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Tumor ablation: emerging uses, challenges, and strategic implementation. A green paper by the Network of Expertise in Cancer (JANE-2), High Tech Medical Resources, network on Physical Methods of Tumor Ablation Cover

Tumor ablation: emerging uses, challenges, and strategic implementation. A green paper by the Network of Expertise in Cancer (JANE-2), High Tech Medical Resources, network on Physical Methods of Tumor Ablation

Open Access
|Jun 2026

References

  1. Zou YW, Ren ZG, Sun Y, Liu ZG, Hu XB, Wang HY, et al. The latest research progress on minimally invasive treatments for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2023; 22: 54-63. doi: 10.1016/j.hbpd.2022.08.004
  2. Citone M, Fanelli F, Falcone G, Mondaini F, Cozzi D, Miele V. A closer look to the new frontier of artificial intelligence in the percutaneous treatment of primary lesions of the liver. Med Oncol 2020; 37: 55. doi: 10.1007/s12032-020-01380-y
  3. Lanza C, Carriero S, Buijs EFM, Mortellaro S, Pizzi C, Sciacqua LV, et al. Robotics in interventional radiology: review of current and future applications. Technol Cancer Res Treat 2023; 22: 15330338231152084. doi: 10.1177/15330338231152084
  4. Vasiniotis Kamarinos N, Sofocleous CT. Imaging and image-guided thermal ablation for oligometastatic colorectal cancer liver disease. Cancer J 2020; 26: 124-8. doi: 10.1097/PPO.0000000000000440
  5. Joint Action Networks. Home - JANE 2. [Internet]. 2025 [cited 2026 Mar 31]. Available at: https://jane-2.eu/
  6. Guckenberger M, Lievens Y, Bouma AB, Collette L, Dekker A, deSouza NM, et al. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol 2020; 21: e18-28. doi: 10.1016/S1470-2045(19)30718-1
  7. Vogelbaum MA, Brown PD, Messersmith H, Brastianos PK, Burri S, Cahill D, et al. Treatment for brain metastases: ASCO-SNO-ASTRO guideline. J Clin Oncol 2022; 40: 492-516. doi: 10.1200/JCO.21.02314
  8. Antonoff MB, Mitchell KG, Kim SS, Salfity HV, Kotova S, Ripley RT, et al. The Society of Thoracic Surgeons (STS) clinical practice guideline on surgical management of oligometastatic non-small cell lung cancer. Ann Thorac Surg 2025; 119: 495-508. doi: 10.1016/j.athoracsur.2024.11.010
  9. Schullian P, Johnston EW, Putzer D, Laimer G, Waroschitz G, Braunwarth E, et al. Stereotactic radiofrequency ablation (SRFA) for recurrent colorectal liver metastases after hepatic resection. Eur J Surg Oncol 2021; 47: 866-73. doi: 10.1016/j.ejso.2020.09.034
  10. Clover AJP, De Terlizzi F, Bertino G, Curatolo P, Odili J, Campana LG, et al. Electrochemotherapy in the treatment of cutaneous malignancy: outcomes and subgroup analysis from the cumulative results from the pan-European International Network for Sharing Practice in Electrochemotherapy database for 2482 lesions in 987 patients (2008–2019). Eur J Cancer 2020; 138: 30-40. doi: 10.1016/j.ejca.2020.06.020
  11. Vogel A, Chan SL, Dawson LA, Kelley RK, Llovet JM, Meyer T, et al. Hepatocellular carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2025; 36: 491-506. doi: 10.1016/j.annonc.2025.02.006
  12. Powles T, Albiges L, Bex A, Comperat E, Grünwald V, Kanesvaran R, et al. Renal cell carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35: 692-706. doi: 10.1016/j.annonc.2024.05.537
