Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future.
OBJECTIVE
To review and compare treatment result for percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of small hepatocellular carcinoma (HCC).


BACKGROUND
PLAT is indicated for small unresectable HCC localized to the liver. From the use of ethanol to the latest technology of radiofrequency ablation, ablative techniques have been refined and their role in the management of HCC established. This review aims to give an overview of various ablative methods, including their efficacy, indications, and limitations, and also tries to look into the future of clinical trials in PLAT.


METHODS
The authors reviewed recent papers in the English medical literature about the use of local ablative therapy for HCC. Focus was given to the results of treatment in terms of local control, progression-free survival, and overall survival, and to compare treatment results with those of surgery.


RESULTS
PLAT for small HCC (<5 cm) with thermal ablation (radiofrequency ablation or microwave coagulation) can achieve effective local control of disease and is superior to ethanol injection. Progressive disease in untreated areas is a common reason for failure. Overall progression-free survival is similar to that of surgical resection.


CONCLUSIONS
Thermal ablation gives good local control of small HCC, is superior to ethanol, and may be comparable to surgical resection in long-term outcome.
Lau
W Y
WY
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. josephlau@cuhk.edu.hk
Leung
Thomas W T
TW
Yu
Simon C H
SC
Ho
Stephen K W
SK
D019342:Acetic Acid / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods* / Q000639:trends; D000075202:Contraindications; D003452:Cryosurgery / Q000379:methods; D000431:Ethanol / Q000008:administration & dosage; D006498:Hepatectomy; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods* / Q000639:trends; D017075:Laser Coagulation; D008113:Liver Neoplasms / Q000628:therapy*; D008863:Microspheres; D008872:Microwaves; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
D000970:Antineoplastic Agents; D015021:Yttrium Radioisotopes; D000431:Ethanol; D019342:Acetic Acid