Semin intervent Radiol 2014; 31(02): 129-137
DOI: 10.1055/s-0034-1373788
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Percutaneous Ablation Technologies in the Treatment of Malignant Liver Tumors

Hyeon Yu
1   Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Charles T. Burke
1   Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2014 (online)

Abstract

Tumor ablation is a minimally invasive technique used to deliver chemical, thermal, electrical, or ultrasonic damage to a specific focal tumor in an attempt to achieve substantial tumor destruction or complete eradication. As the technology continues to advance, several image-guided tumor ablations have emerged to effectively manage primary and secondary malignancies in the liver. Percutaneous chemical ablation is one of the oldest and most established techniques for treating small hepatocellular carcinomas. However, this technique has been largely replaced by newer modalities including radiofrequency ablation, microwave ablation, laser-induced interstitial thermotherapy, cryoablation, high-intensity–focused ultrasound ablation, and irreversible electroporation. Because there exist significant differences in underlying technological bases, understanding each mechanism of action is essential for achieving desirable outcomes. In this article, the authors review the current state of each ablation method including technological and clinical considerations.

 
  • References

  • 1 Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev 2007; 33 (5) 437-447
  • 2 Clark TW, Soulen MC. Chemical ablation of hepatocellular carcinoma. J Vasc Interv Radiol 2002; 13 (9, Pt 2) S245-S252
  • 3 Shiina S, Tagawa K, Niwa Y , et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR Am J Roentgenol 1993; 160 (5) 1023-1028
  • 4 Lencioni R, Bartolozzi C, Caramella D , et al. Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients. Cancer 1995; 76 (10) 1737-1746
  • 5 Livraghi T, Giorgio A, Marin G , et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology 1995; 197 (1) 101-108
  • 6 Da Ines D, Buc E, Petitcolin V , et al. Massive hepatic necrosis with gastric, splenic, and pancreatic infarctions after ethanol ablation for hepatocellular carcinoma. J Vasc Interv Radiol 2010; 21 (8) 1301-1305
  • 7 Hasegawa S, Yamasaki N, Hiwaki T , et al. Factors that predict intrahepatic recurrence of hepatocellular carcinoma in 81 patients initially treated by percutaneous ethanol injection. Cancer 1999; 86 (9) 1682-1690
  • 8 McWilliams JP, Yamamoto S, Raman SS , et al. Percutaneous ablation of hepatocellular carcinoma: current status. J Vasc Interv Radiol 2010; 21 (8, Suppl): S204-S213
  • 9 Shiina S, Teratani T, Obi S , et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 2005; 129 (1) 122-130
  • 10 Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology 2004; 127 (6) 1714-1723
  • 11 Lencioni RA, Allgaier HP, Cioni D , et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003; 228 (1) 235-240
  • 12 Cho YK, Kim JK, Kim MY, Rhim H, Han JK. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology 2009; 49 (2) 453-459
  • 13 Orlando A, Leandro G, Olivo M, Andriulli A, Cottone M. Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials. Am J Gastroenterol 2009; 104 (2) 514-524
  • 14 Shiina S, Tagawa K, Unuma T , et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study. Cancer 1991; 68 (7) 1524-1530
  • 15 Swabb EA, Wei J, Gullino PM. Diffusion and convection in normal and neoplastic tissues. Cancer Res 1974; 34 (10) 2814-2822
  • 16 Ohnishi K, Ohyama N, Ito S, Fujiwara K. Small hepatocellular carcinoma: treatment with US-guided intratumoral injection of acetic acid. Radiology 1994; 193 (3) 747-752
  • 17 Ohnishi K, Nomura F, Ito S, Fujiwara K. Prognosis of small hepatocellular carcinoma (less than 3 cm) after percutaneous acetic acid injection: study of 91 cases. Hepatology 1996; 23 (5) 994-1002
  • 18 Ohnishi K, Yoshioka H, Ito S, Fujiwara K. Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma. Hepatology 1998; 27 (1) 67-72
  • 19 Tamai T, Seki T, Imamura M , et al. Percutaneous injection of a low-concentration alkaline solution targeting hepatocellular carcinoma. Oncol Rep 2000; 7 (4) 719-723