  13. Murphy MC, Wrobel MM, Fisher DA, Cahalane AM, Fintelmann FJ. Update on image-guided thermal lung ablation: Society guidelines, therapeutic alternatives, and postablation imaging findings. Am J Roentgenol 2022; 219: 471-85. doi: 10.2214/AJR.21.27099
  14. Beets G, Sebag-Montefiore D, Andritsch E, Arnold D, Beishon M, Crul M, et al. ECCO essential requirements for quality cancer care: colorectal cancer. A critical review. Crit Rev Oncol Hematol 2017; 110: 81-93. doi: 10.1016/j.critrevonc.2016.12.001
  15. Dong F, Wu Y, Li W, Li X, Zhou J, Wang B, et al. Advancements in microwave ablation for tumor treatment and future directions. iScience 2025; 28: 112175. doi: 10.1016/j.isci.2025.112175
  16. Campbell WA, Makary MS. Advances in image-guided ablation therapies for solid tumors. Cancers 2024; 16: 2560. doi: 10.3390/cancers16142560
  17. Strand NH, Hagedorn JM, Dunn T, Johnson B, Abd-Elsayed A, Covington S, et al. Advances in radiofrequency ablation: mechanism of action and technology. Ann Palliat Med 2024; 13: 1028-34. doi: 10.21037/apm-23-457
  18. Paolucci I, Bulatović M, Weber S, Tinguely P. Thermal ablation with configurable shapes: a comprehensive, automated model for bespoke tumor treatment. Eur Radiol Exp 2023; 7: 67. doi: 10.1186/s41747-023-00381-6
  19. Tasu JP, Tougeron D, Rols MP. Irreversible electroporation and electrochemotherapy in oncology: state of the art. Diagn Interv Imaging 2022; 103: 499-509. doi: 10.1016/j.diii.2022.09.009
  20. Uribe Rivera AK, Seeliger B, Goffin L, García-Vázquez A, Mutter D, Giménez ME. Robotic assistance in percutaneous liver ablation therapies: a systematic review and meta-analysis. Ann Surg Open 2024; 5: e406. doi: 10.1097/AS9.0000000000000406
  21. Schulz HH, Pos AL, Van Der Lei S, Vos DJW, Dijkstra M, Timmer FEF, et al. Ablation confirmation software in thermal ablation of liver tumours: a scoping review of contemporary applications and clinical usability. Cardiovasc Intervent Radiol 2026; 49: 231-53. doi: 10.1007/s00270-025-04265-7
  22. Partridge B, Rossmeisl JH, Kaloss AM, Basso EKG, Theus MH. Novel ablation methods for treatment of gliomas. J Neurosci Methods 2020; 336: 108630. doi: 10.1016/j.jneumeth.2020.108630
  23. Sotirchos VS, Petre EN, Sofocleous CT. Percutaneous image-guided ablation for hepatic metastases. J Med Imaging Radiat Oncol 2023; 67: 832-41. doi: 10.1111/1754-9485.13594
  24. Ramalingam V, McCarthy CJ, Degerstedt S, Ahmed M. Image-guided prostate cryoablation: state-of-the-art. Medicina (Mex) 2023; 59: 1589. doi: 10.3390/medicina59091589
  25. Pereira PL, Siemou P, Rempp HJ, Hoffmann R, Hoffmann RT, Kettenbach J, et al. CT versus MR guidance for radiofrequency ablation in patients with colorectal liver metastases: a 10-year follow-up favors MR guidance. Eur Radiol 2023; 34: 4663-71. doi: 10.1007/s00330-023-10270-6
  26. Vovdenko S, Ali S, Ali H, Taratkin M, Morozov A, Suvorov A, et al. Contrast-enhanced ultrasound (CEUS) as a follow-up method after the focal treatment of renal tumors: systematic review and meta-analysis. Int Urol Nephrol 2024; 56: 3415-26. doi: 10.1007/s11255-024-04102-9
