Ablative strategies for recurrent hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the fifth leading cause of cancer death worldwide and the third leading cause of all diseases worldwide. Liver transplantation, surgical resection and ablation are the three main curative treatments for HCC. Liver transplantation is the optimal treatment option for HCC, but its usage is limited by the shortage of liver sources. Surgical resection is considered the first choice for early-stage HCC, but it does not apply to patients with poor liver function. Therefore, more and more doctors choose ablation for HCC. However, intrahepatic recurrence occurs in up to 70% patients within 5 years after initial treatment. For patients with oligo recurrence after primary treatment, repeated resection and local ablation are both alternative. Only 20% patients with recurrent HCC (rHCC) indicate repeated surgical resection because of limitations in liver function, tumor location and intraperitoneal adhesions. Local ablation has become an option for the waiting period when liver transplantation is unavailable. For patients with intrahepatic recurrence after liver transplantation, local ablation can reduce the tumor burden and prepare them for liver transplantation. This review systematically describes the various ablation treatments for rHCC, including radiofrequency ablation, microwave ablation, laser ablation, high-intensity focused ultrasound ablation, cryablation, irreversible electroporation, percutaneous ethanol injection, and the combination of ablation and other treatment modalities.

Keywords: Hepatocellular carcinoma; Recurrence; Ablative therapy; Thermal ablation

Core Tip: Despite the tremendous efforts in the fight against hepatocellular carcinoma, there is still no way to prevent its recurrence. Intrahepatic recurrence can be treated by repeated resection and ablation, and there are many studies showing the advantages and disadvantages of each treatment method. For tumors ≤ 3 cm in diameter, there is no significant difference between surgery resection and radiofrequency/microwave ablation treatment. Non-thermal ablation treatment has clearer borders but a higher postoperative recurrence rate. Percutaneous ethanol injection has comparable efficacy to radiofrequency ablation for small tumors. Multiple recurrences require combined systemic therapy.