Objective: To review and compare treatment result for percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of small hepatocellular carcinoma (HCC).
Summary Background Data: 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.
Hepatocellular carcinoma (HCC) is a common disease worldwide. It has been estimated that 315,000 new cases of HCC were diagnosed in 1985, accounting for 4.1% of all human cancer cases in the world. 1 About 70% and 12% of all cases were found in Asia and Africa, respectively. 1 Recent evidence has shown that the incidence and mortality rate of HCC are rising in North America and Europe. 2,3 The prognosis of HCC is generally poor. Partial hepatectomy remains the best hope for a cure but is suitable for only 9% to 27% of patients. 4,5 The presence of significant background cirrhosis often precludes liver resection in patients with HCC. Recurrence of tumor within the liver remnant is also common in patients who have undergone curative liver resection. Further resection is often not possible for recurrent tumor because of limited liver reserve. In these situations and if the tumor is relatively small (<5 cm), few in number (three or fewer), and confined to the liver, local ablation of the tumor using minimally invasive techniques is a recognized form of treatment. Local ablative therapy has the advantages of preserving the uninvolved liver parenchyma, has no systemic side effects compared to systemic or intra-arterial chemotherapy, and also avoids the morbidity and mortality of major hepatic surgery.