Combined Treatments in Liver Ablations

Percutaneous ablation is a curative treatment indicated in very early and early hepatocellular carcinoma (HCC). Procedural success remains disappointing in lesions ≥3.0 cm and located in subcapsular and perivascular areas. To overcome these limitations, combination treatments have been proposed. The combination of ablation and transarterial chemoembolization (TACE) is widely adopted in clinical practice and may improve survival, particularly in patients with single nodules 3 to 5 cm in size. However, technical issues and clinical indications are still debated. Radiofrequency ablation (RFA) may also be combined with percutaneous ethanol injection to improve local tumor control; limited data show safety and efficacy of this option. The combination of ablation and systemic treatments is still debated. Intravenous injection of thermosensitive liposomal doxorubicin in association with prolonged RFA is under investigation in patients with single lesions