Laser ablation for small hepatocellular carcinoma: State of the art and future perspectives

Abstract

During the last two decades, various local thermal ablative techniques for the treatment of unresectable hepatocellular carcinoma (HCC) have been developed. According to internationally endorsed guidelines, percutaneous thermal ablation is the mainstay of treatment in patients with small HCC who are not candidates for surgical resection or transplantation. Laser ablation (LA) represents one of currently available loco-ablative techniques. In this article, the general principles, technique, image guidance, and patient selection are reported. Primary effectiveness, long-term outcome, and complications are also discussed. A review of published data suggests that LA is equivalent to the more popular and widespread radiofrequency ablation in both local tumor control and long-term outcome in the percutaneous treatment of early HCC. In addition, the LA technique using multiple thin laser fibres allows improved ablative effectiveness in HCCs greater than 3 cm. Reference centres should be equipped with all the available techniques so as to be able to use the best and the most suitable procedure for each type of lesion for each patient.

Keywords: Hepatocellular carcinoma; Laser; Laser ablation; Liver; Minimally invasive procedures.

Figures

Figure 1

Representative case of complete ablation of large nodule with multi-fibre technique. A: Computed tomography (CT) scan before laser ablation (LA) session shows a nodular lesion 6 cm in maximum diameter (hepatocellular carcinoma moderately differentiated) localized in the S6 with exophytic growth (exophytic component > 40%); B: CT scan performed 4 wk after LA procedure shows complete necrosis of the tumor. Four illuminations were performed using the pullback technique and the treatment lasted 24 min. The procedure was well tolerated and the patient was discharged from the hospital 24 h after the procedure. The only side effects were mild pain and self-limiting fever lasting for 7 d.

Figure 2

Representative case of complete ablation of hepatocellular carcinoma of 5 cm with combined treatment (laser ablation followed by trans-arterial-chemo-embolization). A: Computed tomography (CT) scan before Laser ablation (LA) shows a lesion 5 cm in diameter beneath the capsule in S8 during arterial phase; B: CT scan after LA shows an area of necrosis larger than basal lesion with small viable foci (white arrowhead) within the zone of coagulation; C: CT scan shows compact retention of iodized oil in the residual viable tissue (black arrowheads) after trans-arterial-chemo-embolization (TACE) session; D: CT scan shows marked volume reduction of treated area and clear shrinkage of viable tissue (black arrowhead) 6 mo after the combined procedure.