Percutaneous local ablation therapy in small hepatocellular carcinoma

Area of Science:

• Hepatology
• Interventional Oncology
• Medical Imaging

Background:

• Hepatocellular carcinoma (HCC) is frequently detected in its early stages through screening programs for chronic liver disease patients.
• Surgical resection, while common, does not offer superior long-term survival compared to local ablation techniques.
• Current local ablation methods are safe, repeatable, and minimally invasive.

Purpose of the Study:

• To compare the efficacy and outcomes of various local ablation modalities for small HCC.
• To identify the most effective local ablation technique for hepatocellular carcinoma treatment.

Main Methods:

• Review of existing comparative studies on percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), radiofrequency ablation (RFA), and microwave coagulation therapy (MCT).
• Analysis of tumor necrosis rates and patient survival data associated with each modality.
• Evaluation of procedural aspects such as ablation volume, treatment sessions, and predictability.

Main Results:

• Radiofrequency ablation (RFA) demonstrated a higher rate of complete tumor necrosis (90-98%) compared to PEI (80-95%), PAI (90-95%), and MCT (94%).
• RFA offers advantages in larger ablation volume, fewer sessions, and predictable outcomes.
• Survival rates at 1, 3, and 5 years were comparable across all modalities, approximately 90%, 70%, and 40-50%, respectively.

Conclusions:

• Radiofrequency ablation (RFA) is recommended as the primary local ablation therapy for most cases of small HCC.
• Percutaneous ethanol injection (PEI) serves as a practical alternative when RFA is not accessible.
• Local ablation therapies provide effective treatment options for early-stage HCC, with RFA showing particular promise.