  • 20 Farnam JL, Smith BC, Johnson BR , et al. Thermochemical ablation in an ex-vivo porcine liver model using acetic acid and sodium hydroxide: proof of concept. J Vasc Interv Radiol 2010; 21 (10) 1573-1578
  • 21 Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality—clinical implications. Technol Cancer Res Treat 2007; 6 (1) 37-48
  • 22 Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng 2005; 33 (2) 223-231
  • 23 Miller L, Leor J, Rubinsky B. Cancer cells ablation with irreversible electroporation. Technol Cancer Res Treat 2005; 4 (6) 699-705
  • 24 Edd JF, Horowitz L, Davalos RV, Mir LM, Rubinsky B. In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Trans Biomed Eng 2006; 53 (7) 1409-1415
  • 25 Melikov KC, Frolov VA, Shcherbakov A, Samsonov AV, Chizmadzhev YA, Chernomordik LV. Voltage-induced nonconductive pre-pores and metastable single pores in unmodified planar lipid bilayer. Biophys J 2001; 80 (4) 1829-1836
  • 26 Lee EW, Chen C, Prieto VE, Dry SM, Loh CT, Kee ST. Advanced hepatic ablation technique for creating complete cell death: irreversible electroporation. Radiology 2010; 255 (2) 426-433
  • 27 Thomson KR, Cheung W, Ellis SJ , et al. Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol 2011; 22 (5) 611-621
  • 28 Narayanan G, Hosein PJ, Arora G , et al. Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma. J Vasc Interv Radiol 2012; 23 (12) 1613-1621
  • 29 Kingham TP, Karkar AM, D'Angelica MI , et al. Ablation of perivascular hepatic malignant tumors with irreversible electroporation. J Am Coll Surg 2012; 215 (3) 379-387
  • 30 Silk MT, Wimmer T, Lee KS , et al. Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Interv Radiol 2014; 25 (1) 112-118
  • 31 Cannon R, Ellis S, Hayes D, Narayanan G, Martin II RC. Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol 2013; 107 (5) 544-549
  • 32 Ng KK, Poon RT, Chan SC , et al. High-intensity focused ultrasound for hepatocellular carcinoma: a single-center experience. Ann Surg 2011; 253 (5) 981-987
  • 33 Wu F, Wang ZB, Chen WZ , et al. Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview. Ultrason Sonochem 2004; 11 (3-4) 149-154
  • 34 Lynn JG, Zwemer RL, Chick AJ, Miller AE. A new method for the generation and use of focused ultrasound in experimental biology. J Gen Physiol 1942; 26 (2) 179-193
  • 35 Shen HP, Gong JP, Zuo GQ. Role of high-intensity focused ultrasound in treatment of hepatocellular carcinoma. Am Surg 2011; 77 (11) 1496-1501
  • 36 Mearini L, Porena M. Transrectal high-intensity focused ultrasound for the treatment of prostate cancer: past, present, and future. Indian J Urol 2010; 26 (1) 4-11
  • 37 Kennedy JE, Ter Haar GR, Cranston D. High intensity focused ultrasound: surgery of the future?. Br J Radiol 2003; 76 (909) 590-599
  • 38 Zhu J, Zhu H, Mei Z , et al. High-intensity focused ultrasound ablation for treatment of hepatocellular carcinoma and hypersplenism: preliminary study. J Ultrasound Med 2013; 32 (10) 1855-1862
  • 39 Hesley GK, Gorny KR, Woodrum DA. MR-guided focused ultrasound for the treatment of uterine fibroids. Cardiovasc Intervent Radiol 2013; 36 (1) 5-13
  • 40 Mearini L. High intensity focused ultrasound, liver disease and bridging therapy. World J Gastroenterol 2013; 19 (43) 7494-7499
  • 41 Xu G, Luo G, He L , et al. Follow-up of high-intensity focused ultrasound treatment for patients with hepatocellular carcinoma. Ultrasound Med Biol 2011; 37 (12) 1993-1999
  • 42 Zhang L, Zhu H, Jin C , et al. High-intensity focused ultrasound (HIFU): effective and safe therapy for hepatocellular carcinoma adjacent to major hepatic veins. Eur Radiol 2009; 19 (2) 437-445
  • 43 Cheung TT, Fan ST, Chu FS , et al. Survival analysis of high-intensity focused ultrasound ablation in patients with small hepatocellular carcinoma. HPB (Oxford) 2013; 15 (8) 567-573
  • 44 Pacella CM, Bizzarri G, Cecconi P , et al. Hepatocellular carcinoma: long-term results of combined treatment with laser thermal ablation and transcatheter arterial chemoembolization. Radiology 2001; 219 (3) 669-678
  • 45 Wu F, Wang ZB, Chen WZ , et al. Advanced hepatocellular carcinoma: treatment with high-intensity focused ultrasound ablation combined with transcatheter arterial embolization. Radiology 2005; 235 (2) 659-667
