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• W2019958865 abstract "Thermal ablation, as a form of minimally invasive therapy for hepatocellular carcinoma (HCC), has become an important treatment modality. Because of the limitations of surgery, the techniques of thermal ablation have become standard therapies for HCC in some situations. This article reviews 4 thermal ablation techniques—radiofrequency (RF) ablation, microwave ablation, laser ablation, and cryoablation. Each of these techniques may have a role in treating HCC, and the mechanisms, equipment, patient selection, results, and complications of each are considered. Furthermore, combined therapies consisting of thermal ablation and adjuvant chemotherapy also show promise for enhancing these techniques. Important areas of research into thermal ablation remain, including improving the ability of ablation to treat larger tumors, determining the indications for each thermal ablation modality, optimizing image guidance, and obtaining good outcome data on the efficacy of these techniques. Thermal ablation, as a form of minimally invasive therapy for hepatocellular carcinoma (HCC), has become an important treatment modality. Because of the limitations of surgery, the techniques of thermal ablation have become standard therapies for HCC in some situations. This article reviews 4 thermal ablation techniques—radiofrequency (RF) ablation, microwave ablation, laser ablation, and cryoablation. Each of these techniques may have a role in treating HCC, and the mechanisms, equipment, patient selection, results, and complications of each are considered. Furthermore, combined therapies consisting of thermal ablation and adjuvant chemotherapy also show promise for enhancing these techniques. Important areas of research into thermal ablation remain, including improving the ability of ablation to treat larger tumors, determining the indications for each thermal ablation modality, optimizing image guidance, and obtaining good outcome data on the efficacy of these techniques. In the past few years, an increasing number of physicians worldwide have adopted several novel image-guided techniques for the local treatment of hepatocellular carcinoma (HCC) as well as metastases to the liver. Thermal ablation, a subset of these techniques, has gained considerable attention as an alternative to surgery in the treatment of primary HCC. Thermal ablation itself comprises several distinct techniques, 4 of which will be considered in this article: radiofrequency (RF) ablation, microwave ablation, laser ablation, and cryoablation. Compared with surgical resection, these techniques have several advantages, including lower cost, lower morbidity, use in an outpatient setting, and use in patients who are not surgical candidates. Additionally, in contrast with surgery, thermal ablation can readily be used to treat recurrences of tumor. In some cases these techniques may require open surgical exposure of the liver, but most can be performed percutaneously or laparoscopically with minimal risk. Moreover, the percutaneous approach can be performed under conscious sedation, further reducing potential morbidity in addition to lowering cost. The goal of thermal ablation is to destroy entire tumors, killing the malignant cells using heat—or freezing in the case of cryoablation—with only minimal damage to surrounding liver and without damaging adjacent organs. The principle of operation is similar for each of the thermal ablation techniques. Each requires placement of a needle-like applicator directly into the tumor, the tip of which then produces thermal energy in a concentrated fashion, creating a hyperthermic or hypothermic injury. With all of the techniques, it is also crucial to destroy a 5–10-mm circumferential cuff of adjacent normal hepatic parenchyma, because the exact tumor margin is uncertain, and microscopic disease may exist in the rim of tissue surrounding the tumor.1Dodd 3rd, G.D. Soulen M.C. Kane R.A. Livraghi T. Lees W.R. Yamashita Y. Gillams A.R. Karahan O.I. Rhim H. Minimally invasive treatment of malignant hepatic tumors at the threshold of a major breakthrough.Radiographics. 