For hepatocellular carcinoma (HCC) patients who are not candidates for liver transplant or resection, lesion ablation can be a curative treatment. With multiple ablation options available and still under investigation, it can be challenging to navigate the differences between them. In this episode, Dr. Tyler Sandow hosts a discussion with interventional radiologists Dr. Kirema Garcia-Reyes, Dr. Sabeen Dhand, and Dr. Kevin Burns on the various ablation options for HCC and when to use each one.

Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:

https://www.cmeuniversity.com/course/take/125738

---

This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.

---

SYNPOSIS

The doctors first discuss Barcelona-Clinic Liver Cancer (BCLC) Stage A patients, where lesion size and location are key factors in deciding between ablation and transarterial therapies. They then compare cryoablation and microwave ablation, highlighting that cryoablation offers better visualization and control of the ablation zone, while microwave ablation is more effective for treating larger lesions.

Dr. Burns introduces histotripsy, a noninvasive treatment that uses ultrasound energy to mechanically ablate tumors. He shares his experiences as an early adopter of this technology and discusses how intraoperative cone beam CT can help treat lesions located near critical structures or those poorly visualized on ultrasound. Finally, Dr. Garcia-Reyes and Dr. Berman provide insights into patient selection, pre-procedural imaging, and technical tips for Y90.

---

TIMESTAMPS

00:00 - Introduction

02:04 - Ablation vs Y90 in BCLC A Patients

05:58 - Same-Day Y90

15:55 - Y90 for Large Tumors

17:51 - Ideal Cases for Cryoablation

19:38 - Explanation of Histotripsy

32:09 - Procedural Specifics for Histotripsy

38:21 - Technical Tips for Y90

---

RESOURCES

Including the Hollow Viscera (Stomach or Bowel) within the Ice Ball during Cryoablation: A Review of Adverse Events (Abramyan et al, 2024):

https://www.jvir.org/article/S1051-0443(24)00681-X/abstract

CME Accreditation Information:

https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf