What is the Future of Image-Guided Radiofrequency Ablation for Hepatocellular Carcinoma?

Image-guided tumour ablation is recommended in patients with early-stage hepatocellular carcinoma (HCC) when surgical options are precluded. Radiofrequency ablation (RFA) has shown superior anticancer effect and greater survival benefit with respect to the seminal percutaneous technique, ethanol injection, in meta-analyses of randomised controlled trials, and is currently established as the standard method for local tumour treatment. Novel thermal and non-thermal techniques for tumour ablation seem to have potential to overcome the limitations of RFA and warrant further clinical investigation. The recent addition of molecular targeted drugs with anti-angiogenic and antiproliferative properties to the therapeutic armamentarium for HCC has prompted the design of clinical trials aimed at investigating the synergies between local ablation and systemic treatments. The outcomes of these trials are eagerly awaited, as they have the potential to revolutionize the treatment of HCC.