When is percutaneous radiofrequency ablation (RFA) indicated for the treatment of liver tumors?

Updated: Mar 30, 2021
  • Author: Badar Bin Bilal Shafi, MBBS, MRCP, FRCR, CCT, EBIR; Chief Editor: Kurt E Roberts, MD  more...
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Answer

In the treatment of HCC, the range of indications for percutaneous RFA is becoming wider than that of surgery and intra-arterial therapies, and it includes the following main categories [7, 3] :

  • HCC at an early stage [17, 18]
  • Primary treatment for small tumors [19, 20]  - A meta-analysis by Jansen et al described local ablative techniques as the treatment of choice for small HCC [21] ; the National Institute for Clinical Excellence (NICE) in the United Kingdom also recommended RFA as the treatment of choice in small tumors [22]
  • Inoperable primary liver tumor
  • Treatment of patients who cannot undergo general anesthesia or are not operative candidates because of comorbidity or advanced age
  • Liver metastasis, most commonly colorectal, especially if the patient is not an operative candidate [23]
  • Can be used for breast, [24] thyroid, [25] and neuroendocrine metastasis [26]
  • Treatment of patients who have a hepatoma or multiple small lesions and are waiting for liver transplantation [6]
  • Recurrent and progressive lesions [27]  - RFA has been used in conjunction with PEI as an alternative to repeat hepatectomy in elderly patients with recurrent HCC after initial hepatic surgery [28]

RFA may be a satisfactory alternative to resection for HCC 3 cm or smaller in Child-Pugh class A or B cirrhosis, and it may be a first-line treatment in HCC 2 cm or smaller in Child-Pugh class A or B cirrhosis. [29]


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