and RFS rates at 1, 3, and 5 years over hepatic resection in the treatment of solitary HCCs, especially for those with 2.1-3.0 cm in diameter. Additionally, RFA-PEI was superior to hepatic resection in major complication rates, length of hospital stay and cost. A meta-analysis showed that for tumors with 3-5 cm in diameter, the 2-year OS was slightly higher in the RFA-PEI than in the RFA group[66]. There were another two studies showed significant clinical improvements in the combination group in terms of the 1-/1.5-/2-/3-/5-year OS[67,68]. Furthermore, post-procedural major complications and pain did not significantly differ between the RFA-PEI groups and RFA groups[69]. A retrospective study found that the combined RFA-PEI group had comparable OS and RFS to repeat hepatectomy for elderly patients with small rHCC after hepatectomy, but with shorter hospital stays and lower rates of major complications and non-tumour-related deaths[70]. In summary, combined therapy with RFA-PEI is suitable for 2 to 3 cm lesions with liver function compensation.

ABLATION COMBINED WITH TACE

Iodized oil and gelatin sponge particles used in TACE can increase RFA- or MWA-induced coagulation necrosis by going through multiple arterio-portal communications. TACE enhances heat transfer in RFA or MWA treatment by blocking hepatic arterial blood flow and reducing perfusion-mediated hepatic blood flow cooling (heat-sink effect)[4,24]. It has been improved in: (1) Minimizing heat loss due to the heat-sink effect; (2) increasing the area of coagulative necrosis; (3) producing more thorough necrosis within the mass; and (4) enlarging the ablation margin, destroying the satellite lesion[4,24,71]. In addition, the digital subtraction angiography technique during TACE helps to detect multiple small tumors and subsequent eradication these tumors[72].

A recent study by Li et al[73] that included 3000 cases of HCC showed the OS rate and CR rate of the TACE-RFA group was significantly higher than the TACE alone group[73]. Another review presented that TACE-RFA combined therapy and surgical resection had a similar 1-year OS rate, 3-year OS rate, 1-year RFS rate, and 3-year RFS rate for early HCC[74]. However, the 5-year OS rate and 5-year RFS rate were lower in patients with TACE-RFA than in those with surgical resection. Furthermore, there were two studies found that TACE-RFA treatment is superior to RFA used alone in OS and RFS[75,76]. A recent study demonstrated that for HCC patients with microvascular invasion (MVI) and rHCC up to three nodules smaller than 3 cm within 2 years, TACE-RFA could achieve better secondary RFS than repeated resection or RFA alone, while RFA alone had survival benefits comparable to repeated resection in other rHCC patients with small recurrence[77]. There was a study that selected 186 patients who underwent TACE-RFA (n = 107) or repeated resection (n = 79) for rHCC with a diameter < 5 cm[72]. It showed fewer complications and shorter hospital stays in the TACE-RFA group than in the repeated resection group, and there were no significant differences in OS nor RFS.

A recent study conducted by Zaitoun et al[78] screened 278 patients with HCC 3-5 cm, and patients were randomized into three groups: 90 underwent TACE (group 1); 95 underwent MWA (group 2); and 93 underwent combined therapy (group 3)[78]. Their study found that group 3 had the significantly lower recurrence rate after 12 mo, and the significantly higher OS and mean progression-free survival than groups 1 and 2. Therefore, the combination of thermal ablation with TACE therapy is an optimal choice for patients with HCC tumors > 3 cm[78,79].

RFA or MWA can be performed the same day or less than 2 wk after TACE[75,78]. The most common complications of TACE-RFA are gastrointestinal bleeding, abscess, liver failure, liver infarction[71].

PERCUTANEOUS VS LAPAROSCOPIC TECHNIQUES

Thermal ablation can be performed safely using percutaneous or laparoscopic techniques. RFA was generally applied to HCC patients who could not endure repeated resection of the tumor or were not eligible for liver transplantation. RFA is commonly used to eliminate percutaneous tumors and is the most appropriate method for HCC masses far from the intestine, bile duct, ureter, or diaphragm[80]. In contrast, the laparoscopic RFA (LRFA) procedure requires general anesthesia, so the patient is more cooperative, the ablation boundaries are clearer, and the ablation can reach deeper. Therefore, laparoscopic RFA performed better than PRFA in the deep-seated liver cancers, such as subphrenic lesions[81].

According to Kwak et al’s study[82] on subphrenic HCC, the local tumor progression rate of the LRFA group was significantly lower than that of the PRFA group, the cumulative OS rate of the LRFA group was significantly higher than that of the PRFA group, and there was no statistical difference in DFS rate between the two groups[82]. Another study showed that laparoscopic MWA seemed to have a tendency to be more effective than percutaneous MWA in the treatment of subcapsular HCC[83]. However, the laparoscopic approach has a higher rate of postoperative complications than the percutaneous approach[80,82,83]. Consequently, LRFA can be a valuable treatment option for subphrenic and subcapsular HCC if accessible using the laparoscopic approach.

