Radiofrequency Ablation for the Local Management Treatment of 1 Hepatocellular Carcinoma : Technical Aspects and Outcomes

27 Hepatocellular carcinoma (HCC) is the 3 leading cause of cancer-related death 28 worldwide, and the incidence of HCC is rising in the United States. Patients with cirrhosis of the 29 liver and viral hepatitis are at the highest risk of developing HCC. The diagnosis of HCC can be 30 made radiographically, with multiphase contrast-enhanced imaging; however, many lesions 31 require biopsy for diagnosis. Various staging and treatment modalities are available for the 32 management of confirmed HCC. Treatment can be classified as curative or palliative based on 33 the Barcelona Clinic Liver Cancer staging system. Curative therapies include ablation, surgical 34 resection, and orthotopic liver transplantation. Radiofrequency ablation has become an accepted 35 first-line treatment for small tumors HCC because of its similar outcomes and less morbidity 36 when compared with surgical resection. However, local recurrence after radiofrequency ablation 37 remains problematic and requires vigilant post-ablation surveillance imaging. Prior to 38 radiofrequency ablation, the physician must take in to account tumor size and location as well as 39 ability to obtain real-time imaging for a percutaneous approach, which is preferred. The 40 procedure requires collaboration with an experienced interventional radiologist in order to obtain 41 the best outcomes and minimize complications. Additionally, Rradiofrequency ablation can also 42 be used in combination with other treatment modalities, such as transarterial chemoembolization, 43 to provide an adequate ablation bed for large tumors. Overall, the utilization of radiofrequency 44 ablation should be part of the armamentarium of all physicians managing patients with HCC. in 45 larger tumors or as a bridge to liver transplantation. This article reviews appropriate the 46 indications, technique, patient and tumor selection, advanced treatment techniques, 47 complications, follow up, and post-treatment outcomes of radiofrequency ablation treatment of 48