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Ablation
Source: Primary Liver Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 17, 2025 · Captured 2026-09-09.
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Context: Treatment of Localized Primary Liver Cancer / Treatment Options for Localized Primary Liver Cancer
When tumor excision, either by transplant or resection, is not feasible or advisable, ablation may be used if the tumor can be accessed percutaneously or, if necessary, through minimally invasive or open surgery. Ablation may be particularly useful for patients with early-stage HCC that is centrally located in the liver and cannot be surgically removed without excessive sacrifice of functional parenchyma.
Ablation can be achieved in the following ways:
Change in temperature (e.g., radiofrequency ablation [RFA], microwave, or cryoablation).
Exposure to a chemical substance (e.g., percutaneous ethanol injection [PEI]).
Direct damage of the cellular membrane (definitive electroporation).
With ablation, a margin of normal liver around the tumor can be considered. Ablation is relatively contraindicated for lesions near bile ducts, the diaphragm, or other intra-abdominal organs that might be injured during the procedure. Furthermore, when tumors are located adjacent to major vessels, the blood flow in the vessels may keep thermal ablation techniques, such as RFA, from reaching optimal temperatures. This is known as the heat-sink effect, which may preclude complete tumor necrosis.
RFA achieves best results in patients with tumors smaller than 3 cm. In this subpopulation, 5-year OS rates may be as high as 59%, and the recurrence-free survival rates may not differ significantly from treatment with hepatic resection.[8,9] Local control success progressively diminishes as the tumor size increases beyond 3 cm.
PEI yields good results in patients with Child-Pugh class A cirrhosis and a single tumor smaller than 3 cm in diameter. In those cases, the 5-year OS rate can be as high as 40% to 59%.[10,11][Level of evidence C2]
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In the few randomized controlled trials that included patients with Child-Pugh class A cirrhosis, RFA proved superior to PEI in rates of complete response and local recurrences. Some of those studies have also shown improved OS with RFA. Furthermore, RFA requires fewer treatment sessions than PEI to achieve comparable outcomes.[12-15]
Of note, RFA may have higher complication rates than PEI,[13] but both techniques are associated with lower complication rates than excision procedures. RFA is a well-established technique in the treatment of HCC.
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