ABLATION VS OTHER LAGICAL TREATMENT

Apart from ablation, non-operative local treatment of HCC includes TACE, stereotactic body radiation therapy (SBRT) and Proton beam radiotherapy (PBT). Many articles have shown that RFA has long-term benefits comparable to repeat hepatectomy (RH) for tumours less than 3 cm[16,20,21,84]. The study showed that RFA has better OS and RFS advantages than TACE for rHCCs in both ≤ 3 cm and > 3 cm lesions[84]. RFA and SBRT showed considerable therapeutic benefit for rHCC ≤ 3 cm, better OS but lower RFS rate for rHCC > 3 cm[84]. A prospective randomized study showed that the LPFS rate of PBT was comparable to that of RFA observed in rHCC patients with ≤ 2 tumor (s) of < 3 cm[85].

The 2-year OS was slightly higher in the RFA-PEI than in the RFA group, and current evidence was difficult to draw a definite conclusion regarding the therapeutic management in terms of local recurrence free proportion and complete tumor necrosis. However, TACE-RFA is comparable to RH in both OS and RFS, and has a lower complication rate and hospital stay than RH. Therefore, in patients with liver function compensation, TACE-RFA local therapy may be considered as a preferred option.

The use of percutaneous fusion imaging-guided RFA is effective and safe for the treatment of subcentimeter rHCC[86]. However, PRFA was not feasible in 34.3% (72/210) of sub-centimeter rHCCs primarily due to poor lesion conspicuity[87]. And fusion imaging with or without CEUS does not always satisfactorily locate sub-centimeter rHCC. Cone-beam CT-guided TACE can also be used as an alternative local therapy for subcentimeter rHCC due to its high technical feasibility and detectability[88].

CONCLUSION

This review methodically describes the treatment of rHCC by various ablation procedures in recent years. Moreover, this study compares the indications, advantages and survival analysis of various ablative treatments. Therefore, we summarize how to choose the appropriate ablation therapy for different rHCC patients (Table 1).

RFA, MWA and CRA can be considered recommended as first-line treatment for rHCC < 3 cm in diameter. RFA is currently the most widely used, PRFA can be used in percutaneous tumors and LRFA can be used in subphrenic and subcapsular tumors, while MWA is more recommended for patients with perivascular lesions and TACE-RFA could be consider for patients with MVI (+). CRA is an option for patients who are not candidates for thermal ablation. For patients with 2 to 3 cm lesions with liver function compensation, PEI-RFA can be selected. TACE combined with RFA/MWA provided better overall and disease-free survival than TACE alone. For tumors with diameter ranging from 3 to 5 cm, MWA, CRA, and TACE-RFA are recommended. Remarkably, TACE-RFA is a better choice for patients with 3-5 cm rHCC with liver function compensation. For tumors > 5 cm in diameter, local ablation can reduce the tumor burden as a bridging therapy during the waiting period for liver transplantation, or as palliative treatment for recurrence after liver transplantation. In conclusion, the treatment decisions were individualized requires a professional liver surgeon to consider the patient performance status, liver function, and recurrent tumor status.

Table 1 Application of various minimally invasive treatments in hepatocellular carcinoma.
Tumour size
Patients condition
Treatment
Sub-centimeterPercutaneous tumorsPRFA
Local ablation therapy is not feasibleTACE
< 3 cmPercutaneous tumorsPRFA
Subphrenic and subcapsular tumorsLRFA
Perivascular tumorsMWA
Can't endure thermal ablationCRA
MVI (+)TACE-RFA
3-5 cmWith liver function compensationTACE-RFA
Liver failureMWA, CRA
Footnotes

Provenance and peer review: Invited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Gastroenterology and hepatology

Country/Territory of origin: China

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): B

Grade C (Good): C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Ota Y, Japan; Tsoulfas G, Greece S-Editor: Li L L-Editor: A P-Editor: Zhao S

