Introduction

Image-guided techniques for local tumor treatment have emerged as a viable therapeutic option for patients with limited hepatic malignant disease when surgery is precluded. Over the past two decades, several methods for chemical ablation or thermal tumor destruction through localized heating or freezing have been developed and clinically tested. This chapter focuses on the use of radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) and colorectal hepatic metastases. Radiofrequency ablation, in fact, is currently established as the primary ablative modality at most institutions.

Eligibility criteria

A careful clinical, laboratory, and imaging assessment has to be performed in each individual patient by a multidisciplinary team to evaluate eligibility for percutaneous ablation. Laboratory tests should include measurement of serum tumor markers, such as alpha-fetoprotein for HCC and carcinoembryonic antigen for colorectal metastases, as well as a full evaluation of the patient's coagulation status. A prothrombin time ratio (normal time/patient's time) greater than 50% and a platelet count higher than 50 000 μL− 1 are required to keep the risk of bleeding at an acceptably low level. The tumor staging protocol must be tailored to the kind of malignancy. In patients with HCC, it should include abdominal ultrasound (US) and computed tomography (CT) or dynamic magnetic resonance (MR) imaging, although in selected cases chest CT and bone scintigraphy may be needed to exclude extrahepatic tumor spread. Whole-body CT and positron emission tomography (PET) or PET/CT may be required to stage patients with hepatic metastases appropriately.