Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2016; 7(4): 477-489
Published online Nov 6, 2016. doi: 10.4292/wjgpt.v7.i4.477
Local ablative treatments for hepatocellular carcinoma: An updated review
Antonio Facciorusso, Gaetano Serviddio, Nicola Muscatiello
Antonio Facciorusso, Nicola Muscatiello, Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
Gaetano Serviddio, Internal Medicine Unit, University of Foggia, 71100 Foggia, Italy
Author contributions: Muscatiello N performed the bibliographic research; Facciorusso A wrote the paper; Serviddio G revised the manuscript; all the authors contributed to the article.
Conflict-of-interest statement: None of the authors have received fees for serving as a speaker or are consultant/advisory board member for any organizations. None of the authors have received research funding from any organizations. None of the authors are employees of any organizations. None of the authors own stocks and/or share in any organizations. None of the authors own patents. None of the authors has conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Antonio Facciorusso, MD, Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale L. Pinto, 1, 71100 Foggia, Italy. antonio.facciorusso@virgilio.it
Telephone: +39-0881-732154 Fax: +39-0881-732135
Received: May 22, 2016
Peer-review started: May 23, 2016
First decision: July 4, 2016
Revised: July 16, 2016
Accepted: August 17, 2016
Article in press: August 19, 2016
Published online: November 6, 2016
Abstract

Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.

Keywords: Liver cancer, Hepatocellular carcinoma, Radiofrequency ablation, Microwave ablation, Radiofrequency ablation

Core tip: Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma. Among ablative therapies, radiofrequency ablation has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Among other thermal treatments, microwave ablation, high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results.