Image-guided radiofrequency ablation (RFA) is an evolving and growing treatment option for patients with hepatocellular carcinoma (HCC) and hepatic metastasis. RFA offers significant advantages as it is less invasive than surgery and carries a low risk of major complications. However, serious complications, including aggressive tumor recurrence, may be observed during follow-up, and recently, mechanical or thermal damage during RFA has been proposed to be one of the causes of this kind of recurrence. Although the exact mechanism of this still remains unclear, physicians should be familiar with the imaging features of aggressive tumor recurrence after RFA for HCC and its risk factors. In addition, in order to prevent or minimize this newly recognized tumor recurrence, a modified RFA technique, combined RFA treatments with transarterial chemoembolization, and cryoablation can be used as alternative treatments. Ultimately, combining an understanding of this potential complication of RFA with an understanding of the possible risk factors for aggressive tumor recurrence and choosing alternative treatments are crucial to optimize clinical outcomes in each patient with HCC.
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Radiomics of hepatopancreatobiliary cancer diagnosis, management, and future prospects D. Koku, Y. Agarwala, M. Vithayathil, P. Tait, E.O. Aboagye, R. Sharma Clinical Radiology.2026; 92: 107167. CrossRef
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Early recurrence of hepatocellular carcinoma in patients after ablation and resection: A propensity score analysis Zongfeng Wu, Yi Zeng, Yichuan Yuan, Yunxing Shi, Jiliang Qiu, Binkui Li, Yunfei Yuan, Wei He The American Journal of Surgery.2024; 228: 94. CrossRef
Thermal ablation for hepatic tumors in high-risk locations Elijah Ndhlovu, Bi-Xiang Zhang, Xiao-Ping Chen, Peng Zhu Clinics and Research in Hepatology and Gastroenterology.2024; 48(3): 102300. CrossRef
CT-guided high dose rate brachytherapy can induce multiple systemic proteins of proliferation and angiogenesis predicting outcome in HCC Lukas Salvermoser, Shraga Nahum Goldberg, Marianna Alunni-Fabbroni, Philipp Maximilian Kazmierczak, Moritz Nikolaus Gröper, Jan Niklas Schäfer, Elif Öcal, Tanja Burkard, Stefanie Corradini, Najib Ben Khaled, Agnese Petrera, Moritz Wildgruber, Jens Ricke, Translational Oncology.2024; 43: 101919. CrossRef
Repeat laparoscopic hepatectomy versus radiofrequency ablation for recurrent hepatocellular carcinoma: A multicenter, propensity score matching analysis Zihui Ma, Xiaolu Lin, Jinglei Zhang, Xingchao Song, Maolin Yan, Lei Guo, Jie Xue, Chongde Lu, Jie Shi, Shuqun Cheng, Weixing Guo BioScience Trends.2024; 18(6): 563. CrossRef
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Salvage Hepatectomy for Recurrent Hepatocellular Carcinoma after Radiofrequency Ablation: A Retrospective Cohort Study with Propensity Score-Matched Analysis Yeshong Park, Ho-Seong Han, Yoo-Seok Yoon, Chang Jin Yoon, Hae Won Lee, Boram Lee, MeeYoung Kang, Jinju Kim, Jai Young Cho Cancers.2023; 15(19): 4745. CrossRef
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Usefulness of ultrasound fusion technology for hepatocellular carcinoma localisation, pre- and post-thermal ablation A Mohamed Afif, OD Laroco, SMD Lau, SM Teo, AS Abdul Rahman, CW Too, N Venkatanarasimha, A Gogna Ultrasound.2022; 30(3): 194. CrossRef
Long-term outcome of percutaneous radiofrequency ablation for periportal hepatocellular carcinoma: tumor recurrence or progression, survival and clinical significance Shoujin Cao, Tianshi Lyu, Zeyang Fan, Haitao Guan, Li Song, Xiaoqiang Tong, Jian Wang, Yinghua Zou Cancer Imaging.2022;[Epub] CrossRef
