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Radiofrequency (RF) ablation was recently introduced as a novel ablation modality for hepatocellular carcinoma (HCC). Several investigators have reported that percutaneous RF ablation for patients with small HCC nodules provide favorable survival with excellent local control. However, several limitations of RFA have been pointed out, such as limited coagulated necrosis and relatively frequent local recurrences in large HCC. The critical factors for treatment success in large tumors included (a) the target diameter of an ablation- or of overlapping ablations - must be larger than the diameter of the tumor that undergoes treatment; (b) reduce the negative effect of blood flow and tissue perfusion on RF heating. To overcome RF limitations, researchers developed several techniques and skills of percutaneous treatments and several studies have demonstrated that multiple RF ablation processes with overlapping of ablation zones or combination therapies are feasible for large liver tumors. In this review, we analyzed varies of treatment strategies for percutaneous RF of large tumors and summarized the efficacy of clinical application.

Treatment strategy and efficacy of imaging-guided radiofrequency ablation in large hepatocellular carcinoma