According to China’s “Diagnostic and Treatment Guidelines for Primary Liver Cancer (2017 Edition),” ablation therapy, along with surgical resection and liver transplantation, are effective treatments for the eradication of liver cancer.
Rationale of radiofrequency ablation
Radiofrequency ablation of liver cancer (RFA) is a common means of ablative therapy for liver cancer.
The principle is to use the position of the head of the puncture electrode to emit medium to high frequency radiofrequency waves to increase the local tissue temperature. When the temperature exceeds 60 °C, the local tissue cell bilayer lipid membrane dissolves, intracellular proteins denature, and mitochondrial enzymes and lysosomal enzymes undergo irreversible coagulation necrosis, thereby destroying the tumor cells.
Radiofrequency ablation simultaneously coagulates and necroses small blood vessels in and around the tumor, thereby cutting off the blood supply to the tumor and rendering the tumor tissue completely necrotic and unrepairable.
Devices used for radiofrequency ablation
Currently, the commonly used electrodes are divided into cold circulation electrodes and extension electrodes, of which cold circulation electrodes are the most commonly used and have a high safety profile.
Adjuncts to radiofrequency ablation
Radiofrequency ablation of hepatocellular carcinoma can be performed under imaging guidance with direct puncture of the liver tumor through the skin abdominal wall; it can also be performed during laparoscopic surgery or under open direct vision/color ultrasound guidance.
Among them, percutaneous ultrasound-guided radiofrequency ablation is currently the most common clinical approach, with the main advantages of minimally invasive, convenient and flexible, repeatable treatment, high safety, and better efficacy.
Progressive maturation of radiofrequency ablation technology
With the advancement of technology and experience, the efficacy of radiofrequency ablation for small hepatocellular carcinoma has been recognized and the indications are gradually expanding.
Of course, radiofrequency ablation treatment has adverse effects and certain risks, and clinicians will determine whether patients are suitable for this minimally invasive procedure on a case-by-case basis.
The physician will do detailed imaging before the procedure to plan the puncture path; select the appropriate RF electrode and output power during the procedure; and strictly observe the vital signs and follow up after the procedure to assess the treatment effect. All of these are important to ensure the success of the procedure.