Ablation therapy is ranked alongside surgical resection and liver transplantation as effective tools for the eradication of liver cancer. Radiofrequency ablation is one of the common methods of ablative therapy.
Which patients with hepatocellular carcinoma are suitable for radiofrequency ablation therapy?
According to the Specifications for the Treatment of Primary Hepatocellular Carcinoma (2017 Edition), ablation therapy may be considered preferred in the following cases:
- small hepatocellular carcinoma that is inoperable or inappropriate for surgery and refuses surgery;
- small central hepatocellular carcinoma with a maximum diameter of no more than 3 cm;
- Recurrent small hepatocellular carcinoma, maximum diameter not exceeding 3 cm;
- Recurrent small hepatocellular carcinoma, maximum diameter not exceeding 3 cm;
- Single lesion larger than 3 cm, or multiple small hepatocellular carcinomas, for ablative therapy, a transhepatic artery chemoembolization plus ablative treatment modality is recommended.
Surgical resection remains the standard of care for hepatocellular carcinoma, especially in the early stages. However, in patients with a single tumor, no more than 5 cm in diameter, no more than 3 tumor nodes, no more than 3 cm in maximum tumor diameter, and a liver function classification of Child-Pugh A or B, local ablation therapy can also achieve radical results.
Local ablation has achieved desirable results in the treatment of small liver cancers in recent years, and therefore, in addition to liver transplantation and liver tumor resection, local ablation can be the treatment of choice for patients with inoperable or inadvisable, refusing surgery, or recurrent multiple small liver cancers.
Overseas, percutaneous ablation can replace surgery as the treatment of choice for hepatocellular carcinoma up to 2 cm in diameter, with the advantages of being minimally invasive, easily tolerated, rapid recovery, reproducible, cost-effective, with definitive outcomes and long-term survival rates equivalent to surgery.
What other patients with liver cancer are suitable for radiofrequency ablation therapy?
The above treatment principles are specific to patients with hepatocellular carcinoma.
The above treatment principles are for primary hepatocellular carcinoma, and they are largely applicable for patients with other types of primary and metastatic hepatocellular carcinoma, especially for patients with liver metastases from colorectal cancer.
For patients with colorectal cancer, close postoperative follow-up and detection of early metastases, ablation therapy can avoid reoperation. It is important to note that systemic systemic chemotherapy and close postoperative follow-up are also required after ablation.
For patients to be treated with targeted therapy, ablative surgery can reduce the tumor load and make targeted therapy more effective.
As for patients with lesions such as highly anamorphic hyperplastic nodules and focal nodular hyperplasia as determined by MRI, ablation can also be performed if there is a trend toward growth with suspected malignancy on follow-up.