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Naeem et al. Hepatoma Res 2018;4:18 Hepatoma Research
DOI: 10.20517/2394-5079.2018.22

Review Open Access

Ablative techniques in hepatocellular carcinoma
treatment

Ehsun Naeem, Shahab Abid

Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan.
Correspondence to: Prof. Shahab Abid, Section of Gastroenterology, Department of Medicine, Aga Khan University, Stadium
Road P.O Box 3500, Karachi 74800, Pakistan. E-mail: shahab.abid@aku.edu

How to cite this article: Naeem E, Abid S. Ablative techniques in hepatocellular carcinoma treatment. Hepatoma Res 2018;4:18.
http://dx.doi.org/10.20517/2394-5079.2018.22

Received: 17 Mar 2018 First Decision: 22 Mar 2018 Revised: 8 May 2018 Accepted: 17 May 2018 Published: 13 Jun 2018
Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Hepatocellular carcinoma has been known to arise commonly in the setting of chronic liver disease. Due to its association
with cirrhosis, patients with hepatocellular carcinoma often present with markedly diminished hepatic functional reserve,
making them poor surgical candidates. For such patients, image-guided percutaneous ablative modalities have provided
a viable alternate curative therapy. Although treatment allocation is a decision based on a number of factors, patients
eligible for percutaneous ablation generally include those with early stage disease, hepatocellular carcinoma with disease
limited to the liver and no extra-hepatic metastases. While percutaneous ethanol injection is the seminal technique,
newer developments have led to it being replaced by percutaneous radiofrequency ablation as the most commonly
employed procedure, due to a better efficacy as well as safety profile. Other ablative modalities including microwave
ablation, laser ablation and cryotherapy are not as widely available. Furthermore, data comparing their effectiveness with
well-established procedures like radiofrequency ablation is limited.

Keywords: Barcelona Clinic liver Cancer staging, chronic liver disease, hepatocellular carcinoma, Milan Criteria,
percutaneous ethanol injection, radiofrequency ablation, surgical resection

INTRODUCTION
The past two decades have seen percutaneous ablation emerge as an exciting new therapeutic approach for
the treatment of hepatic malignancies worldwide. While surgery is still regarded as the mainstay of therapy
for hepatocellular carcinoma (HCC), high tumor burden and reduced hepatic functional reserve, as often
encountered in such patients, precludes surgical resection in a significant proportion of patients . For such
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