Ablation therapy for large hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China, and when a single tumor is larger than 5 cm in diameter, it is defined as large HCC. Large HCC has the characteristics of high degree of tumor malignancy and high risk of tumor metastasis and vascular invasion, which increases the difficulty of treatment. Surgical resection is the preferred treatment regimen for large HCC, but only 20%-30% of patients are candidates for surgical treatment. Transarterial chemoembolization (TACE) is recommended as the treatment regimen for unresectable large HCC in Chinese and international guidelines. It can control tumor progression and prolong the survival time of patients; however, repeated TACE has limited efficacy and may cause serious damage to liver function, and TACE alone can no longer meet clinical needs. With the development of tumor ablation techniques such as radiofrequency ablation, microwave ablation, and cryoablation, TACE combined with tumor ablation has become an important treatment method for large HCC. However, there are still controversies over the effect of ablation on large HCC, and therefore, how to choose the appropriate ablation time, reduce tumor residue and recurrence after ablation, and finally bring survival benefits to patients remains a difficult problem to be solved in clinical and scientific research. This article reviews the current status, predicaments, and future development trends of ablation therapy for large HCC.