Journal of Liver Cancer

Recommendation and Guideline

Local ablation for hepatocellular carcinoma: 2024 expert consensus-based practical recommendation of the Korean Liver Cancer Association: Seungchul Han, Pil Soo Sung, Soo Young Park, Jin Woong Kim, Hyun Pyo Hong, Jung-Hee Yoon, Dong Jin Chung, Joon Ho Kwon, Sanghyeok Lim, Jae Hyun Kim, Seung Kak Shin, Tae Hyung Kim, Dong Ho Lee, Jong Young Choi; J Liver Cancer. 2024;24(2):131-144. Published online August 30, 2024; DOI: https://doi.org/10.17998/jlc.2024.08.04

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Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the firstline treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and posttreatment management of patients.

Citations

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Practical consensus multi-specialty guidelines on image-guided ablation for hepatocellular carcinoma
David S. Lu
Journal of Liver Cancer.2024; 24(2): 120. CrossRef

Original Article

The efficacy of treatment for hepatocellular carcinoma in elderly patients: Han Ah Lee, Sangheun Lee, Hae Lim Lee, Jeong Eun Song, Dong Hyeon Lee, Sojung Han, Ju Hyun Shim, Bo Hyun Kim, Jong Young Choi, Hyunchul Rhim, Do Young Kim; J Liver Cancer. 2023;23(2):362-376. Published online September 14, 2023; DOI: https://doi.org/10.17998/jlc.2023.08.03

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Abstract PDF Supplementary Material

Background/Aim
Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established.
Methods
Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC.
Results
Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05).
Conclusions
Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.

Citations

Citations to this article as recorded by

Efficacy and Safety of Surgical Resection in Elderly Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Jin-Soo Lee, Dong Ah Park, Seungeun Ryoo, Jungeun Park, Gi Hong Choi, Jeong-Ju Yoo
Gut and Liver.2024; 18(4): 695. CrossRef
Achieving Sufficient Therapeutic Outcomes of Surgery in Elderly Hepatocellular Carcinoma Patients through Appropriate Selection
Han Ah Lee
Gut and Liver.2024; 18(4): 556. CrossRef

Review Article

Practice Guidelines for Management of Hepatocellular Carcinoma: Global Discrepancies and Solution of Local Ablation: Hong Soo Kim; Journal of the Korean Liver Cancer Study Group. 2011;11(1):6-11. Published online February 28, 2011

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Abstract PDF: A curative modality for hepatocellular carcinoma was a resection or a liver transplantation in a past decades, but nowadays local ablation therapy like a percutaneous alcohol injection or a radiofrequency ablation is comparable with a surgical resection. So a local ablation therapy is considered as a curative modality. Recently early detection of a small hepatocellular carcinoma is becoming easy due to use a suveillance ultrasonography and computed tomography in a high risk patients. Grobally, an indication for local ablation therapy is a small hepatocellular carcinoma less than 3 cm in diameter and have a well-reserved liver function. But patients who met above indication is also controlled by a liver transplantation or a surgical resection. So we should pay attention to a difference between treatment guidelines and a strengths and weaknesses of local ablation therapy.

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