2000; 20: 9-27Crossref PubMed Scopus (541) Google Scholar Originally intended for patients with contraindications to surgery, thermal ablation has now become an alternative first-line therapy for some malignant liver tumors. The exact indications for each thermal ablation technique, however, are not yet clearly defined. Currently, the decision to use ablation, and which ablation technique to use, depends on multiple factors. In theory, the technique that produces the largest ablation zone, ie, region of thermal injury, should be superior.2Goldberg S.N. Charboneau J.W. Dodd 3rd, G.D. Dupuy D.E. Gervais D.A. Gillams A.R. Kane R.A. Lee Jr, F.T. Livraghi T. McGahan J.P. Rhim H. Silverman S.G. Solbiati L. Vogl T.J. Wood B.J. Image-guided tumor ablation proposal for standardization of terms and reporting criteria.Radiology. 2003; 228: 335-345Crossref PubMed Scopus (343) Google Scholar Other characteristics of the ablation zone are also important, and may vary among techniques and devices, including the zone shape, uniformity, and reliability. In practice, the decision of whether or not to use thermal ablation is based on patient-specific criteria involving number, size, and location of tumors. The decision regarding which ablation and image guidance technique to use depends on the training and preference of the individual physician and the resources available at a given medical center. Clinical results so far indicate that the different techniques of thermal ablation have roughly equivalent efficacy for treating HCC, although good outcome data have yet to be established. In this article, RF ablation will be considered first because it is the most thoroughly studied and has accumulated the most clinical experience. The use of RF energy for the treatment of hepatic tumors was pioneered more than a decade ago. In the United States, the current technology for RF ablation was approved for generic tissue ablation by the United States Food and Drug Administration (FDA) in 1997. It has since been approved by the FDA for the treatment of unresectable hepatic tumors. Additionally, both government and private insurers have recognized it as a viable alternative treatment for hepatic tumors and have agreed to reimburse for the procedure. These developments combined with promising clinical reports have driven the widespread use of RF ablation for the treatment of HCC. RF ablation produces thermal injury in living tissue via an alternating electric current in the radiofrequency range (460–500 kHz). Shielded needle electrodes are used to concentrate the energy in selected tissue. The tip of the electrode conducts the current, which causes local ionic agitation and subsequent frictional heat. Temperatures in excess of 50°C produce tissue coagulation. Much of the work in this field has focused on device improvements that enhance ablation zone size. Two main strategies have been used to this end: the multitined expandable electrode and the internally cooled electrode. Currently, there are 3 RF devices that dominate the US market. The first 2 are multitined expandable electrodes (Figures 1A–B). Each consists of a central straight-needle cannula that is used to deploy an array of curved electrode tines from the tip into the adjacent tissue (RITA Medical Systems Inc, Mountain View, CA; and Boston Scientific, Natlick, MA). The configurations of the electrode arrays are designed to produce large spherical ablation zones. The third device (Valleylab, Boulder, CO) consists of a straight, internally cooled needle electrode (Figure 1C). The internal cooling is designed to prevent charring of the adjacent tissues and thus create a larger ablation zone. This applicator may be used alone or as a triangular 3-needle cluster electrode. All RF devices require the use of 2 or more dispersive electrodes in the form of adhesive pads that attach to the patient’s back and/or legs. The major factor that limits the size of the ablation zone with all of these devices is hepatic perfusion.3Leyendecker J.R. Dodd 3rd, G.D. Minimally invasive techniques for the treatment of liver tumors.Semin Liver Dis. 2001; 21: 283-291Crossref PubMed Scopus (31) Google Scholar Normal blood flow through the liver produces perfusion-mediated tissue cooling. One method of overcoming this limitation is to temporarily occlude flow in the hepatic artery and/or portal vein, reducing the amount of heat carried away by the blood flow through the liver.4Washburn W.K. Dodd 3rd, G.D. Kohlmeier R.E. McCoy V.A. Napier D.H. Hubbard L.G. Halff G.A. Esterl R.M. Cigarroa F.G. Sharkey F.E. Radiofrequency tissue ablation effect of hepatic blood flow occlusion on thermal injuries produced in cirrhotic livers.Ann Surg Oncol. 