A multifunctional nanoplatform for improving microwave hyperthermia by a combination therapy of vessel disruptive agent and immune modulator Zhiheng Zeng, Xiaohan Sun, Zhongbing Huang, Changhui Fu, Jun Ren, Meng Niu, Longfei Tan, Xiangling Ren, Qiong Wu, Xianwei Meng Colloids and Surfaces B: Biointerfaces.2022; 217: 112616. CrossRef
Myofibroblasts: A key promoter of tumorigenesis following radiofrequency tumor ablation Marwan Moussa, David Mwin, Haixing Liao, M. Fatih Atac, Aurelia Markezana, Eithan Galun, S. Nahum Goldberg, Muneeb Ahmed, Yanlin Yu PLOS ONE.2022; 17(7): e0266522. CrossRef
Progression of hepatocellular carcinoma after radiofrequency ablation: Current status of research Shilun Wu, Zhuxin Li, Changyu Yao, Shuying Dong, Jun Gao, Shan Ke, Ruhang Zhu, Sen Huang, Shaohong Wang, Li Xu, Chen Ye, Jian Kong, Wenbing Sun Frontiers in Oncology.2022;[Epub] CrossRef
Activated Hepatic Stellate Cells in Hepatocellular Carcinoma: Their Role as a Potential Target for Future Therapies Esraa Ali, Andriy Trailin, Filip Ambrozkiewicz, Václav Liška, Kari Hemminki International Journal of Molecular Sciences.2022; 23(23): 15292. CrossRef
Cancer—Yesterday, Today, Tomorrow Valentin Titus Grigorean, Daniel Alin Cristian Medicina.2022; 59(1): 98. CrossRef
Small single perivascular hepatocellular carcinoma: comparisons of radiofrequency ablation and microwave ablation by using propensity score analysis Chao An, Wang-Zhong Li, Zhi-Mei Huang, Xiao-Ling Yu, Yu-Zhi Han, Fang-Yi Liu, Song-Song Wu, Jie Yu, Ping Liang, Jinhua Huang European Radiology.2021; 31(7): 4764. CrossRef
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Construction of a novel radiomics nomogram for the prediction of aggressive intrasegmental recurrence of HCC after radiofrequency ablation Xiuling Lv, Minjiang Chen, Chunli Kong, Gaofeng Shu, Miaomiao Meng, Weichuan Ye, Shimiao Cheng, Liyun Zheng, Shiji Fang, Chunmiao Chen, Fazong Wu, Qiaoyou Weng, Jianfei Tu, Zhongwei Zhao, Jiansong Ji European Journal of Radiology.2021; 144: 109955. CrossRef
Repeat hepatectomy versus radiofrequency ablation in management of recurrent hepatocellular carcinoma: an average treatment effect analysis Darren W. Chua, Ye-Xin Koh, Nicholas L. Syn, Tan Yu Chuan, Teo Jin Yao, Ser-Yee Lee, Brian K. P. Goh, Peng-Chung Cheow, Alexander Y. Chung, Chung-Yip Chan Annals of Surgical Oncology.2021; 28(12): 7731. CrossRef
Optimal application of stereotactic body radiotherapy and radiofrequency ablation treatment for different multifocal hepatocellular carcinoma lesions in patients with Barcelona Clinic Liver Cancer stage A4–B1: a pilot study Feiqian Wang, Kazushi Numata, Atsuya Takeda, Katsuaki Ogushi, Hiroyuki Fukuda, Hiromi Nihonmatsu, Koji Hara, Makoto Chuma, Yuichirou Tsurugai, Shin Maeda BMC Cancer.2021;[Epub] CrossRef
Monitoring radiofrequency therapy‐induced tumor cell dissemination by in vivo flow cytometry Xi Zhu, Cong Wei, Yang Zhang, Zheying Meng, Bing Hu, Fuli Zhang, Xunbin Wei, Tao Ying Cytometry Part A.2021; 99(6): 593. CrossRef
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Nanotechnology Based Approach for Hepatocellular Carcinoma Targeting Abdulsalam Alhalmi, Sarwar Beg, Kanchan Kohli, Md. Waris, Tanuja Singh Current Drug Targets.2021; 22(7): 779. CrossRef
RF Ablation Versus Cryoablation for Small Perivascular Hepatocellular Carcinoma: Propensity Score Analyses of Mid-Term Outcomes So Yeon Cha, Tae Wook Kang, Ji Hye Min, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim, Hyo Keun Lim, Dong Hyun Sinn, Min Su Park CardioVascular and Interventional Radiology.2020; 43(3): 434. CrossRef
Surgical resection versus radiofrequency ablation for Barcelona Clinic Liver Cancer very early stage hepatocellular carcinoma: long-term results of a single-center study Chih-Yang Hsiao, Rey-Heng Hu, Cheng-Maw Ho, Yao-Ming Wu, Po-Huang Lee, Ming-Chih Ho The American Journal of Surgery.2020; 220(4): 958. CrossRef