References
1.  Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209-249.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 50630]  [Cited by in F6Publishing: 45909]  [Article Influence: 15303.0]  [Reference Citation Analysis (47)]
2.  Zhang JA, Kwee SA, Wong LL. Late recurrence of hepatocellular carcinoma after liver transplantation. Hepatoma Res. 2017;3:58-66.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 11]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
3.  Yao LQ, Chen ZL, Feng ZH, Diao YK, Li C, Sun HY, Zhong JH, Chen TH, Gu WM, Zhou YH, Zhang WG, Wang H, Zeng YY, Wu H, Wang MD, Xu XF, Pawlik TM, Lau WY, Shen F, Yang T. Clinical Features of Recurrence After Hepatic Resection for Early-Stage Hepatocellular Carcinoma and Long-Term Survival Outcomes of Patients with Recurrence: A Multi-institutional Analysis. Ann Surg Oncol. 2022;.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 19]  [Article Influence: 9.5]  [Reference Citation Analysis (0)]
4.  Izzo F, Granata V, Grassi R, Fusco R, Palaia R, Delrio P, Carrafiello G, Azoulay D, Petrillo A, Curley SA. Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update. Oncologist. 2019;24:e990-e1005.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 164]  [Cited by in F6Publishing: 246]  [Article Influence: 49.2]  [Reference Citation Analysis (0)]
5.  Hasegawa K, Kokudo N, Makuuchi M, Izumi N, Ichida T, Kudo M, Ku Y, Sakamoto M, Nakashima O, Matsui O, Matsuyama Y. Comparison of resection and ablation for hepatocellular carcinoma: a cohort study based on a Japanese nationwide survey. J Hepatol. 2013;58:724-729.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 263]  [Cited by in F6Publishing: 274]  [Article Influence: 24.9]  [Reference Citation Analysis (0)]
6.  Roayaie S, Obeidat K, Sposito C, Mariani L, Bhoori S, Pellegrinelli A, Labow D, Llovet JM, Schwartz M, Mazzaferro V. Resection of hepatocellular cancer ≤ 2 cm: results from two Western centers. Hepatology. 2013;57:1426-1435.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 300]  [Cited by in F6Publishing: 271]  [Article Influence: 24.6]  [Reference Citation Analysis (0)]
7.  Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol. 2010;40:107-111.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 217]  [Cited by in F6Publishing: 261]  [Article Influence: 18.6]  [Reference Citation Analysis (0)]
8.  Au KP, Chok KSH. Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm. World J Gastroenterol. 2018;24:5081-5094.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 50]  [Cited by in F6Publishing: 43]  [Article Influence: 7.2]  [Reference Citation Analysis (0)]
9.  Au KP, Fung JYY, Dai WC, Chan ACY, Lo CM, Chok KSH. Verifying the Benefits of Radical Treatment in Posttransplant Hepatocellular Carcinoma Oligo-recurrence: A Propensity Score Analysis. Liver Transpl. 2022;28:51-64.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
10.  Yamashita Y, Yoshida Y, Kurihara T, Itoh S, Harimoto N, Ikegami T, Yoshizumi T, Uchiyama H, Shirabe K, Maehara Y. Surgical results for recurrent hepatocellular carcinoma after curative hepatectomy: Repeat hepatectomy versus salvage living donor liver transplantation. Liver Transpl. 2015;21:961-968.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 24]  [Cited by in F6Publishing: 25]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
11.  Chan AC, Chan SC, Chok KS, Cheung TT, Chiu DW, Poon RT, Fan ST, Lo CM. Treatment strategy for recurrent hepatocellular carcinoma: salvage transplantation, repeated resection, or radiofrequency ablation? Liver Transpl. 2013;19:411-419.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 93]  [Cited by in F6Publishing: 104]  [Article Influence: 9.5]  [Reference Citation Analysis (0)]
12.  Fuks D, Dokmak S, Paradis V, Diouf M, Durand F, Belghiti J. Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology. 2012;55:132-140.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 196]  [Cited by in F6Publishing: 224]  [Article Influence: 18.7]  [Reference Citation Analysis (0)]
13.  Chan DL, Morris DL, Chua TC. Clinical efficacy and predictors of outcomes of repeat hepatectomy for recurrent hepatocellular carcinoma - a systematic review. Surg Oncol. 2013;22:e23-e30.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 45]  [Cited by in F6Publishing: 50]  [Article Influence: 4.5]  [Reference Citation Analysis (0)]
14.  Zhou Y, Sui C, Li B, Yin Z, Tan Y, Yang J, Liu Z. Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review. World J Surg Oncol. 2010;8:55.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 92]  [Article Influence: 6.6]  [Reference Citation Analysis (0)]