2003; 10: 773-777Crossref PubMed Scopus (24) Google Scholar Patient selection is based on tumor number, size, and location. At our institution, patients are considered for RF ablation if they have fewer than 5 tumors, each less than 5 cm in diameter, and no evidence of extrahepatic tumor. We have treated patients with larger and/or more numerous tumors under extraordinary circumstances. The ideal size of a nodule for ablation is less than 3 cm in maximum dimension, and the ideal location is deep in the liver parenchyma. Nodules adjacent to the diaphragm, gallbladder, major bile ducts, and especially bowel structures should be approached with caution. In the latter case, bowel perforation can result, and therefore special interventional techniques may be needed to separate bowel from liver. Contraindications to treatment include excessive tumor burden and evidence of extrahepatic tumor. RF ablation is also contraindicated in most patients with Child class C cirrhosis (ie, hyperbilirubinemia, hypoalbuminemia, poorly controlled ascites, and severe encephalopathy). Finally, coagulation parameters, including platelet count, international normalized ratio, and partial thromboplastin times, should be corrected before ablation. RF ablation of hepatic tumors can be performed percutaneously, laparoscopically, or via laparotomy, and by using various imaging guidance techniques, including sonography, computerized tomography (CT), or magnetic resonance imaging (MRI). The choice of approach, image guidance technique, and RF ablation device is dictated most commonly by the training of the physician performing the procedure and local institutional practice standards. Each approach offers potential advantages over the others. However, to date, there is no proof that these potential advantages translate into altered patient survival. The percutaneous approach can be used when patients have fewer than 5 tumors; each measuring <5 cm; all visible by sonography, CT scan, or MRI; with a safe route of access. An intraoperative approach (by laparoscopy or laparotomy) may be needed in patients with tumors measuring >5 cm, tumors not adequately visualized by imaging, tumors that are inaccessible percutaneously, and tumors directly adjacent to bowel. Contrary to some claims, tumors adjacent to the gallbladder and the diaphragm can be treated percutaneously with careful technique and the correct equipment.5Chopra S. Dodd 3rd, G.D. Chanin M.P. Chintapalli K.N. Radiofrequency ablation of hepatic tumors adjacent to the gallbladder feasibility and safety.AJR Am J Roentgenol. 2003; 180: 697-701Crossref PubMed Scopus (92) Google Scholar, 6Head H.W. Chopra S. Kurian B. Hubbard L.G. Dodd G.D. Radiofrequency ablation of hepatic lesions against the dome of the diaphragm. 2004Google Scholar Laparoscopy and laparotomy both have three potential advantages over percutaneous RF ablation: (1) the ability to stage the tumor by direct visual inspection of the peritoneal cavity; (2) the ability to use intraoperative sonography to detect additional tumors not seen by other imaging techniques; and (3) the ability to perform a Pringle maneuver (temporary occlusion of the portal vein and hepatic artery) to increase the size of the ablation zone. Laparoscopy is less invasive than laparotomy, but restricts access to the liver and positioning of the sonography and RF ablation probes. Laparotomy affords the greatest exposure and the ability to combine RF ablation with hepatic resection.7Tanabe K.K. Curley S.A. Dodd G.D. Siperstein A.E. Goldberg S.N. Radiofrequency ablation the experts weigh in.Cancer. 