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  • Review Article
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Image-guided ablation of primary liver and renal tumours

Nature Reviews Clinical Oncology volume 12, pages 175–186 (2015)Cite this article

Subjects

Key Points

  • Hepatocellular carcinoma (HCC) is increasingly detected at an early, asymptomatic stage owing to surveillance programmes in at-risk patient populations

  • Patients with early stage HCC (single tumour <5 cm or up to three nodules <3 cm) should be considered for any available curative treatments, including liver transplantation, hepatic resection, and image-guided ablation (IGA)

  • IGA is currently recommended as the standard of care for patients with early stage HCC when surgical options are precluded, and has potential as a first-line treatment for very early stage tumours smaller than 2 cm

  • Small (<5 cm) renal tumours, often incidentally detected at imaging for alternative symptomatology, are an increasingly problematic clinical management issue in an ageing population

  • Active surveillance or partial nephrectomy is usually invoked after detection of small renal tumours, but both of these approaches can be onerous for patients who often have an indolent malignancy

  • Diligent image-guided ablation, increasingly by cryoablation, represents a useful, minimally invasive treatment option with reduced costs and morbidity

Abstract

Image-guided ablation (IGA) techniques have evolved considerably over the past 20 years and are increasingly used to definitively treat small primary cancers of the liver and kidney. IGA is recommended by most guidelines as the best therapeutic choice for patients with early stage hepatocellular carcinoma (HCC)—defined as either a single tumour smaller than 5 cm or up to three nodules smaller than 3 cm—when surgical options are precluded, and has potential as first-line therapy, in lieu of surgery, for patients with very early stage tumours smaller than 2 cm. With regard to renal cell carcinoma, despite the absence of any randomized trial comparing the outcomes of IGA with those of standard partial nephrectomy, a growing amount of data demonstrate robust oncological outcomes for this minimally invasive approach and testify to its potential as a standard-of-care treatment. Herein, we review the various ablation techniques, the supporting evidence, and clinical application of IGA in the treatment of primary liver and kidney cancers.

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Figure 1: Ablative treatment planning.
Figure 2: Pixel-density thresholding of CT data to improve the precision of periprocedural assessment.
Figure 3: Pre-procedural, peri-procedural and post-procedural assessment of a cryoablation procedure.

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  1. Department of Radiology, University Hospitals of Southampton, Tremona Road, Southampton, SO16 6YD, Hampshire, UK

    David J. Breen

  2. Department of Liver Transplantation, Division of Diagnostic Imaging and Intervention, Hepatology and Infectious Diseases, Pisa University Hospital and School of Medicine, Building No. 29, 2nd Floor, Via Paradisa 2, Pisa, IT-56124, Italy

    Riccardo Lencioni

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Breen, D., Lencioni, R. Image-guided ablation of primary liver and renal tumours. Nat Rev Clin Oncol 12, 175–186 (2015). https://doi.org/10.1038/nrclinonc.2014.237

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