15.  Wen T, Jin C, Facciorusso A, Donadon M, Han HS, Mao Y, Dai C, Cheng S, Zhang B, Peng B, Du S, Jia C, Xu F, Shi J, Sun J, Zhu P, Nara S, Millis JM; MDT of West China Hospital*. Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: an international expert consensus. Hepatobiliary Surg Nutr. 2018;7:353-371.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 51]  [Cited by in F6Publishing: 62]  [Article Influence: 10.3]  [Reference Citation Analysis (0)]
16.  Aquina CT, Eskander MF, Pawlik TM. Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature. Front Oncol. 2022;12:832405.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 8]  [Reference Citation Analysis (0)]
17.  Qian K, Zhang F, Allison SK, Zheng C, Yang X. Image-guided locoregional non-intravascular interventional treatments for hepatocellular carcinoma: Current status. J Interv Med. 2021;4:1-7.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 1]  [Reference Citation Analysis (0)]
18.  Cheung TT, Ma KW, She WH. A review on radiofrequency, microwave and high-intensity focused ultrasound ablations for hepatocellular carcinoma with cirrhosis. Hepatobiliary Surg Nutr. 2021;10:193-209.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 21]  [Article Influence: 7.0]  [Reference Citation Analysis (0)]
19.  Bai XM, Cui M, Yang W, Wang H, Wang S, Zhang ZY, Wu W, Chen MH, Yan K, Goldberg SN. The 10-year Survival Analysis of Radiofrequency Ablation for Solitary Hepatocellular Carcinoma 5 cm or Smaller: Primary versus Recurrent HCC. Radiology. 2021;300:458-469.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 33]  [Article Influence: 11.0]  [Reference Citation Analysis (0)]
20.  Zhang CS, Zhang JL, Li XH, Li L, Li X, Zhou XY. Is radiofrequency ablation equal to surgical re-resection for recurrent hepatocellular carcinoma meeting the Milan criteria? J BUON. 2015;20:223-230.  [PubMed]  [DOI]  [Cited in This Article: ]
21.  Xia Y, Li J, Liu G, Wang K, Qian G, Lu Z, Yang T, Yan Z, Lei Z, Si A, Wan X, Zhang H, Gao C, Cheng Z, Pawlik TM, Wang H, Lau WY, Wu M, Shen F. Long-term Effects of Repeat Hepatectomy vs Percutaneous Radiofrequency Ablation Among Patients With Recurrent Hepatocellular Carcinoma: A Randomized Clinical Trial. JAMA Oncol. 2020;6:255-263.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 63]  [Cited by in F6Publishing: 108]  [Article Influence: 27.0]  [Reference Citation Analysis (0)]
22.  Kawano Y, Sasaki A, Kai S, Endo Y, Iwaki K, Uchida H, Shibata K, Ohta M, Kitano S. Prognosis of patients with intrahepatic recurrence after hepatic resection for hepatocellular carcinoma: a retrospective study. Eur J Surg Oncol. 2009;35:174-179.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 44]  [Cited by in F6Publishing: 51]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
23.  Nielsen HJ. Detrimental effects of perioperative blood transfusion. Br J Surg. 1995;82:582-587.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 158]  [Cited by in F6Publishing: 156]  [Article Influence: 5.4]  [Reference Citation Analysis (0)]
24.  Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;7:1054-1063.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 209]  [Cited by in F6Publishing: 210]  [Article Influence: 23.3]  [Reference Citation Analysis (1)]
25.  Afaghi P, Lapolla MA, Ghandi K. Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients. Heliyon. 2021;7:e06454.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 3]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
26.  Lubner MG, Brace CL, Hinshaw JL, Lee FT Jr. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol. 2010;21:S192-S203.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 414]  [Cited by in F6Publishing: 435]  [Article Influence: 31.1]  [Reference Citation Analysis (0)]
27.  Ierardi AM, Mangano A, Floridi C, Dionigi G, Biondi A, Duka E, Lucchina N, Lianos GD, Carrafiello G. A new system of microwave ablation at 2450 MHz: preliminary experience. Updates Surg. 2015;67:39-45.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 43]  [Cited by in F6Publishing: 39]  [Article Influence: 4.3]  [Reference Citation Analysis (0)]
28.  Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DS. Microwave liver ablation: influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol. 2008;19:1087-1092.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 158]  [Cited by in F6Publishing: 162]  [Article Influence: 10.1]  [Reference Citation Analysis (0)]
29.  Liang P, Wang Y. Microwave ablation of hepatocellular carcinoma. Oncology. 2007;72 Suppl 1:124-131.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 153]  [Cited by in F6Publishing: 151]  [Article Influence: 8.9]  [Reference Citation Analysis (0)]
30.  Zhang M, Ma H, Zhang J, He L, Ye X, Li X. Comparison of microwave ablation and hepatic resection for hepatocellular carcinoma: a meta-analysis. Onco Targets Ther. 2017;10:4829-4839.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 38]  [Article Influence: 5.4]  [Reference Citation Analysis (0)]