2004; 100: 641-650Crossref PubMed Scopus (64) Google Scholar Regardless of approach, with current energy deposition algorithms, a single ablation takes from 8 to 25 minutes and increases the temperature of the ablated tissue to between 50°C and 100°C. Several imaging techniques are available for guidance during RF ablation. Many practitioners worldwide use ultrasound to guide probe placement and monitor the procedure. Under ultrasound, RF ablation produces a roughly spherical transient hyperechoic zone that extends perpendicular to the exposed electrode tip or tines (Figure 2). This hyperechoic reaction is caused by the production of microbubbles as water in the heated tissue vaporizes. The hyperechoic zone has been shown to correspond roughly to the actual zone of gross tissue necrosis.8Leyendecker J.R. Dodd 3rd, G.D. Halff G.A. McCoy V.A. Napier D.H. Hubbard L.G. Chintapalli K.N. Chopra S. Washburn W.K. Esterl R.M. Cigarroa F.G. Kohlmeier R.E. Sharkey F.E. Sonographically observed echogenic response during intraoperative radiofrequency ablation of cirrhotic livers pathologic correlation.AJR Am J Roentgenol. 2002; 178: 1147-1151Crossref PubMed Scopus (96) Google Scholar Because current equipment reliably produces ablations of about 3 cm surrounding the needle tip, tumors larger than 3 cm in greatest dimension necessitate multiple overlapping ablations to be completely destroyed.9Montgomery R.S. Rahal A. Dodd 3rd, G.D. Leyendecker J.R. Hubbard L.G. Radiofrequency ablation of hepatic tumors variability of lesion size using a single ablation device.AJR Am J Roentgenol. 2004; 182: 657-661Crossref PubMed Scopus (76) Google Scholar, 10Dodd 3rd, G.D. Frank M.S. Aribandi M. Chopra S. Chintapalli K.N. Radiofrequency thermal ablation computer analysis of the size of the thermal injury created by overlapping ablations.AJR Am J Roentgenol. 2001; 177: 777-782Crossref PubMed Scopus (308) Google Scholar Unfortunately, the hyperechoic reaction produced by multiple ablations can obscure the margins of a tumor and thus limit the efficacy of sonographic guidance. At some centers, CT and MR guidance are preferred over sonography. Both techniques yield better depiction of the final extent of the ablation zone. MR guidance is the only imaging technique that allows real-time monitoring of tissue temperatures. Nonetheless, both CT and MR guidance add considerable expense to the procedure that is unwarranted when treating most small tumors. The results of multiple clinical series of RF ablation for liver tumors have confirmed the effectiveness of the technique (Figures 3A–B).11Rossi S. Buscarini E. Garbagnati F. Di Stasi M. Quaretti P. Rago M. Zangrandi A. Andreola S. Silverman D. Buscarini L. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.AJR Am J Roentgenol. 1998; 170: 1015-1022Crossref PubMed Scopus (570) Google Scholar, 12Curley S.A. Izzo F. Delrio P. Ellis L.M. Granchi J. Vallone P. Fiore F. Pignata S. Daniele B. Cremona F. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies results in 123 patients.Ann Surg. 1999; 230: 1-8Crossref PubMed Scopus (1017) Google Scholar, 13Livraghi T. Goldberg S.N. Lazzaroni S. Meloni F. Solbiati L. Gazelle G.S. Small hepatocellular carcinoma treatment with radio-frequency ablation versus ethanol injection.Radiology. 1999; 210: 655-661Crossref PubMed Scopus (1180) Google Scholar, 14Livraghi T. Goldberg S.N. Lazzaroni S. Meloni F. Ierace T. Solbiati L. Gazelle G.S. Hepatocellular carcinoma radio-frequency ablation of medium and large lesions.Radiology. 2000; 214: 761-768Crossref PubMed Scopus (953) Google Scholar, 15Shirato K. Morimoto M. Tomita N. Kokawa A. Sugimori K. Saito T. Numata K. Sekihara H. Tanaka K. Small hepatocellular carcinoma therapeutic effectiveness of percutaneous radio frequency ablation therapy with a LeVeen needle electrode.J Ultrasound Med. 2002; 21: 67-76PubMed Google Scholar, 16Lencioni R.A. Allgaier H.P. Cioni D. Olschewski M. Deibert P. Crocetti L. Frings H. Laubenberger J. Zuber I. Blum H.E. Bartolozzi C. Small hepatocellular carcinoma in cirrhosis randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection.Radiology. 2003; 228: 235-240Crossref PubMed Scopus (860) Google Scholar Moreover, the technique has proven more effective for HCC than for hepatic metastases.11Rossi S. Buscarini E. Garbagnati F. Di Stasi M. Quaretti P. Rago M. Zangrandi A. Andreola S. Silverman D. Buscarini L. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.AJR Am J Roentgenol. 