Initial Clinical Assessment and Patient Selection

For many years, partial hepatectomy and liver transplantation have been considered as the only forms of curative treatment for hepatocellular carcinoma (HCC). Unfortunately, only 10–20 % of HCC is resectable. Anatomic location, size or number of lesions, inadequate liver remnant, or comorbid conditions preclude surgery in the majority of patients. Orthotopic liver transplantation can cure some patients with poor liver function due to underlying cirrhosis, but few patients are eligible because of advanced stage of HCC at initial diagnosis and because of scarcity of liver donors, especially in some parts of the world. Currently, radiofrequency ablation (RFA) is commonly used in patients with small HCC confined to the liver, especially when the tumors are unresectable because of poor general condition of the patients or because of compromised liver function. Using RFA as a bridge to liver transplantation results in low treatment morbidity and favorable HCC responses and reduces drop-out rate of patients while on the liver transplant waiting list due to HCC progression. Local ablative therapy now competes with partial hepatectomy and liver transplantation as the primary treatment for patients with small HCC. The application of RFA has a number of potential advantages in patients with HCC. The procedure is relatively safe and well tolerated, and its complication rates in most reported series are low. Data have accumulated to support the safety and effectiveness of RFA in selected patients. To achieve good treatment outcomes, proper clinical assessment and patient selection are important. This chapter introduces the clinical assessment and patient selection for RFA [1].