31.  Galanakis N, Kehagias E, Matthaiou N, Samonakis D, Tsetis D. Transcatheter arterial chemoembolization combined with radiofrequency or microwave ablation for hepatocellular carcinoma: a review. Hepat Oncol. 2018;5:HEP07.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 10]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
32.  Jacques SL. Laser-tissue interactions. Photochemical, photothermal, and photomechanical. Surg Clin North Am. 1992;72:531-558.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 255]  [Cited by in F6Publishing: 187]  [Article Influence: 5.8]  [Reference Citation Analysis (0)]
33.  Bown SG. Phototherapy in tumors. World J Surg. 1983;7:700-709.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 376]  [Cited by in F6Publishing: 293]  [Article Influence: 7.1]  [Reference Citation Analysis (0)]
34.  Orlacchio A, Bolacchi F, Chegai F, Bergamini A, Costanzo E, Del Giudice C, Angelico M, Simonetti G. Comparative evaluation of percutaneous laser and radiofrequency ablation in patients with HCC smaller than 4 cm. Radiol Med. 2014;119:298-308.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 20]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
35.  Di Costanzo GG, Tortora R, D'Adamo G, De Luca M, Lampasi F, Addario L, Galeota Lanza A, Picciotto FP, Tartaglione MT, Cordone G, Imparato M, Mattera S, Pacella CM. Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: a randomized trial. J Gastroenterol Hepatol. 2015;30:559-565.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 55]  [Cited by in F6Publishing: 60]  [Article Influence: 6.7]  [Reference Citation Analysis (0)]
36.  Zhang L, Wang N, Shen Q, Cheng W, Qian GJ. Therapeutic efficacy of percutaneous radiofrequency ablation versus microwave ablation for hepatocellular carcinoma. PLoS One. 2013;8:e76119.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 79]  [Cited by in F6Publishing: 82]  [Article Influence: 7.5]  [Reference Citation Analysis (0)]
37.  Germani G, Pleguezuelo M, Gurusamy K, Meyer T, Isgrò G, Burroughs AK. Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocelullar carcinoma: a meta-analysis. J Hepatol. 2010;52:380-388.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 209]  [Cited by in F6Publishing: 208]  [Article Influence: 14.9]  [Reference Citation Analysis (0)]
38.  Morisco F, Camera S, Guarino M, Tortora R, Cossiga V, Vitiello A, Cordone G, Caporaso N, Di Costanzo GG; Italian Liver Cancer (ITA. LI.CA) group. Laser ablation is superior to TACE in large-sized hepatocellular carcinoma: a pilot case-control study. Oncotarget. 2018;9:17483-17490.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 10]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
39.  Luerken L, Haimerl M, Doppler M, Uller W, Beyer LP, Stroszczynski C, Einspieler I. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. Rofo. 2022;194:1075-1086.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
40.  Ng KK, Poon RT, Chan SC, Chok KS, Cheung TT, Tung H, Chu F, Tso WK, Yu WC, Lo CM, Fan ST. High-intensity focused ultrasound for hepatocellular carcinoma: a single-center experience. Ann Surg. 2011;253:981-987.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 79]  [Cited by in F6Publishing: 94]  [Article Influence: 7.2]  [Reference Citation Analysis (0)]
41.  Wu F, Wang ZB, Chen WZ, Zou JZ, Bai J, Zhu H, Li KQ, Jin CB, Xie FL, Su HB. Advanced hepatocellular carcinoma: treatment with high-intensity focused ultrasound ablation combined with transcatheter arterial embolization. Radiology. 2005;235:659-667.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 178]  [Cited by in F6Publishing: 196]  [Article Influence: 10.3]  [Reference Citation Analysis (0)]
42.  Nishikawa H, Osaki Y. Comparison of high-intensity focused ultrasound therapy and radiofrequency ablation for recurrent hepatocellular carcinoma. Hepatobiliary Surg Nutr. 2013;2:168-170.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 1]  [Reference Citation Analysis (0)]
43.  Zou YW, Ren ZG, Sun Y, Liu ZG, Hu XB, Wang HY, Yu ZJ. The latest research progress on minimally invasive treatments for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int. 2023;22:54-63.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 6]  [Article Influence: 6.0]  [Reference Citation Analysis (0)]
44.  Chan AC, Cheung TT, Fan ST, Chok KS, Chan SC, Poon RT, Lo CM. Survival analysis of high-intensity focused ultrasound therapy versus radiofrequency ablation in the treatment of recurrent hepatocellular carcinoma. Ann Surg. 2013;257:686-692.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 46]  [Cited by in F6Publishing: 55]  [Article Influence: 5.0]  [Reference Citation Analysis (0)]
45.  Shen HP, Gong JP, Zuo GQ. Role of high-intensity focused ultrasound in treatment of hepatocellular carcinoma. Am Surg. 2011;77:1496-1501.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 16]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
