In situ ablation of hepatic tumors

The various technologies and approaches for in situ ablation of hepatic tumors are reviewed and the relative merits discussed. The reported experience, though limited, is encouraging but the technology is still maturing. At present in situ ablation ought to be restricted to patients with inoperable disease, unless patients are recruited into randomized trials comparing in situ ablation with hepatic surgical resection in specific patient groups. Emerging technologies such as gene therapy and electro/sonoporation will also impact on how we best manage patients with malignant hepatic tumors. It seems improbable that any one modality will prevail on efficacy, and a more likely scenario for future therapy may well be a combination multimodal approach tailored to the individual patient and the biological characteristics of the tumor.