  • 46 Jin C, Zhu H, Wang Z , et al. High-intensity focused ultrasound combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: long-term follow-up and clinical analysis. Eur J Radiol 2011; 80 (3) 662-669
  • 47 Vaezy S, Martin R, Keilman G , et al. Control of splenic bleeding by using high intensity ultrasound. J Trauma 1999; 47 (3) 521-525
  • 48 Noble ML, Vaezy S, Keshavarzi A , et al. Spleen hemostasis using high-intensity ultrasound: survival and healing. J Trauma 2002; 53 (6) 1115-1120
  • 49 Shi B, Zhu H, Liu YJ , et al. Experimental studies and clinical experiences on treatment of secondary hypersplenism with extracorporeal high-intensity focused ultrasound. Ultrasound Med Biol 2012; 38 (11) 1911-1917
  • 50 Pacella CM, Francica G, Di Costanzo GG. Laser ablation for small hepatocellular carcinoma. Radiol Res Pract 2011; 2011: 595627
  • 51 Masters A, Bown SG. Interstitial laser hyperthermia in tumour therapy. Ann Chir Gynaecol 1990; 79 (4) 244-251
  • 52 Thomsen S. Pathologic analysis of photothermal and photomechanical effects of laser-tissue interactions. Photochem Photobiol 1991; 53 (6) 825-835
  • 53 Jacques SL. Laser-tissue interactions. Photochemical, photothermal, and photomechanical. Surg Clin North Am 1992; 72 (3) 531-558
  • 54 Di Costanzo GG, D'Adamo G, Tortora R , et al. A novel needle guide system to perform percutaneous laser ablation of liver tumors using the multifiber technique. Acta Radiol 2013; 54 (8) 876-881
  • 55 Bown SG. Phototherapy in tumors. World J Surg 1983; 7 (6) 700-709
  • 56 Wyman DR, Whelan WM, Wilson BC. Interstitial laser photocoagulation: Nd:YAG 1064.  nm optical fiber source compared to point heat source. Lasers Surg Med 1992; 12 (6) 659-664
  • 57 Germer CT, Roggan A, Ritz JP , et al. Optical properties of native and coagulated human liver tissue and liver metastases in the near infrared range. Lasers Surg Med 1998; 23 (4) 194-203
  • 58 Ritz JP, Roggan A, Germer CT, Isbert C, Müller G, Buhr HJ. Continuous changes in the optical properties of liver tissue during laser-induced interstitial thermotherapy. Lasers Surg Med 2001; 28 (4) 307-312
  • 59 Tranberg KG. Percutaneous ablation of liver tumours. Best Pract Res Clin Gastroenterol 2004; 18 (1) 125-145
  • 60 Pacella CM, Bizzarri G, Francica G , et al. Percutaneous laser ablation in the treatment of hepatocellular carcinoma with small tumors: analysis of factors affecting the achievement of tumor necrosis. J Vasc Interv Radiol 2005; 16 (11) 1447-1457
  • 61 Arienti V, Pretolani S, Pacella CM , et al. Complications of laser ablation for hepatocellular carcinoma: a multicenter study. Radiology 2008; 246 (3) 947-955
  • 62 Puls R, Langner S, Rosenberg C , et al. Laser ablation of liver metastases from colorectal cancer with MR thermometry: 5-year survival. J Vasc Interv Radiol 2009; 20 (2) 225-234
  • 63 Orlacchio A, Bolacchi F, Chegai F , et al. Comparative evaluation of percutaneous laser and radiofrequency ablation in patients with HCC smaller than 4 cm. Radiol Med (Torino) 2013;
  • 64 Zou X, Liu Q, Zhou X , et al. Ultrasound-guided percutaneous laser and ethanol ablation of rabbit VX2 liver tumors. Acta Radiol 2013; 54 (2) 181-187
  • 65 Chen MS, Li JQ, Zheng Y , et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006; 243 (3) 321-328
  • 66 McGahan JP, Browning PD, Brock JM, Tesluk H. Hepatic ablation using radiofrequency electrocautery. Invest Radiol 1990; 25 (3) 267-270
  • 67 Buscarini E, Savoia A, Brambilla G , et al. Radiofrequency thermal ablation of liver tumors. Eur Radiol 2005; 15 (5) 884-894
  • 68 Brace CL. Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences?. Curr Probl Diagn Radiol 2009; 38 (3) 135-143
  • 69 Nicoli N, Casaril A, Marchiori L , et al. Intraoperative and percutaneous radiofrequency thermal ablation in the treatment of hepatocellular carcinoma. Chir Ital 2000; 52 (1) 29-40
  • 70 Grasso A, Watkinson AF, Tibballs JM, Burroughs AK. Radiofrequency ablation in the treatment of hepatocellular carcinoma—a clinical viewpoint. J Hepatol 2000; 33 (4) 667-672
  • 71 Dong B, Liang P, Yu X , et al. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: results in 234 patients. AJR Am J Roentgenol 2003; 180 (6) 1547-1555
