Radiofrequency Ablation (RFA) for Liver Cancer — Curative Treatment for Early HCC
For patients with early-stage hepatocellular carcinoma (HCC) — particularly those whose liver function or comorbidities make surgery high-risk — radiofrequency ablation offers curative treatment through a needle rather than an operating theatre incision. Complete ablation rates exceed 90% for tumours ≤3 cm, and long-term survival outcomes in carefully selected patients rival surgical resection. I am Dr Chetan Kalal, DM Hepatologist at Gleneagles Hospital Mumbai. RFA for HCC at our centre is coordinated through the hepatology-led multidisciplinary tumour board with our interventional radiology team.
How RFA Destroys Liver Tumours
A thin needle electrode is inserted directly into the tumour — percutaneously (through the skin), laparoscopically, or during open surgery. Alternating electric current at radiofrequency (460–500 kHz) is delivered through the tip, agitating tissue molecules and generating frictional heat. Temperatures within the ablation zone reach 60–100°C, causing irreversible coagulative necrosis of both the tumour and a 5–10 mm safety margin of surrounding tissue. This margin is critical: it must cover microscopic tumour extension that is not visible on imaging.
Microwave ablation (MWA) works on a similar principle using microwave energy. It heats tissue faster and is less affected by the “heat sink effect” (cooling by adjacent large blood vessels), making it preferable for tumours near major hepatic veins. The two techniques are used complementarily based on tumour location.
Who Is Suitable for RFA?
RFA is most effective for small HCC within the BCLC very early (0) and early (A) stages:
- Single tumour ≤5 cm in a patient unfit for surgery (most common indication)
- Single tumour ≤3 cm — best outcomes; complete ablation is most reliable
- Up to 3 nodules, each ≤3 cm
- Preserved liver function (Child-Pugh A or B7)
- No vascular invasion, no extrahepatic spread
- Tumour accessible by imaging guidance without major vessel or bile duct traversal
RFA is also used as a bridge to liver transplant — ablating the tumour to maintain eligibility within Milan or UCSF criteria while waiting for a donor, and to prevent tumour progression during the waiting period.
The Procedure at Gleneagles Hospital
The decision to perform RFA — and the specific technique — is made through the hepatology multidisciplinary tumour board, which includes Dr Kalal’s hepatology team, interventional radiology, and oncology. The tumour board reviews imaging (contrast-enhanced CT or MRI), liver function, performance status, and discusses the best approach: RFA versus MWA, percutaneous versus laparoscopic, and whether combination with TACE is beneficial.
The procedure itself is performed by our interventional radiology team under ultrasound or CT guidance, with the patient under local anaesthesia and IV sedation or general anaesthesia. Duration is 30–90 minutes depending on the number and size of nodules. Most patients are admitted overnight and discharged the following day.
Response assessment is performed at 4–6 weeks by contrast-enhanced CT or MRI. Complete ablation is defined as the absence of any arterial enhancement within the ablation zone. Local tumour recurrence — detected as a new enhancing nodule at the ablation margin — is re-treated with repeat ablation or alternative therapy.
RFA vs surgical resection: For very early HCC (BCLC 0, single tumour ≤2 cm), outcomes of RFA and resection are comparable. For larger tumours (3–5 cm), surgical resection offers lower local recurrence rates where it is feasible and liver function permits. The decision is individualised — Dr Kalal’s tumour board discusses both options with every patient.
Risks
RFA is a well-tolerated procedure. Post-ablation syndrome (fever, malaise, mild right upper quadrant pain) occurs in 30–40% of patients and resolves within 3–5 days with simple analgesia. Serious complications — intrahepatic abscess, bleeding, bile duct injury, tumour seeding along the needle track — occur in under 3% of cases at experienced centres. Tumour seeding risk is minimised by track ablation on needle withdrawal.
Discuss Your HCC Treatment Options
If you or a family member has been diagnosed with liver cancer and is exploring ablation as an option, Dr Kalal’s multidisciplinary team will review the full picture — tumour stage, liver function, surgical risk — and recommend the most appropriate treatment. Gleneagles Hospital, Mumbai.