2019 Volume 65 Issue 5 Pages 433-443
Image-guided tumor ablation is a well-established hallmark of local cancer therapy. Ablation is potentially curative, minimally invasive, and easily repeatable for recurrence. There are mainly two categories of ablation: chemical ablation and thermal ablation. Thermal ablation, which includes radiofrequency ablation, microwave ablation, and others, is now the standard. In the treatment of hepatocellular carcinoma, various nonsurgical therapies have developed. Among them, ablation is regarded as best for the early-stage cancer. Ablation has achieved good long-term results and now regarded as a satisfactory alternative to resection for small HCC. Ablation is also a potentially curative treatment for metastatic liver tumors. In Japan, ablation will be reimbursed and more widely performed in other fields than the liver in the near future. In other countries, they use ablations for tumors in the liver, the lung, the bones, the thyroid and others. Between the United States and Japan, there are some different practices in ablation while many practices are similar. Asia has the largest number of ablation procedures and the largest market scale in the world. Asia is the area where percutaneous ethanol injection and microwave ablation started. Various innovations and sophisticated instruments, such as a dedicated ultrasound transducer for puncture, a dedicated procedure bed, contrast-enhanced ultrasound, multimodality fusion imaging and others, would further improve outcome in ablation. Training programs may be useful to understand basic concepts and learn cardinal skills. Ablation with the use of sophisticated techniques would be superior to conventional surgery in the treatment of liver tumors.
