• HEPATOCELLULAR CARCINOMA
• MICROWAVE ABLATION
• NETWORK META-ANALYSIS
• PERCUTANEOUS ETHANOL INJECTION
• RADIOFREQUENCY ABLATION
• SYSTEMATIC REVIEW

• Humans
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Ethanol/therapeutic use
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Network Meta-Analysis
• Prospective Studies
• Randomized Controlled Trials as Topic
• Ablation Techniques

• clinical outcomes
• hepatocellular carcinoma
• microwave ablation
• progression

• Key Research and Development Project of Gansu Province, China

• feasibility
• interventional oncology
• radiofrequency ablation

Recently, Stereotactic Body Radiotherapy (SBRT) has been suggested for managing hepatocellular carcinoma (HCC) curatively. Thus, we conducted this clinical study to evaluate retrospectively the effect of individualized audio-visual (AV) coaching, respiratory modulated SBRT.

Between 2014 and 2018, 29 patients with inoperable Barcelona Clinic Liver Cancer (BCLC) stage 0-B HCC received AV coaching, respiratory-modulated SBRT. We constructed a task-oriented multidisciplinary team to establish a standard operation process of respiratory modulation procedures and developed our AV coaching devices. In the training period, a goodness-of-fit test was applied individually. SBRT was delivered with a total dose of 40–54 Gy in 5–6 fractions individually. Freedom from local progression (FFLP) and overall survival (OS) were estimated using SPSS (version 17, SPSS Inc., Chicago, IL, USA) life tables.

The patient characteristics were as follows: 32.7 ± 16 mm in maximum tumor diameter (range 11–94); BCLC stage 0: 3.4%, BCLC A: 48.3%, BCLC B: 48.3%; Child-Pugh classification A: 86.2%, Child-Pugh classification B: 13.8%, and a median of 2 prior liver-directed treatments (range 0–7). One-, 2-, and 3-year rates of FFLP of SBRT were 96.6%, 96.6%, and 96.6%, respectively. One-, 2-, and 3-year rates of OS were 81.5%, 72.4%, and 67.2%, respectively. No adverse event (AE) occurred in 41.4% of patients, 48.3% developed grade (G) 1–2 AE, 10.3% had G3 AE and none had G4-5 AE.

Respiration-modulated SBRT is a promising noninvasive treatment option for patients with inoperable and localized HCC. Our data show that SBRT provides comparable tumor control to historical curative options like surgery and radiofrequency ablation of localized tumors. Thus, we are conducting a further prospective clinical trial with the intent to demarcate the clinical effectiveness of SBRT in a larger population of patients with HCC.

• Hepatocellular carcinoma
• Stereotactic ablative radiotherapy
• Stereotactic body radiation therapy

As an emerging minimally invasive treatment method, percutaneous ablation is more and more widely used in the treatment of liver tumors. It has been recommended by guidelines for diagnosis and treatment of hepatocellular carcinoma (HCC) as a curative treatment alongside surgical resection and liver transplantation. In recent years, with the continuous advancement and innovation of percutaneous ablation technologies, their clinical efficacy and safety have been significantly improved, which has led to the expanded application of percutaneous ablation in the treatment of HCC—more and more patients who were previously considered unsuitable for ablation therapies are now being treated with percutaneous ablation. Obviously, percutaneous ablation can reduce the risk of treatment changes from curative strategies to palliative strategies. Based on clinical practice experience, this review enumerates the advantages and disadvantages of different ablative modalities and summarizes the existing combinations of ablation techniques, thus will help clinicians choose the most appropriate ablative modality for each patient and will provide scientific guidance for improving prognosis and making evidence-based treatment decisions. In addition, we point out the challenges and future prospects of the ablation therapies, thereby providing direction for future research.

• assistive technology
• hepatocellular carcinoma
• image guidance
• percutaneous ablation

• combination therapy
• cryoablation
• hepatocellular carcinoma
• microwave ablation
• transcatheter arterial chemoembolization

• Complication
• Heat-sink effect
• Hepatocellular carcinoma
• Microwave ablation

We aimed to assess local tumor progression (LTP) rate and associated prognostic factors in 92 patients who underwent radiofrequency ablation (RFA) using saline-perfused electrodes to treat hepatocellular carcinoma (HCC) (≤ 5 cm).

Total 92 patients with 148 HCCs were treated with RFA using salineperfused electrodes, from 2009 to 2015. We retrospectively evaluated technical success, technique efficacy, and LTP rates. Potential prognostic factors for LTP were perivascular tumor, subphrenic tumor, artificial ascites, tumor size (≥ 2 cm), and previous treatment of transarterial chemoembolization. Analysis was performed by lesion, rather than by person.

During follow-up period from 1 to 97.4 months, total cumulative LTP rates were 7.9%, 11.4%, and 14.6% at 1, 3, and 5 years, respectively. These values were significantly higher in the perivascular (35.1%; p = 0.009) and subphrenic group (38.9%; p = 0.002) at 5-year. We did not observe any significant difference in LTP according to other prognostic factors (p > 0.05).