1998; 170: 1015-1022Crossref PubMed Scopus (570) Google Scholar In general, a very high rate of complete ablation of hepatic tumors is achievable (as high as 98% in 1 series).12Curley S.A. Izzo F. Delrio P. Ellis L.M. Granchi J. Vallone P. Fiore F. Pignata S. Daniele B. Cremona F. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies results in 123 patients.Ann Surg. 1999; 230: 1-8Crossref PubMed Scopus (1017) Google Scholar However, because the ability to achieve complete ablation is closely related to tumor size, better results have been reported with smaller tumors. As tumor size exceeds 3 cm, the rate of complete ablation decreases to as low as 47.6%.14Livraghi T. Goldberg S.N. Lazzaroni S. Meloni F. Ierace T. Solbiati L. Gazelle G.S. Hepatocellular carcinoma radio-frequency ablation of medium and large lesions.Radiology. 2000; 214: 761-768Crossref PubMed Scopus (953) Google Scholar Fortunately, many intrahepatic recurrences can be managed with repeat ablation. Despite these encouraging results regarding complete tumor ablation, there are little data concerning long-term survival outcomes after RF ablation for HCC. In 1 recent study, 52 patients with HCC treated with RF had overall 1- and 2-year local recurrence-free survival rates of 98% and 96%, respectively.16Lencioni R.A. Allgaier H.P. Cioni D. Olschewski M. Deibert P. Crocetti L. Frings H. Laubenberger J. Zuber I. Blum H.E. Bartolozzi C. Small hepatocellular carcinoma in cirrhosis randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection.Radiology. 2003; 228: 235-240Crossref PubMed Scopus (860) Google Scholar The need to collect good outcome data, to the end of evaluating the true efficacy of RF ablation, is clearly a crucial area for research over the next few years. The most common side effect of RF ablation in the liver is pain, although this is typically of short duration. There is also a well-recognized postablation syndrome, characterized by low-grade fever and general malaise, lasting less than 3 weeks.17Dodd lll, G.D. Napier D. Schoolfield J.D. Hubbard R.N. Percutaneous radiofrequency ablation of hepatic tumors Post-ablation syndrome.AJR Am J Roentgenol. 2004; (in press)Google Scholar Major complications, ie, those that if untreated might lead to death, significant morbidity, and disability, or to a lengthened hospital stay, are rare with RF ablation. Minor complications, such as minor skin burn from the dispersive electrode, do not significantly alter management. One review of 400 ablation procedures in 512 patients revealed major complications in 6% of cases and minor complications in 36%.18Rhim H. Dodd 3rd, G.D. Chintapalli K.N. Wood B.J. Dupuy D.E. Hvizda J.L. Sewell P.E. Goldberg S.N. Radiofrequency thermal ablation of abdominal tumors lessons learned from complications.Radiographics. 2004; 24: 41-52Crossref PubMed Scopus (239) Google Scholar Reported major complications have consisted of peritoneal hemorrhage, neoplastic seeding, intrahepatic abscesses, adjacent organ thermal damage including intestinal perforation, and pneumothorax. Procedure-related death is very rare. In a recent multicenter study in which 2320 patients with 3554 liver tumors were treated with percutaneous RF ablation, 6 deaths (0.3%) were noted.19Livraghi T. Solbiati L. Meloni M.F. Gazelle G.S. Halpern E.F. Goldberg S.N. Treatment of focal liver tumors with percutaneous radio-frequency ablation complications encountered in a multicenter study.Radiology. 2003; 226: 441-451Crossref PubMed Scopus (1127) Google Scholar Two of these resulted from multiorgan failure after intestinal perforation, 1 from septic shock after Staphylococcus aureus peritonitis, 1 from massive hemorrhage after tumor rupture, 1 from liver failure after stenosis of the right bile duct, as well as one case of sudden death of unknown cause 3 days postprocedure. The most extensive experience with microwave ablation for HCC has been in Japan and China. Percutaneous microwave ablation was first used as an adjunct to liver biopsy and was subsequently adapted for hepatic tumor ablation. It is now used clinically in Japan and China and is undergoing trials in the United States. Microwaves emitted around a bipolar antenna needle tip induce an alternating