Ablation Techniques for Hepatic and Pulmonary Malignancies

Ablation techniques have become pivotal in the management of primary and secondary tumours of the liver and lung, offering minimally invasive alternatives for patients unfit for surgery. Thermal modalities such as radiofrequency ablation (RFA) and microwave ablation (MWA) employ carefully controlled energy delivery to induce coagulative necrosis within targeted lesions. Advances in probe geometry, multi‐antenna systems and real-time imaging guidance have improved the precision of ablation zones, minimising damage to adjacent vasculature and critical structures. In hepatic applications, RFA and MWA provide effective local control for small hepatocellular carcinomas (HCC) and oligometastases, with percutaneous or laparoscopic approaches tailored to lesion location. In the pulmonary field, computed‐tomography‐guided ablation permits treatment of primary lung cancers and metastases with low morbidity, even in medically inoperable cases. Challenges remain in achieving complete ablation near large blood vessels, where the heat sink effect can limit thermal penetration, and in preventing residual disease that may promote angiogenesis or immune evasion. To address these issues, combined strategies pairing ablation with targeted nanoparticles, immune checkpoint blockade or adjuvant therapies are under active investigation, aiming to convert local tumour eradication into systemic antitumour immunity. Emerging non-thermal modalities, such as irreversible electroporation, offer further options where thermal techniques may be contraindicated, preserving extracellular matrix integrity and supporting faster organ recovery.

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Ablation Techniques for Hepatic and Pulmonary Malignancies publication trend

The graph below shows the total number of articles in ablation techniques for hepatic and pulmonary malignancies across all publications each year (not limited to Nature Index journals).

Technical terms

Radiofrequency ablation (RFA): A thermal technique that uses alternating current to produce ionic agitation and frictional heat, inducing coagulative necrosis in target tissue.

Microwave ablation (MWA): A form of thermal ablation in which electromagnetic waves at microwave frequencies generate rapid oscillation of water molecules, producing higher intratumoural temperatures over shorter durations.

Immunogenic cell death (ICD): A form of cell death that stimulates innate and adaptive immune responses by releasing damage-associated molecular patterns and tumour antigens.

Tumour microenvironment (TME): The complex milieu of stromal cells, immune infiltrates, extracellular matrix and signalling molecules that surround and interact with cancer cells.

Heat sink effect: The cooling impact of adjacent blood flow, which can dissipate thermal energy from the ablation zone and lead to incomplete tumour destruction.

References

1. Autophagy-amplifying nanoparticles evoke immunogenic cell death combined with anti-PD-1/PD-L1 for residual tumors immunotherapy after RFA. Journal of Nanobiotechnology (2023).
2. Radiofrequency ablation: mechanisms and clinical applications. MedComm (2024).
3. Heat Sink Effect on Tumor Ablation Characteristics as Observed in Monopolar Radiofrequency, Bipolar Radiofrequency, and Microwave, Using Ex Vivo Calf Liver Model. Medicine (2015).
4. Insufficient Radiofrequency Ablation Promotes Angiogenesis of Residual Hepatocellular Carcinoma via HIF-1α/VEGFA. PLOS ONE (2012).
5. CT-guided percutaneous microwave ablation of pulmonary malignancies: Results in 69 cases. World Journal of Surgical Oncology (2012).