title: [Ablative techniques and the clinical utility of ablation as first-line treatment in the initial phase of hepatocellular cancer].
abstract: The objective of screening programs is to diagnose the disease in the initial asymptomatic stages, preferably when the lesions have not exceeded 2 cm in size. In this disease stage, potentially curative treatments can be applied with excellent long-term survival. Percutaneous ablation (preferentially radiofrequency) has shown a considerable capacity for inducing complete necrosis in these small lesions, with a minimal rate of adverse effects and a lower financial cost than hepatic resection. For these reasons, in recent years it has been suggested that percutaneous ablation could constitute the first therapeutic option in patients with hepatocarcinoma in very early stages. In this study, we conducted a review of the scientific evidence that supports the use of percutaneous ablation in this scenario. Although there are no clinical trials specifically designed to evaluate the better therapeutic option (ablation vs. resection) in the initial stages, numerous cohort studies, a metaanalysis and a cost-effectiveness study using a Markov model suggest that ablation could constitute the first therapeutic option in early stages of hepatocellular carcinoma, reserving resection for those cases in which ablation fails or is not feasible.
authors.affiliation: Unidad de Oncología Hepática, Servicio de Hepatología, Hospital Clínic, Barcelona, ICMDM, IDIBAPS, Universidad de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBEREHD). Electronic address: aforner@clinic.ub.es.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Forner
mesh_terms: D055011:Ablation Techniques; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging
keywords: BCLC; Estadio muy inicial; Hepatocarcinoma; Radiofrecuencia; Radiofrequency; Resección quirúrgica; Surgical resection; Very early stage