Emerging local ablation techniques

Local ablation technologies for hepatic malignancy have developed rapidly in the past decade, with advances in several percutaneous or externally delivered treatment methods including radiofrequency ablation, microwave ablation, laser ablation, and high-intensity focused ultrasound. Research has focused on increasing the size of the ablation zone and minimizing heat-sink effects. More recent developments include improvements in treatment planning and navigation with integration of several imaging modalities, as well as automated delivery of the ablation through robotics. These improvements will allow increased consistency in treatment delivery and will facilitate translation to the community setting. Combination therapies with multimodality guidance are on the cutting edge of image-guided, minimally invasive cancer therapies. Local ablation is being combined with regional therapies, such as arterial chemoembolization and local activation of systemically administered drugs, with promising results. Potential combinations with local ablation also include external radiation therapy and antitumor immune modulation. Image-guided oncology is emerging as an important part of the interventional radiology practice, thanks in part to the innovation and imaging background that lies at the roots of our discipline.