Traitement percutané du carcinome hépatocellulaire

Despite advances in imaging techniques and surveillance program, most hepatocellular carcinoma patients are still diagnosed at advanced stages and cannot benefit from surgical curative treatment. Percutaneous destruction of tumour by chemical substances or thermal energy sources is a good alternative to surgery. Percutaneous ethanol injection, the earliest developed method, has been widely reported and has proven its efficacy achieving a complete response in 80-100 % of hepatocellular carcinoma less than 3 cm in diameter. It is simple, safe and cheap and is until now the gold standard in percutaneous treatments. Over the past 10 years, methods using thermotherapy (radiofrequency, microwaves, laser) have been developed. Radiofrequency is the most assessed method and it achieves at least the same response as percutaneous ethanol injection but with a complication rate which could be higher. Microwave and laser are promising technologies, but only few clinical data are available. Randomized controlled trials are needed in order to assess treatment response, long-term survival, safety and cost-efficacy of the new techniques.