Abstract
Percutaneous ablation is a curative treatment indicated in very early and early hepatocellular
carcinoma (HCC). Procedural success remains disappointing in lesions ≥3.0 cm and located
in subcapsular and perivascular areas. To overcome these limitations, combination
treatments have been proposed. The combination of ablation and transarterial chemoembolization
(TACE) is widely adopted in clinical practice and may improve survival, particularly
in patients with single nodules 3 to 5 cm in size. However, technical issues and clinical
indications are still debated. Radiofrequency ablation (RFA) may also be combined
with percutaneous ethanol injection to improve local tumor control; limited data show
safety and efficacy of this option. The combination of ablation and systemic treatments
is still debated. Intravenous injection of thermosensitive liposomal doxorubicin in
association with prolonged RFA is under investigation in patients with single lesions < 7
cm. While there is no indication for the use of systemic drugs (specifically sorafenib)
in the adjuvant setting, the observation that RFA is able to activate inflammatory
reactions has raised interest in the possibility of combining RFA with the new immuno-oncology
drugs, for local and distant tumor control. Thus ablation would no longer be reserved
only to early HCC but could be exploited also in more advanced stages.
Keywords
percutaneous ablation - transarterial chemoembolization - sorafenib - ethanol injection
- combined treatments
