Radiofrequency Ablation for the Local Treatment of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the 3 leading cause of cancer-related death worldwide, and the incidence of HCC is rising in the United States. Patients with cirrhosis of the liver and viral hepatitis are at the highest risk of developing HCC. Radiofrequency ablation has become an accepted first-line treatment for small HCC because of its similar outcomes when compared with surgical resection. However, local recurrence after radiofrequency ablation remains problematic and requires vigilant post-ablation surveillance imaging. Prior to radiofrequency ablation, the physician must take in to account tumor size and location as well as ability to obtain real-time imaging for a percutaneous approach, which is preferred. The procedure requires collaboration with an experienced interventional radiologist in order to obtain the best outcomes and minimize complications. Additionally, radiofrequency ablation can be used in combination with other treatment modalities, such as transarterial chemoembolization, to provide an adequate ablation bed for large tumors. Overall, the utilization of radiofrequency ablation should be part of the armamentarium of all physicians managing patients with HCC. This article reviews appropriate patient and tumor selection, advanced treatment techniques, complications, follow up, and post-treatment outcomes of radiofrequency ablation of HCC.