Minimally invasive image-guided therapies for hepatocellular carcinoma

Minimally invasive therapies are gaining increasing attention as an alternative to standard surgical therapies in the treatment of primary hepatocellular carcinoma. These include therapies administered transcatheterally (arterial embolization, intraarterial chemoinfusion, and combination chemoembolization) and percutaneously (chemical ablation with ethanol or acetic acid, and thermal ablation with radiofrequency, microwave, or laser energies). Benefits over surgical resection include the anticipated reduction in morbidity and mortality, low cost, suitability for real time image guidance, the ability to perform ablative procedures on outpatients, and the potential application in a wider spectrum of patients, including nonsurgical candidates. This review examines reported clinical success, potential complications, current limitations, and future directions of development of chemoembolization, ethanol and acetic acid instillation, and radiofrequency, microwave, and laser thermal ablation.