electric field that causes vibration and rotation of water molecules in surrounding tissue, resulting in thermal coagulation. Two main types of microwave delivery systems have been used for microwave ablation. The first type are the systems in clinical use in Japan and China (Microtaze, Nippon Shoji, Osaka, Japan; and UMC-I, Institute 207 of the Aerospace Industry Company and PLA General Hospital, Beijing, China), which consist of microwave generators that emit a 2450-MHz microwave, and a 16-gauge microwave antenna (Figure 4). A 14-gauge cannula is introduced percutaneously with imaging guidance. Through the outer guiding needle, the antenna is introduced into the nodule, and thermal ablation is performed with a single treatment of 60–75-W output for 60–300 seconds. To coagulate a large area for nodules more than 2.0 cm in diameter, 2–3 guide needles are introduced in an arrangement to facilitate optimal coagulation of the entire tumor volume. An antenna is inserted through each outer guiding needle, and multiple treatments are performed in a single session. Unlike with RF ablation, no retractable prongs or needle tip cooling are used, and the resulting ablation tends to be more elliptical. For this reason, the expected diameter of ablation is less than it is with RF ablation and measures slightly less than 2 cm. Therefore, more sessions may be needed to treat larger tumors. However, the treatment sessions may be shorter than with RF ablation because an ablation is produced in a much shorter time with these systems. The second type of system is an FDA-approved device being used in clinical trials in the United States (VivaWave; Vivant Medical, Mountain View, CA). Its generator emits a 915-MHz microwave and uses a single unified 13-gauge needle-antenna for percutaneous use, with an exposed active dipole element of 3.7 cm at the tip (Figure 5). With this device, the antenna is inserted directly into the nodule, and thermal ablation is performed with a single treatment of 40-W output for 10 minutes. Studies suggest that the straight-needle antenna creates an ablation diameter comparable to or slightly smaller than that of RF ablation devices.20Mahvi D.M. Microwave ablation of colorectal liver metastases. 2003Google Scholar The same company also has designed another applicator consisting of a central straight-needle cannula that is used to deploy a loop-shaped antenna from the tip into the adjacent tissue (Figure 6). The loop has been shown to produce ablation zones averaging approximately 3.5 cm in minimum diameter in porcine liver, which constitutes an improvement over the straight applicator.21Shock S.A. Meredith K. Warner T.F. Sampson L.A. Wright A.S. Winter 3rd, T.C. Mahvi D.M. Fine J.P. Lee Jr, F.T. Microwave ablation with loop antenna in vivo porcine liver model.Radiology. 2004; 231: 143-149Crossref PubMed Scopus (119) Google Scholar Under ultrasound, all microwave ablation applicators produce a transient hyperechoic zone around the needle, similar to that observed with RF ablation.Figure 6A prototype single-loop microwave antenna. The probe (arrow) is inserted in tissue, and the loop (arrowhead) is deployed while electrocautery energy is applied to cut through tissue.View Large Image Figure ViewerDownload (PPT) Despite the differences in technology, the indications, contraindications, and patient selection criteria for microwave ablation are similar to those presented for RF ablation.1Dodd 3rd, G.D. Soulen M.C. Kane R.A. Livraghi T. Lees W.R. Yamashita Y. Gillams A.R. Karahan O.I. Rhim H. Minimally invasive treatment of malignant hepatic tumors at the threshold of a major breakthrough.Radiographics. 2000; 20: 9-27Crossref PubMed Scopus (541) Google Scholar Like RF ablation, microwave ablation can be performed by percutaneous means, laparoscopy, or laparotomy. As with RF ablation, the approach for microwave ablation usually is dictated by the training of the physician performing the procedure. Also, the criteria regarding the approach mentioned above in the RF ablation section (ie, laparoscopy or laparotomy for tumors measuring >5 cm, tumors not adequately visualized, and tumors directly adjacent to bowel) will likely apply to microwave ablation, because microwave ablation zones are on the same order of size as those created by RF. The number of trials evaluating treatment of HCC with microwave ablation is not as large as with RF ablation. However, in the past few years, an increasing number of groups from the Far East have reported results of microwave ablation studies.22Horigome H. Nomura T. Saso K. Itoh M. Standards for selecting percutaneous ethanol injection therapy or percutaneous microwave coagulation therapy for solitary small hepatocellular carcinoma consideration of local recurrence.Am J Gastroenterol. 