Treatment of hepatocellular carcinoma by interventional methods

In the treatment of early and intermediate hepatocellular carcinoma the ran ge of indications for percutaneous ablation techniques is becoming wider th an surgery or intra-arterial therapies. Indeed., whereas for some years onl y patients with up to three small tumours were treated, with the introducti on of the single-session technique performed under general anaesthesia, eve n patients with more advanced disease are now being treated. Although it is understood that partial resection assures the highest local control, the s urvival rates after surgery are roughly comparable with percutaneous ethano l injection (PEI). The explanation is due to a balance among advantages and disadvantages of the two therapies. PEI survival curves are better than cu rves of resected patients who present adverse prognostic factors, and this means that surgery needs a better selection of the patients. Indications fo r both of therapies are reported. An unanswered question remains the choice between PEI and other new ablation procedures. In our department we curren tly use radio-frequency ablation in the majority of patients but consider P EI and segmental transarterial chemoembolisation complementary, and use the m according to the features of the disease and the response. Evaluation of therapeutic efficacy, technique and results of them are reported.