RFA with saline-perfused electrode is a safe and effective treatment modality for HCC (≤ 5 cm), with lower LTP rates. Nevertheless, perivascular and subphrenic HCCs demonstrated higher LTP rate than other sites. It is imperative to note that perivascular and subphrenic location of HCC are associated with a high risk of local recurrence, despite the use of salineperfused electrodes.

The increasing set of liver-directed therapies (LDT) have become an integral part of hepatocellular carcinoma (HCC) treatment. These range from percutaneous ablative techniques to arterial embolization, and varied radiotherapy strategies. They are now used for local disease control, symptom palliation, and bold curative strategies. The big challenge in the face of these innovative and sometimes overlapping technologies is to identify the best opportunity of use. In real practice, many patients may take benefit from LDT used as a bridge to curative treatment such as resection and liver transplantation. Varying trans-arterial embolization strategies are used, and comparison between established and developing technologies is scarce. Also, radioembolization utilizing yttrium-90 (Y-90) for locally advanced or intermediate-stage HCC needs further evidence of clinical efficacy. There is increasing interest on LDT-led changes in tumor biology that could have implications in systemic therapy efficacy. Foremost, additional to its apoptotic and necrotic properties, LDT could warrant changes in vascular endothelial growth factor (VEGF) expression and release. However, trans-arterial chemoembolization (TACE) used alongside tyrosine-kinase inhibitor (TKI) sorafenib has had its efficacy contested. Most recently, interest in associating Y-90 and TKI has emerged. Furthermore, LDT-led differences in tumor immune microenvironment and immune cell infiltration could be an opportunity to enhance immunotherapy efficacy for HCC patients. Early attempts to coordinate LDT and immunotherapy are being made. We here review LDT techniques exposing current evidence to understand its extant reach and future applications alongside systemic therapy development for HCC.

• HCC
• RFA
• TACE
• VEGF
• Yttrium-90
• combination
• hepatocellular carcinoma
• immunotherapy
• liver-directed therapy
• radiation

Percutaneous ablation has quickly arisen as one of the important alternative treatments for hepatocellular carcinoma (HCC). We aimed to compare the therapeutic effects of radiofrequency ablation (RFA) and other ablative techniques on HCCs.

Databases were searched to identify literature on complete tumor ablation (CTA), overall survival (OS), local tumor recurrence (LTR), and complications of RFA in the treatment of HCC, compared with those of microwave ablation (MWA), percutaneous ethanol injection (PEI), PEI plus RFA, cryoablation (CRA), laser ablation (LSA), and high-intensity focused ultrasound. Randomized controlled trials and high-quality cohort studies were included in the assessment.

The effects of MWA and CRA appeared to be similar to those of RFA, but lower rates of LTR and higher rates of CTA in large tumors compared with RFA were reported (P < 0.05). CTA rates were lower in patients treated with PEI (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.06–0.42), and higher in those treated with PEI plus RFA (OR 2.28, 95% CI 1.19–3.60), with an increased incidence of fever (P < 0.05). LSA resulted in lower CTA rates (OR 0.32, 95% CI 0.13–0.81) and OS (hazard ratio 1.47, 95% CI 1.01–2.15), with a lower incidence of complications.

Compared with RFA, identical effects were found in MWA and CRA groups. Fewer complications were observed in PEI and LSA group. PEI plus RFA appeared more effective, with a higher rate of complications. Well-designed randomized controlled trials are further needed to confirm above results.

• Ablative techniques
• Hepatocellular carcinoma
• Radiofrequency ablation
• Therapeutic effects

• Acetic Acid/therapeutic use
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation/mortality
• Cause of Death
• Chemoembolization, Therapeutic/methods
• Chemoembolization, Therapeutic/mortality
• Ethanol/therapeutic use
• Humans
• Laser Therapy/adverse effects
• Laser Therapy/mortality
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Microwaves/therapeutic use
• Network Meta-Analysis
• Odds Ratio
• Postoperative Complications/epidemiology
• Randomized Controlled Trials as Topic
• Tumor Burden

• 10/4001/11 Department of Health
• 13/89/03 Department of Health

The aim of this study is to compare radiofrequency ablation (RFA) with stereotactic body radiotherapy (SBRT) for hepatocellular carcinomas (HCC) smaller than 3 cm. A Markov cohort model was developed to simulate a cohort of patients aged 60–65 years with small HCCs who had undergone either RFA or SBRT and were followed up over their remaining life expectancy. The inclusion criteria were: (1) HCC ≤3 cm in diameter with ≤ 3 nodules; (2) absence of extrahepatic metastasis or portal/hepatic vein invasion; (3) Child‐Pugh Class A or B. Twenty thousand virtual patients were randomly assigned to undergo RFA or SBRT. Predicted life expectancy was 6.452 and 6.371 years in the RFA and SBRT groups, respectively. The probability distributions of the expected overall survival were nearly identical. The 95% confidence intervals were 6.25–6.66 and 6.17–6.58 years for RFA and SBRT, respectively. The difference between RFA and SBRT was insignificant (P = 0.2884). Two‐way sensitivity analysis demonstrated that if the tumor is 2–3 cm, SBRT is the preferred treatment option. Our Markov model has shown that expected overall survival of SBRT is nearly identical to RFA in HCCs smaller than 3 cm, but SBRT may have an advantage for tumors 2 cm and larger. A randomized trial is required to confirm these findings.

