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Editorial

Radiofrequency, microwave, and laser ablation of liver tumors:
Radiofrequency, microwave, and laser ablation of liver tumors:
time to move toward a tailored ablation technique?
time to move toward a tailored ablation technique?

Paola Tombesi, Francesca Di Vece, Sergio Sartori
Department of Medical, Section of Interventional Ultrasound, St. Anna Hospital, 44100 Ferrara, Italy

Address for correspondence:
Dr. Sergio Sartori, Department of Medical, Section of Interventional Ultrasound, St. Anna Hospital, Via A. Moro, 44100 Ferrara, Italy.
E-mail: srs@unife.it
Received: 03-02-2015, Accepted: 06-04-2015

INTRODUCTION Thermal ablation techniques include either heating
ablation [RFA, microwave ablation (MWA), laser thermal
Primary and secondary hepatic tumors are quite common ablation (LTA), and high-intensity focused ultrasound] or
and constitute a significant source of mortality. Primary freezing ablation (cryoablation). This paper will deal with the
liver cancer is the fifth most common cancer worldwide “hot” ablation techniques, focusing on RFA, MWA, and LTA.
and the third most common cause of cancer mortality, RFA is the most used technique worldwide, and its efficacy
and secondary involvement of the liver, particularly from has been largely proven over the last 20 years. However, a lot
colorectal carcinoma, is even more common. [1,2] of clinical studies suggest that MWA and LTA are as effective
as RFA, and the choice of the thermal ablation modality is
Although surgical resection remains the gold standard for usually determined by the experience and preference of the
eligible patients with hepatocellular carcinoma (HCC) or interventional oncologists and radiologists, as well as by the
liver metastases (LM), and liver transplantation is considered availability of the different devices in the single centers. [13-16]
the standard therapy for selected patients with HCC, in the RFA, MWA, and LTA share some main technical aspects. In
last years the role of ablation therapies in the treatment of brief, all of them rely on controlled thermal energy delivery
primary and secondary liver tumors continued to increase, aimed at raising the tissue temperature between 60 °C and
as they have widely been proven to be effective and safe. [3-10] 100 °C to determine coagulative necrosis of tumor lesions, [17,18]
They play a key role in the treatment of patients who are not as well as the placement of a needle (RFA electrode, MWA
eligible, poor candidates for surgery, or who refuse surgery antenna, or LTA fiber through a fine needle) into the target
and are increasingly used as a bridge to liver transplantation lesion. On the other hand, each thermal technique shows
in patients with HCC. In addition, some recent studies peculiar advantages and limitations that could make each
suggested that radiofrequency ablation (RFA) is as effective of them more suitable than the other ones to treat patients
as surgical resection in the treatment of very early HCC. [11,12] and tumors with different characteristics.
Depending on tumor size and number, thermal ablation can
be chosen as the only treatment, combined with systemic Therefore, the opening question of this paper is the following:
therapies, surgery, or other regional treatments, in order to is it time to move toward a tailored approach to thermal
utilize a multimodality approach to the patient aimed at the ablation?
best treatment result.
RADIOFREQUENCY ABLATION
Access this article online
Quick Response Code
Website: RFA is based on alternating current of RF waves. The
http://www.hrjournal.net/ alternating current transmitted via an insulated electrode tip
inserted into the tissue generates ionic agitation and frictional
heats that extend into adjacent tissue by conduction. When
DOI:
10.4103/2394-5079.155697 temperature > 60 °C is achieved, the tissue heating results
in coagulative necrosis of the tumor.

52 Hepatoma Research | Volume 1 | Issue 2 | July 15, 2015