Treatment of hepatocellular carcinoma by interventional methods

In the treatment of early and intermediate hepatocellular carcinoma the range of indications for percutaneous ablation techniques is becoming wider than surgery or intra-arterial therapies. Indeed, whereas for some years only patients with up to three small tumours were treated, with the introduction of the single-session technique performed under general anaesthesia, even patients with more advanced disease are now being treated. Although it is understood that partial resection assures the highest local control, the survival rates after surgery are roughly comparable with percutaneous ethanol injection (PEI). The explanation is due to a balance among advantages and disadvantages of the two therapies. PEI survival curves are better than curves of resected patients who present adverse prognostic factors, and this means that surgery needs a better selection of the patients. Indications for both of therapies are reported. An unanswered question remains the choice between PEI and other new ablation procedures. In our department we currently use radio-frequency ablation in the majority of patients but consider PEI and segmental transarterial chemoembolisation complementary, and use them according to the features of the disease and the response. Evaluation of therapeutic efficacy, technique and results of them are reported.