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Bale et al. Hepatoma Res 2023;9:44 Hepatoma Research
DOI: 10.20517/2394-5079.2023.71

Review Open Access

Treatment of intrahepatic cholangiocarcinoma:

evidence for the role of percutaneous ablation

Reto Bale 1 , Timothy M. Pawlik 2
1
Department of Radiology, Interventional Oncology - Stereotaxy and Robotics, Medical University Innsbruck, Innsbruck 6020,
Austria.
2
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Correspondence to: Dr. Reto Bale, Department of Radiology, Interventional Oncology - Stereotaxy and Robotics, Medical
University Innsbruck, Anichstraße 35, Innsbruck 6020, Austria. E-mail: reto.bale@i-med.ac.at

How to cite this article: Bale R, Pawlik TM. Treatment of intrahepatic cholangiocarcinoma: evidence for the role of percutaneous
ablation. Hepatoma Res 2023;9:44. https://dx.doi.org/10.20517/2394-5079.2023.71
Received: 23 Jun 2023 First Decision: 4 Aug 2023 Revised: 14 Aug 2023 Accepted: 18 Oct 2023 Published: 24 Oct 2023

Academic Editors: Salvatore Gruttadauria, Feng Shen Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a rare cancer with generally poor prognosis. In this narrative review, we
examine the role of thermal ablation and summarize the current literature. Radiofrequency ablation (RFA) and
microwave ablation (MWA) are both safe and well-tolerated as a minimally invasive local curative treatment
option for patients suffering from primary and secondary liver tumors. Both methods can be used in patients with
medical morbidities that would preclude surgery, as well as individuals with anatomical or functional constraints
that impede liver resection. In unresectable iCCA, the median OS after conventional percutaneous US- or CT-
guided RFA and MWA is between 20 and 39 months and 10 and 28 months, respectively. In recurrent iCCA,
percutaneous RFA and MWA achieved a median OS of 21-27 months and 21-31 months, respectively. These data
are comparable to long-term outcomes after surgical resection (SR), with the number of nodules and tumor size
affecting prognosis. Stereotactic radiofrequency ablation (SRFA) allows for effective treatment of large and
multiple iCCA nodules within one session and achieves short- and long-term results in inoperable patients
compared with resection. With the addition of SRFA as an alternative treatment option, the proportion of patients
who can be treated with curative treatment has significantly increased. In the absence of prospective trials
comparing thermal ablation and surgical resection, we recommend a patient-specific decision-making process.
Future research to identify technical and clinical prognostic criteria, as well as molecular markers of tumor biology,
may help select patients for ablation and subsequent outcomes.

Keywords: Cholangiocellular carcinoma, ablation, radiofrequency ablation, stereotaxy, image fusion, microwave
ablation, SRFA, SMWA

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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