Koza Asanda, Bhogal Ricky H, Fotiadis Nicos, Mavroeidis Vasileios K
Department of Interventional Radiology, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK.
Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK.
Biomedicines. 2023 Mar 31;11(4):1062. doi: 10.3390/biomedicines11041062.
The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.
肝细胞癌（HCC）的管理仍然复杂，并且将继续依赖肝病学家、外科医生、放射科医生、肿瘤学家和放疗师的多学科协作。通过对患者进行适当的分期并选择合适的治疗方法，HCC的治疗效果正在改善。包括肝切除和原位肝移植（OLT）在内的外科治疗是具有明确治愈意图的选择。然而，患者的适用性以及器官的可获得性构成了重要限制。因此，非手术选择，如消融技术，发挥着越来越重要的作用，尤其是在小肝癌中，其总体生存率和无病生存率可与手术切除相媲美。在公认的分类系统中，消融技术在全球范围内得到推荐，显示出越来越有前景的结果。最近的技术改进以及机器人辅助的新兴应用，可能会扩展治疗模式以实现更好的肿瘤学效果。目前，在极早期和早期不可切除的疾病中，经皮热消融被认为是首选治疗方法。由于其不同的特点，包括射频消融、微波消融、冷冻消融和不可逆电穿孔在内的各种消融技术已显示出不同的比较优势和适用性。我们在此回顾现有消融技术在当前HCC复杂多学科管理中的作用，主要关注适应证和治疗效果，并讨论未来前景。