Effect of Perfluorobutane Microbubbles on Radiofrequency Ablation for Hepatocellular Carcinoma: Suppression of Steam Popping and Its Clinical Implication Dong Young Jeong, Tae Wook Kang, Ji Hye Min, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim, Hyo Keun Lim, Dong Hyun Sinn, Heewon Han Korean Journal of Radiology.2020; 21(9): 1077. CrossRef
Radiofrequency ablation using internally cooled wet electrodes in bipolar mode for the treatment of recurrent hepatocellular carcinoma after locoregional treatment: A randomized prospective comparative study Jae Won Choi, Jeong Min Lee, Dong Ho Lee, Jung-Hwan Yoon, Yoon Jun Kim, Jeong-Hoon Lee, Su Jong Yu, Eun Ju Cho, Do Young Kim PLOS ONE.2020; 15(9): e0239733. CrossRef
Intraprocedurally EOB-MRI/US fusion imaging focusing on hepatobiliary phase findings can help to reduce the recurrence of hepatocellular carcinoma after radiofrequency ablation Feiqian Wang, Kazushi Numata, Hiromi Nihonmatsu, Makoto Chuma, Satoshi Moriya, Akito Nozaki, Katsuaki Ogushi, Hiroyuki Fukuda, Litao Ruan, Masahiro Okada, Wen Luo, Norihiro Koizumi, Masayuki Nakano, Masako Otani, Yoshiaki Inayama, Shin Maeda International Journal of Hyperthermia.2020; 37(1): 1149. CrossRef
Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions Anum Aslam, Richard Kinh Gian Do, Avinash Kambadakone, Bradley Spieler, Frank H Miller, Ahmed M Gabr, Resmi A Charalel, Charles Y Kim, David C Madoff, Mishal Mendiratta-Lala World Journal of Hepatology.2020; 12(10): 738. CrossRef
Predicting outcomes for recurrent hepatocellular carcinoma within Milan criteria after complete radiofrequency ablation Hsin-Yeh Chen, Sheng-Nan Lu, Chao-Hung Hung, Jing-Houng Wang, Chien-Hung Chen, Yi-Hao Yen, Yuan-Hung Kuo, Kwong-Ming Kee, Tatsuo Kanda PLOS ONE.2020; 15(11): e0242113. CrossRef
Lung Metastasis Postradioembolization of Hepatocellular Carcinoma With Tumor in Vein Harit Kapoor, Sreeja Sanampudi, Joseph Owen, Driss Raissi ACG Case Reports Journal.2020; 7(2): e00322. CrossRef
Percutaneous cryoablation for perivascular hepatocellular carcinoma: Therapeutic efficacy and vascular complications Ran Kim, Tae Wook Kang, Dong Ik Cha, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim, Hyo Keun Lim, Dong Hyun Sinn European Radiology.2019; 29(2): 654. CrossRef
A novel software platform for volumetric assessment of ablation completeness Marco Solbiati, Riccardo Muglia, S. Nahum Goldberg, Tiziana Ierace, Alessandro Rotilio, Katia M Passera, Ilaria Marre, Luigi Solbiati International Journal of Hyperthermia.2019; 36(1): 336. CrossRef
Intrahepatic distant recurrence after radiofrequency ablation of hepatocellular carcinoma: relationship with portal hypertension Ran Kim, Woo Kyoung Jeong, Tae Wook Kang, Kyoung Doo Song, Min Woo Lee, Soo Hyun Ahn, Hyunchul Rhim Acta Radiologica.2019; 60(12): 1609. CrossRef
LncRNA FUNDC2P4 down-regulation promotes epithelial–mesenchymal transition by reducing E-cadherin expression in residual hepatocellular carcinoma after insufficient radiofrequency ablation Jiangzheng Zeng, Xinrui Cai, Xinbao Hao, Fen Huang, Zhihui He, Huamao Sun, Yanda Lu, Junhua Lei, Wangyuan Zeng, Yu Liu, Rongcheng Luo International Journal of Hyperthermia.2018; 34(6): 802. CrossRef
Stress-induced phosphoprotein 1 mediates hepatocellular carcinoma metastasis after insufficient radiofrequency ablation Tianhong Su, Junbin Liao, Zihao Dai, Lixia Xu, Shuling Chen, Yifei Wang, Zhenwei Peng, Qiuyang Zhang, Sui Peng, Ming Kuang Oncogene.2018; 37(26): 3514. CrossRef
Periostin involved in the activated hepatic stellate cells-induced progression of residual hepatocellular carcinoma after sublethal heat treatment: its role and potential for therapeutic inhibition Rui Zhang, Xia-Hui Lin, Min Ma, Jie Chen, Jun Chen, Dong-Mei Gao, Jie-Feng Cui, Rong-Xin Chen Journal of Translational Medicine.2018;[Epub] CrossRef
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