46.  Li JJ, Gu MF, Luo GY, Liu LZ, Zhang R, Xu GL. Complications of high intensity focused ultrasound for patients with hepatocellular carcinoma. Technol Cancer Res Treat. 2009;8:217-224.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 34]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
47.  Rong G, Bai W, Dong Z, Wang C, Lu Y, Zeng Z, Qu J, Lou M, Wang H, Gao X, Chang X, An L, Chen Y, Yang Y. Cryotherapy for cirrhosis-based hepatocellular carcinoma: a single center experience from 1595 treated cases. Front Med. 2015;9:63-71.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 5]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
48.  Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology. 2004;127:1714-1723.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 474]  [Cited by in F6Publishing: 426]  [Article Influence: 21.3]  [Reference Citation Analysis (0)]
49.  Yang Y, Wang C, Lu Y, Bai W, An L, Qu J, Gao X, Chen Y, Zhou L, Wu Y, Feng Y, Zhang M, Chang X, Lv J. Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2012;19:674-684.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 44]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
50.  Wang C, Lu Y, Chen Y, Feng Y, An L, Wang X, Su S, Bai W, Zhou L, Yang Y, Xu D. Prognostic factors and recurrence of hepatitis B-related hepatocellular carcinoma after argon-helium cryoablation: a prospective study. Clin Exp Metastasis. 2009;26:839-848.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 23]  [Cited by in F6Publishing: 27]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
51.  Tameez Ud Din A, Tameez-Ud-Din A, Chaudhary FMD, Chaudhary NA, Siddiqui KH. Irreversible Electroporation For Liver Tumors: A Review Of Literature. Cureus. 2019;11:e4994.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 8]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
52.  Shiina S, Sato K, Tateishi R, Shimizu M, Ohama H, Hatanaka T, Takawa M, Nagamatsu H, Imai Y. Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery. Can J Gastroenterol Hepatol. 2018;2018:4756147.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 54]  [Cited by in F6Publishing: 58]  [Article Influence: 9.7]  [Reference Citation Analysis (0)]
53.  Gupta P, Maralakunte M, Sagar S, Kumar-M P, Bhujade H, Chaluvashetty SB, Kalra N. Efficacy and safety of irreversible electroporation for malignant liver tumors: a systematic review and meta-analysis. Eur Radiol. 2021;31:6511-6521.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 16]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
54.  Mafeld S, Wong JJ, Kibriya N, Stenberg B, Manas D, Bassett P, Aslam T, Evans J, Littler P. Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes. Cardiovasc Intervent Radiol. 2019;42:577-583.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 26]  [Cited by in F6Publishing: 21]  [Article Influence: 3.5]  [Reference Citation Analysis (0)]
55.  Kalra N, Gupta P, Gorsi U, Bhujade H, Chaluvashetty SB, Duseja A, Singh V, Dhiman RK, Chawla YK, Khandelwal N. Irreversible Electroporation for Unresectable Hepatocellular Carcinoma: Initial Experience. Cardiovasc Intervent Radiol. 2019;42:584-590.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 31]  [Cited by in F6Publishing: 35]  [Article Influence: 7.0]  [Reference Citation Analysis (0)]
56.  Bhutiani N, Philips P, Scoggins CR, McMasters KM, Potts MH, Martin RC. Evaluation of tolerability and efficacy of irreversible electroporation (IRE) in treatment of Child-Pugh B (7/8) hepatocellular carcinoma (HCC). HPB (Oxford). 2016;18:593-599.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 41]  [Cited by in F6Publishing: 45]  [Article Influence: 5.6]  [Reference Citation Analysis (0)]
57.  Dollinger M, Beyer LP, Haimerl M, Niessen C, Jung EM, Zeman F, Stroszczynski C, Wiggermann P. Adverse effects of irreversible electroporation of malignant liver tumors under CT fluoroscopic guidance: a single-center experience. Diagn Interv Radiol. 2015;21:471-475.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 30]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]
58.  Weis S, Franke A, Berg T, Mössner J, Fleig WE, Schoppmeyer K. Percutaneous ethanol injection or percutaneous acetic acid injection for early hepatocellular carcinoma. Cochrane Database Syst Rev. 2015;1:CD006745.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 12]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
59.  Yu SJ, Yoon JH, Lee JM, Lee JY, Kim SH, Cho YY, Yoo JJ, Lee M, Lee DH, Cho Y, Cho EJ, Lee JH, Kim YJ, Kim CY. Percutaneous ethanol injection therapy is comparable to radiofrequency ablation in hepatocellular carcinoma smaller than 1.5 cm: A matched case-control comparative analysis. Medicine (Baltimore). 2016;95:e4551.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 10]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
