Thermal ablation therapy, including radiofrequency ablation (RFA) and microwave ablation (MWA), is considered the optimal locoregional treatment for unresectable early-stage hepatocellular carcinomas (HCCs). Percutaneous image-guided ablation is a minimally invasive treatment that is being increasingly performed because it achieves good clinical outcomes with a lower risk of complications. However, the physics and principles of RFA and MWA markedly differ. Although percutaneous thermal ablation under image guidance may be challenging in HCC cases with limited access or a risk of thermal injury, a number of ablative techniques, each of which may be advantageous and disadvantageous for individual cases, are available. Furthermore, even when a HCC is eligible for ablation based on tumor selection and technical factors, additional patient factors may have an impact on whether it is the appropriate treatment choice. Therefore, a basic understanding of the advantages and limitations of each ablation device and imaging guidance technique, respectively, is important. We herein provide an overview of the basic principles of tissue heating in thermal ablation, clinical and laboratory parameters for ablation therapy, preprocedural management, imaging assessments of responses, and early adverse events. We also discuss associated challenges and how they may be overcome using optimized imaging techniques.
热消融治疗，包括射频消融（RFA）和微波消融（MWA），被认为是不可切除早期肝细胞癌（HCC）的最佳局部区域治疗方法。经皮影像引导消融是一种微创治疗，因其能实现良好的临床效果且并发症风险较低，正得到日益广泛的应用。然而，RFA与MWA的物理机制和原理存在显著差异。尽管在影像引导下对某些入路受限或存在热损伤风险的HCC病例进行经皮热消融可能具有挑战性，但目前已有多种消融技术可供选择，每种技术对具体病例可能各有利弊。此外，即使HCC在肿瘤选择和技术因素方面符合消融条件，其他患者相关因素也可能影响其是否适合作为治疗选择。因此，分别理解各种消融设备和影像引导技术的优势与局限性至关重要。本文概述了热消融中组织加热的基本原理、消融治疗的临床与实验室参数、术前管理、疗效的影像学评估以及早期不良事件，并探讨了相关挑战及如何通过优化影像技术加以应对。
Tips for Preparing and Practicing Thermal Ablation Therapy of Hepatocellular Carcinoma
肿瘤(癌症)患者之家