1999; 94: 1914-1917Crossref PubMed Scopus (55) Google Scholar, 23Shibata T. Iimuro Y. Yamamoto Y. Maetani Y. Ametani F. Itoh K. Konishi J. Small hepatocellular carcinoma comparison of radio-frequency ablation and percutaneous microwave coagulation therapy.Radiology. 2002; 223: 331-337Crossref PubMed Scopus (461) Google Scholar, 24Xu H.X. Xie X.Y. Lu M.D. Chen J.W. Yin X.Y. Xu Z.F. Liu G.J. Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation.Clin Radiol. 2004; 59: 53-61Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar In general, these studies have come to similar conclusions as the RF ablation studies. In particular, they show a greater effectiveness in treating small tumors. Xu et al. analyzed rates of complete tumor ablation in 112 HCC nodules treated with percutaneous microwave ablation.24Xu H.X. Xie X.Y. Lu M.D. Chen J.W. Yin X.Y. Xu Z.F. Liu G.J. Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation.Clin Radiol. 2004; 59: 53-61Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar The overall complete ablation rate was 92.6%. However, the complete ablation rate was significantly lower and the rate of local tumor progression was significantly higher in tumors ≥4.0 cm. Two recent studies of percutaneous microwave ablation for HCC have shown encouraging rates of complete tumor ablation, as well as positive outcome data. Dong et al. attained 89% complete ablation in 259 HCC nodules.25Dong B. Liang P. Yu X. Su L. Yu D. Cheng Z. Zhang J. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma results in 234 patients.AJR Am J Roentgenol. 2003; 180: 1547-1555Crossref PubMed Scopus (217) Google Scholar Posttreatment biopsies revealed no viable tumor in 180 of 192 nodules (92.8%). Six tumors were resected, and complete tumor necrosis was seen in 5. The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 92.70%, 81.60%, 72.85%, 66.37%, and 56.70%, respectively. Lu et al. treated 107 nodules, with more than half of the tumor nodules measuring larger than 2 cm in diameter.26Lu M.D. Chen J.W. Xie X.Y. Liu L. Huang X.Q. Liang L.J. Huang J.F. Hepatocellular carcinoma US-guided percutaneous microwave coagulation therapy.Radiology. 2001; 221: 167-172Crossref PubMed Scopus (167) Google Scholar After follow-up of at least 9 months, local tumor progression was found in only 1 nodule < 2 cm and 5 nodules > 2 cm. Disease-free survival rates at 1 and 2 years were 55% and 41%, respectively, and overall survival rates at 1, 2, and 3 years were 96%, 83%, and 73%, respectively. Reported complications of microwave ablation are similar to those reported for RF ablation and are typically mild. Two large series reported only local pain, low-grade fever, liver enzyme elevation, pleural effusion, contained subcapsular bleeding, and minor skin burns.25Dong B. Liang P. Yu X. Su L. Yu D. Cheng Z. Zhang J. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma results in 234 patients.AJR Am J Roentgenol. 2003; 180: 1547-1555Crossref PubMed Scopus (217) Google Scholar, 26Lu M.D. Chen J.W. Xie X.Y. Liu L. Huang X.Q. Liang L.J. Huang J.F. Hepatocellular carcinoma US-guided percutaneous microwave coagulation therapy.Radiology. 2001; 221: 167-172Crossref PubMed Scopus (167) Google Scholar More serious complications are rare. Two major complications, both hepatic abscesses, and 1 fatality caused by liver failure within 30 days of the procedure were reported in another study.24Xu H.X. Xie X.Y. Lu M.D. Chen J.W. Yin X.Y. Xu Z.F. Liu G.J. Ultrasound-guided p" @default.
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• W2019958865 title "Thermal ablation for hepatocellular carcinoma" @default.
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