60.  Khan KN, Yatsuhashi H, Yamasaki K, Yamasaki M, Inoue O, Koga M, Yano M. Prospective analysis of risk factors for early intrahepatic recurrence of hepatocellular carcinoma following ethanol injection. J Hepatol. 2000;32:269-278.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 113]  [Cited by in F6Publishing: 118]  [Article Influence: 4.9]  [Reference Citation Analysis (0)]
61.  Orlando A, Leandro G, Olivo M, Andriulli A, Cottone M. Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials. Am J Gastroenterol. 2009;104:514-524.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 181]  [Cited by in F6Publishing: 172]  [Article Influence: 11.5]  [Reference Citation Analysis (0)]
62.  Liu B, Long J, Wang W, Huang G, Jiang C, Zhang X, Liu M, Liang P, Yu J, Xie X, Kuang M. Treatment of hepatocellular carcinoma in the caudate lobe: US-guided percutaneous radiofrequency ablation combined with ethanol ablation. Clin Radiol. 2018;73:647-656.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 8]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
63.  Shankar S, vanSonnenberg E, Morrison PR, Tuncali K, Silverman SG. Combined radiofrequency and alcohol injection for percutaneous hepatic tumor ablation. AJR Am J Roentgenol. 2004;183:1425-1429.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 45]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
64.  Shiina S, Tagawa K, Unuma T, Takanashi R, Yoshiura K, Komatsu Y, Hata Y, Niwa Y, Shiratori Y, Terano A. Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study. Cancer. 1991;68:1524-1530.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 3]  [Reference Citation Analysis (0)]
65.  Chen S, Peng Z, Lin M, Chen Z, Hu W, Xie X, Liu L, Qian G, Peng B, Li B, Kuang M. Combined percutaneous radiofrequency ablation and ethanol injection versus hepatic resection for 2.1-5.0 cm solitary hepatocellular carcinoma: a retrospective comparative multicentre study. Eur Radiol. 2018;28:3651-3660.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 13]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
66.  Chen MS, Zhang YJ, Li JQ, Liang HH, Zhang YQ, Zheng Y. [Randomized clinical trial of percutaneous radiofrequency ablation plus absolute ethanol injection compared with radiofrequency ablation alone for small hepatocellular carcinoma]. Zhonghua Zhong Liu Za Zhi. 2005;27:623-625.  [PubMed]  [DOI]  [Cited in This Article: ]
67.  Li Z, Zhang K, Lin SM, Mi DH, Cao N, Wen ZZ, Li ZX. Radiofrequency ablation combined with percutaneous ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia. 2017;33:237-246.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 13]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
68.  Zhu ZX, Liao MH, Wang XX, Huang JW. Radiofrequency ablation with or without ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis. Minerva Med. 2016;107:381-391.  [PubMed]  [DOI]  [Cited in This Article: ]
69.  Lu DE, Cheng SW, Lin YS, Tu MW, Lee CH, Chen C, Chen KH. Combination of radiofrequency ablation and percutaneous ethanol injection versus radiofrequency ablation alone for hepatocellular carcinoma: a systematic review and meta-analysis. Ann Hepatol. 2022;27:100729.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 8]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
70.  Chen S, Peng Z, Xiao H, Lin M, Chen Z, Jiang C, Hu W, Xie X, Liu L, Peng B, Kuang M. Combined radiofrequency ablation and ethanol injection versus repeat hepatectomy for elderly patients with recurrent hepatocellular carcinoma after initial hepatic surgery. Int J Hyperthermia. 2018;34:1029-1037.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 6]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
71.  Jiang C, Cheng G, Liao M, Huang J. Individual or combined transcatheter arterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma: a time-to-event meta-analysis. World J Surg Oncol. 2021;19:81.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 23]  [Cited by in F6Publishing: 25]  [Article Influence: 8.3]  [Reference Citation Analysis (0)]
72.  Peng Z, Wei M, Chen S, Lin M, Jiang C, Mei J, Li B, Wang Y, Li J, Xie X, Kuang M. Combined transcatheter arterial chemoembolization and radiofrequency ablation versus hepatectomy for recurrent hepatocellular carcinoma after initial surgery: a propensity score matching study. Eur Radiol. 2018;28:3522-3531.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 26]  [Cited by in F6Publishing: 38]  [Article Influence: 6.3]  [Reference Citation Analysis (0)]
73.  Li W, Man W, Guo H, Yang P. Clinical study of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of advanced hepatocellular carcinoma. J Cancer Res Ther. 2016;12:C217-C220.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 18]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