• Hepatocellular carcinoma
• Markov
• radiofrequency ablation
• stereotactic

• bipolar radiofrequency ablation
• hepatic tumor
• multi-needle insertion

• Hepatocellular carcinomas
• Meta-analysis
• Radiofrequency ablation
• Transcatheter arterial chemoembolization

• HCC
• RFA
• TACE
• ablation
• chemoembolization

• Liver tumors
• liver metastases
• percutaneous ablation
• systematic review

• Humans
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation
• Chemoembolization, Therapeutic
• Clinical Trials as Topic
• Combined Modality Therapy
• Liver Neoplasms/mortality
• Liver Neoplasms/therapy
• Survival Rate
• Treatment Outcome

Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). The most used treatments include transarterial chemoembolization and radiofrequency ablation. Surgical resection has also been successfully used as a bridging procedure, and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function. The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation, reducing HCC recurrence after transplantation, and improving post-transplant overall survival. To date, no data from prospective randomized studies are available; however, for HCC patients listed for LT within the Milan criteria, prolonging the waiting time over 6-12 mo is a risk factor for tumor spread. Bridging treatments are useful in containing tumor progression and decreasing dropout. Furthermore, the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT. Lastly, although a definitive conclusion can not be reached, the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival. Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT. Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.

• Hepatocellular carcinoma
• Bridging treatment
• Downstaging
• Liver cirrhosis
• Liver transplantation
• Liver resection
• Waiting list
• Waiting time
• Dropout rate

• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Liver Transplantation/adverse effects
• Liver Transplantation/mortality
• Neoadjuvant Therapy/adverse effects
• Neoadjuvant Therapy/mortality
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Patient Dropouts
• Risk Factors
• Time Factors
• Treatment Outcome
• Waiting Lists/mortality

• Combination therapy
• Hepatectomy
• Hepatocellular carcinoma
• Radiofrequency ablation
• Transcatheter arterial chemoembolization

• Complete ablation
• Hepatocellular carcinoma
• Local ablation
• Local recurrence
• Radiofrequency ablation

• Aged
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Catheter Ablation/adverse effects
• Catheter Ablation/instrumentation
• Disease Progression
• Electrodes
• Equipment Design
• Female
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Retrospective Studies
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Tumor Burden

• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation/methods
• Chemoembolization, Therapeutic/methods
• Disease Progression
• Female
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Statistics, Nonparametric
• Survival Rate
• Treatment Outcome

• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/surgery
• Catheter Ablation/adverse effects
• Catheter Ablation/methods
• Contrast Media
• Disease Progression
• Electrodes
• Female
• Humans
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Postoperative Complications
• Tomography, X-Ray Computed
• Treatment Outcome

• Catheter Ablation/methods
• Colorectal Neoplasms/radiotherapy
• Disease-Free Survival
• Follow-Up Studies
• Humans
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/secondary
• Tumor Burden

To prospectively evaluate the safety and short-term therapeutic efficacy of switching monopolar radiofrequency ablation (RFA) with multiple electrodes to treat medium-sized (3.1-5.0 cm), hepatocellular carcinomas (HCC).

In this prospective study, 30 patients with single medium-sized HCCs (mean, 3.5 cm; range, 3.1-4.4 cm) were enrolled. The patients were treated under ultrasonographic guidance by percutaneous switching monopolar RFA with a multichannel RF generator and two or three internally cooled electrodes. Contrast-enhanced CT scans were obtained immediately after RFA, and the diameters and volume of the ablation zones were then measured. Follow-up CT scans were performed at the first month after ablation and every three months thereafter. Technical effectiveness, local progression and remote recurrence of HCCs were determined.

There were no major immediate or periprocedural complications. However, there was one bile duct stricture during the follow-up period. Technical effectiveness was achieved in 29 of 30 patients (97%). The total ablation time of the procedures was 25.4 ± 8.9 minutes. The mean ablation volume was 73.8 ± 56.4 cm³ and the minimum diameter was 4.1 ± 7.3 cm. During the follow-up period (mean, 12.5 months), local tumor progression occurred in three of 29 patients (10%) with technical effectiveness, while new HCCs were detected in six of 29 patients (21%).

Switching monopolar RFA with multiple electrodes in order to achieve a sufficient ablation volume is safe and efficient. This method also showed relatively successful therapeutic effectiveness on short-term follow up for the treatment of medium-sized HCCs.

• Interventional procedures
• Liver
• Preliminary clinical study
• Radiofrequency ablation

• Adult
• Aged
• Bile Duct Neoplasms/pathology
• Catheter Ablation
• Cholangiocarcinoma/secondary
• Cholangiocarcinoma/surgery
• Contrast Media
• Disease Progression
• Female
• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Postoperative Complications
• Retrospective Studies
• Statistics, Nonparametric
• Survival Rate