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Page 12 of 17 Li et al. Hepatoma Res. 2025;11:25 https://dx.doi.org/10.20517/2394-5079.2025.63

To address these challenges, current research efforts are increasingly focused on multidimensional and
multimodal comprehensive interventions. Foremost, achieving complete ablation under precise imaging
guidance remains the cornerstone of successful treatment. Advanced imaging modalities - including CEUS,
CTHA, PET/CT, and emerging intraoperative OI techniques - hold promise for improving the accuracy of
ablation margin delineation and enabling real-time monitoring [12,18,43] . Furthermore, postoperative adjuvant
therapies, particularly combinations involving interventional, molecular targeted, and immunotherapeutic
approaches, have demonstrated potential in delaying tumor recurrence [38,67] .

Based on these considerations, we propose an integrated management framework and decision algorithm
for HCC thermal ablation [Figure 3]. This framework begins with preoperative risk stratification and
multidisciplinary team (MDT) evaluation to identify high-risk features - including large or irregular tumors
and those adjacent to critical structures - enabling consideration of alternative approaches such as surgical
resection or combined TACE-ablation. The intraoperative phase emphasizes real-time imaging guidance
with continuous assessment of the ablation zone and safety margins, incorporating technical adjustments
such as multi-point ablation when needed, and allowing for immediate salvage ablation if margins appear
insufficient [12,43,44] . Postoperative management is guided by one-month definitive imaging assessment.
Patients are stratified according to clinical and pathological findings. For patients with confirmed
macroscopic residual lesions in anatomically suitable locations and no distant metastases, local treatment
options such as repeat ablation, TACE, or radiotherapy should be prioritized. For patients without
macroscopic residual disease but exhibiting high-risk features (e.g., MVI, multiple tumors, or large tumor
size), local regional therapies such as TACE may be considered to reduce the risk of early recurrence [52-54] .
Concurrently, immunotherapy and/or targeted therapy serve as viable adjunctive strategies, demonstrating
favorable recurrence control in multiple studies. Patients exhibiting tumor “inflamed” characteristics may
derive greater benefit from immunotherapy [62,63,66] . Furthermore, novel therapies including nanomedicine
and CIK cell therapy remain exploratory and should only be administered within rigorously designed
clinical trials [14,16,68] . For patients achieving complete remission without high-risk features, standardized
follow-up protocols are recommended, encompassing regular imaging studies and serological assessments.

Looking forward, advancements in HCC thermal ablation will inevitably depend on the deep integration of
imaging-guided precision ablation and mechanism-driven combination therapies. The convergence of
multidisciplinary approaches and innovative technologies is anticipated to overcome current therapeutic
limitations, facilitating the development of personalized and precision medicine strategies that significantly
improve long-term patient outcomes.