  • 72 Lu MD, Xu HX, Xie XY , et al. Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a restrospective comparative study. J Gastroenterol 2005; 40 (11) 1054-1060
  • 73 Shibata T, Iimuro Y, Yamamoto Y , et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 2002; 223 (2) 331-337
  • 74 Poggi G, Montagna B, DI Cesare P , et al. Microwave ablation of hepatocellular carcinoma using a new percutaneous device: preliminary results. Anticancer Res 2013; 33 (3) 1221-1227
  • 75 Shibata T, Niinobu T, Ogata N, Takami M. Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer 2000; 89 (2) 276-284
  • 76 Tanaka K, Shimada H, Nagano Y, Endo I, Sekido H, Togo S. Outcome after hepatic resection versus combined resection and microwave ablation for multiple bilobar colorectal metastases to the liver. Surgery 2006; 139 (2) 263-273
  • 77 Cammà C, Di Marco V, Orlando A , et al; Unità Interdipartimentale Neoplasie Epatiche (U.I.N.E) Group. Treatment of hepatocellular carcinoma in compensated cirrhosis with radio-frequency thermal ablation (RFTA): a prospective study. J Hepatol 2005; 42 (4) 535-540
  • 78 Lencioni R, Cioni D, Crocetti L , et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 2005; 234 (3) 961-967
  • 79 Tateishi R, Shiina S, Teratani T , et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer 2005; 103 (6) 1201-1209
  • 80 Guglielmi A, Ruzzenente A, Sandri M , et al. Radio frequency ablation for hepatocellular carcinoma in cirrhotic patients: prognostic factors for survival. J Gastrointest Surg 2007; 11 (2) 143-149
  • 81 Guglielmi A, Ruzzenente A, Battocchia A, Tonon A, Fracastoro G, Cordiano C. Radiofrequency ablation of hepatocellular carcinoma in cirrhotic patients. Hepatogastroenterology 2003; 50 (50) 480-484
  • 82 Seror O, N'Kontchou G, Ibraheem M , et al. Large (>or=5.0-cm) HCCs: multipolar RF ablation with three internally cooled bipolar electrodes—initial experience in 26 patients. Radiology 2008; 248 (1) 288-296
  • 83 Kuang M, Lu MD, Xie XY , et al. Liver cancer: increased microwave delivery to ablation zone with cooled-shaft antenna—experimental and clinical studies. Radiology 2007; 242 (3) 914-924
  • 84 Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2011; 98 (9) 1210-1224
  • 85 Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 2005; 54 (8) 1151-1156
  • 86 O'Rourke AP, Haemmerich D, Prakash P, Converse MC, Mahvi DM, Webster JG. Current status of liver tumor ablation devices. Expert Rev Med Devices 2007; 4 (4) 523-537
  • 87 Erinjeri JP, Clark TW. Cryoablation: mechanism of action and devices. J Vasc Interv Radiol 2010; 21 (8, Suppl): S187-S191
  • 88 Bryant G. DSC measurement of cell suspensions during successive freezing runs: implications for the mechanisms of intracellular ice formation. Cryobiology 1995; 32 (2) 114-128
  • 89 Baust JG, Gage AA. The molecular basis of cryosurgery. BJU Int 2005; 95 (9) 1187-1191
  • 90 Finelli A, Rewcastle JC, Jewett MA. Cryotherapy and radiofrequency ablation: pathophysiologic basis and laboratory studies. Curr Opin Urol 2003; 13 (3) 187-191
  • 91 Weber SM, Lee Jr FT, Chinn DO, Warner T, Chosy SG, Mahvi DM. Perivascular and intralesional tissue necrosis after hepatic cryoablation: results in a porcine model. Surgery 1997; 122 (4) 742-747
  • 92 Sheen AJ, Poston GJ, Sherlock DJ. Cryotherapeutic ablation of liver tumours. Br J Surg 2002; 89 (11) 1396-1401
  • 93 Xu KC, Niu LZ, Zhou Q , et al. Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma. World J Gastroenterol 2009; 15 (29) 3664-3669
  • 94 Adam R, Hagopian EJ, Linhares M , et al. A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies. Arch Surg 2002; 137 (12) 1332-1339 , discussion 1340
  • 95 Pearson AS, Izzo F, Fleming RY , et al. Intraoperative radiofrequency ablation or cryoablation for hepatic maligancies. Am J Surg 1999; 178 (6) 592-599
  • 96 Seifert JK, Morris DL. World survey on the complications of hepatic and prostate cryotherapy. World J Surg 1999; 23 (2) 109-113 , discussion 113–114
  • 97 Sheen AJ, Siriwardena AK. The end of cryotherapy for the treatment of nonresectable hepatic tumors?. Ann Surg Oncol 2005; 12 (3) 202-204