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Di Costanzo et al. Hepatoma Res 2018;4:53 Hepatoma Research
DOI: 10.20517/2394-5079.2018.56

Review Open Access

Thermal ablation of large unresectable
hepatocellular carcinoma in cirrhotic patients

Giovan Giuseppe Di Costanzo, Raffaella Tortora, Anna Opramolla, Marco Guarracino
Transplantation Department, Liver Unit, A Cardarelli Hospital, Naples 80131, Italy.

Correspondence to: Dr. Giovan Giuseppe Di Costanzo, Transplantation Department, Liver Unit, A Cardarelli Hospital, Via A. Cardarelli 9,
Naples 80131, Italy. E-mail: ggdicostanzo@libero.it

How to cite this article: Di Costanzo GG, Tortora R, Opramolla A, Guarracino M. Thermal ablation of large unresectable hepatocellular
carcinoma in cirrhotic patients. Hepatoma Res 2018;4:53. http://dx.doi.org/10.20517/2394-5079.2018.56

Received: 11 May 2018 First Decision: 19 Jun 2018 Revised: Jul 10 2018 Accepted: Jul 10 2018 Published: 17 Sep 2018
Science Editors: Guang-Wen Cao Copy Editor: Huan-Liang Wu Production Editor: Zhong-Yu Guo

Abstract
Hepatocellular carcinoma (HCC) is one of the most common and lethal malignancies worldwide. Surgery is
the mainstay of treatment, but less than 20%-30% of patients are good candidates. Actually, thermal ablation
is considered the best treatment with curative intent for cirrhotic patients with unresectable HCC ≤ 3 cm.
Unfortunately, radio frequency efficacy in obtaining the complete ablation of HCC nodules diminishes with
increasing tumor size and local tumor progression is more frequent in larger nodules. To overcome these problems,
higher-powered generators, different devices and techniques have been attempted. Furthermore, microwave
ablation has been introduced with the promise of a large ablative capacity. The aim of this review is to describe the
role of thermal ablation for the treatment of large unresectable HCC.

Keywords: Hepatocellular carcinoma, hypertermic ablation, radiofrequency, microwave ablation

INTRODUCTION
Hepatocellular carcinoma (HCC) is one of the most common and lethal malignancies worldwide. Surgery
is the mainstay of treatment, but less than 20%-30% of patients are good candidates mainly due to cancer
[1]
multifocality, position of nodules, liver insufficiency, and severe portal hypertension . When feasible,
resection ensures better local control of cancer and longer disease-free survival, but it carries a higher rate
[2,3]
of complication as compared to local ablation . In early 1990’s, thermal ablation with radiofrequency
(RFA) has been introduced for the treatment of HCC. This technique has become increasingly popular
and a large amount of studies have been published confirming its efficacy. Actually, thermal ablation is
[4-8]
considered the best treatment with curative intent for cirrhotic patients with unresectable HCC ≤ 3 cm .

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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