74.  Yi PS, Huang M, Zhang M, Xu L, Xu MQ. Comparison of Transarterial Chemoembolization Combined with Radiofrequency Ablation Therapy versus Surgical Resection for Early Hepatocellular Carcinoma. Am Surg. 2018;84:282-288.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 11]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
75.  Peng ZW, Zhang YJ, Chen MS, Xu L, Liang HH, Lin XJ, Guo RP, Zhang YQ, Lau WY. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol. 2013;31:426-432.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 310]  [Cited by in F6Publishing: 361]  [Article Influence: 30.1]  [Reference Citation Analysis (0)]
76.  Ni JY, Liu SS, Xu LF, Sun HL, Chen YT. Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol. 2013;19:3872-3882.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 112]  [Cited by in F6Publishing: 117]  [Article Influence: 10.6]  [Reference Citation Analysis (0)]
77.  Sun X, Yang Z, Mei J, Lyu N, Lai J, Chen M, Zhao M. The guiding value of microvascular invasion for treating early recurrent small hepatocellular carcinoma. Int J Hyperthermia. 2021;38:931-938.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
78.  Zaitoun MMA, Elsayed SB, Zaitoun NA, Soliman RK, Elmokadem AH, Farag AA, Amer M, Hendi AM, Mahmoud NEM, Salah El Deen D, Alsowey AM, Shahin S, Basha MAA. Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3-<5 cm. Int J Hyperthermia. 2021;38:248-256.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 9]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
79.  Iezzi R, Pompili M, Posa A, Coppola G, Gasbarrini A, Bonomo L. Combined locoregional treatment of patients with hepatocellular carcinoma: State of the art. World J Gastroenterol. 2016;22:1935-1942.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 48]  [Cited by in F6Publishing: 46]  [Article Influence: 5.8]  [Reference Citation Analysis (0)]
80.  Eun HS, Lee BS, Kwon IS, Yun GY, Lee ES, Joo JS, Sung JK, Moon HS, Kang SH, Kim JS, Shin HJ, Kim TK, Chun K, Kim SH. Advantages of Laparoscopic Radiofrequency Ablation Over Percutaneous Radiofrequency Ablation in Hepatocellular Carcinoma. Dig Dis Sci. 2017;62:2586-2600.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 21]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
81.  Song KD, Lim HK, Rhim H, Lee MW, Kang TW, Paik YH, Kim JM, Joh JW. Hepatic resection vs percutaneous radiofrequency ablation of hepatocellular carcinoma abutting right diaphragm. World J Gastrointest Oncol. 2019;11:227-237.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 18]  [Cited by in F6Publishing: 19]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]
82.  Kwak MH, Lee MW, Ko SE, Rhim H, Kang TW, Song KD, Kim JM, Choi GS. Laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for subphrenic hepatocellular carcinoma. Ultrasonography. 2022;41:543-552.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
83.  Della Corte A, Ratti F, Monfardini L, Marra P, Gusmini S, Salvioni M, Venturini M, Cipriani F, Aldrighetti L, De Cobelli F. Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma. Int J Hyperthermia. 2020;37:542-548.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 4]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
84.  Zheng J, Cai J, Tao L, Kirih MA, Shen Z, Xu J, Liang X. Comparison on the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis. Int J Surg. 2020;83:196-204.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 12]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
85.  Kim TH, Koh YH, Kim BH, Kim MJ, Lee JH, Park B, Park JW. Proton beam radiotherapy vs. radiofrequency ablation for recurrent hepatocellular carcinoma: A randomized phase III trial. J Hepatol. 2021;74:603-612.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 55]  [Cited by in F6Publishing: 101]  [Article Influence: 33.7]  [Reference Citation Analysis (0)]
86.  Lee MW, Lim HK. Management of sub-centimeter recurrent hepatocellular carcinoma after curative treatment: Current status and future. World J Gastroenterol. 2018;24:5215-5222.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 16]  [Cited by in F6Publishing: 16]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
87.  Song KD, Lee MW, Rhim H, Kang TW, Cha DI, Sinn DH, Lim HK. Percutaneous US/MRI Fusion-guided Radiofrequency Ablation for Recurrent Subcentimeter Hepatocellular Carcinoma: Technical Feasibility and Therapeutic Outcomes. Radiology. 2018;288:878-886.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 46]  [Cited by in F6Publishing: 62]  [Article Influence: 10.3]  [Reference Citation Analysis (0)]
88.  Choi JW, Kim HC, Lee JH, Yu SJ, Cho EJ, Kim MU, Hur S, Lee M, Jae HJ, Chung JW. Cone Beam CT-Guided Chemoembolization of Probable Hepatocellular Carcinomas Smaller than 1 cm in Patients at High Risk of Hepatocellular Carcinoma. J Vasc Interv Radiol. 2017;28:795-803.e1.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 10]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]