  27. Zirakchian Zadeh M, Yeh R, Kunin HS, Kirov AS, Petre EN, Gönen M, et al. Real-time split-dose PET/CT-guided ablation improves colorectal liver metastasis detection and ablation zone margin assessments without the need for repeated contrast injection. Cancers 2022; 14: 6253. doi: 10.3390/cancers14246253
  28. Bijlstra OD, Boreel MME, Van Mossel S, Burgmans MC, Kapiteijn EHW, Oprea-Lager DE, et al. The value of 18F-FDG-PET-CT imaging in treatment evaluation of colorectal liver metastases: a systematic review. Diagnostics 2022; 12: 715. doi: 10.3390/diagnostics12030715
  29. Delis SG, Dervenis C. Selection criteria for liver resection in patients with hepatocellular carcinoma and chronic liver disease. World J Gastroenterol 2008; 14: 3452. doi: 10.3748/wjg.14.3452
  30. Mazzone P. Preoperative evaluation of the lung resection candidate. Cleve Clin J Med 2012; 79(5 e-Suppl 1): S17-22. doi: 10.3949/ccjm.79.s2.04
  31. Partridge B, Rossmeisl JH, Kaloss AM, Basso EKG, Theus MH. Novel ablation methods for treatment of gliomas. J Neurosci Methods 2020; 336:108630. doi: 10.1016/j.jneumeth.2020.108630
  32. Llovet JM, Pinyol R, Yarchoan M, Singal AG, Marron TU, Schwartz M, et al. Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma. Nat Rev Clin Oncol 2024; 21: 294-311. doi: 10.1038/s41571-024-00868-0
  33. Wah TM, Irving HC, Gregory W, Cartledge J, Joyce AD, Selby PJ. Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. BJU Int 2014; 113: 416-28. doi: 10.1111/bju.12349
  34. Zhao Q, Wang J, Fu Y, Hu B. Radiofrequency ablation for stage < IIB nonsmall cell lung cancer: opportunities, challenges, and the road ahead. Thorac Cancer 2023; 14: 3181-90. doi: 10.1111/1759-7714.15114
  35. Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, et al. Soft tissue and visceral sarcomas: ESMO–EURACAN–GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2021; 32: 1348-65. doi: 10.1016/j.annonc.2021.07.006
  36. Van Der Lei S, Puijk RS, Dijkstra M, Schulz HH, Vos DJW, De Vries JJJ, et al. Thermal ablation versus surgical resection of small-size colorectal liver metastases (COLLISION): an international, randomised, controlled, phase 3 non-inferiority trial. Lancet Oncol 2025; 26: 187-99. doi: 10.1016/S1470-2045(24)00660-0
  37. Izumi N, Hasegawa K, Nishioka Y, Takayama T, Yamanaka N, Kudo M, et al. A multicenter randomized controlled trial to evaluate the efficacy of surgery vs. radiofrequency ablation for small hepatocellular carcinoma (SURF trial). J Clin Oncol 2019; 37(15 Suppl): 4002. doi: 10.1200/JCO.2019.37.15_suppl.4002
  38. Xu Y, Shen Q, Wang N, Wu PP, Huang B, Kuang M, et al. Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma. Chin J Cancer 2017; 36: 14. doi: 10.1186/s40880-017-0183-x
  39. Carriero S, Lanza C, Pellegrino G, Ascenti V, Sattin C, Pizzi C, et al. Ablative therapies for breast cancer: state of art. Technol Cancer Res Treat 2023; 22: 15330338231157193. doi: 10.1177/15330338231157193
  40. Ghosn M, Solomon SB. Current management of oligometastatic lung cancer and future perspectives: results of thermal ablation as a local ablative therapy. Cancers 2021; 13: 5202. doi: 10.3390/cancers13205202
  41. Eid M, Semaan K, Saad E, Saliby RM, Chehade REH, McGregor BA. The role of ablative therapy for primary and oligometastatic renal cell carcinoma. Kidney Cancer 2024; 8: 187-92. doi: 10.1177/24684570241292207
  42. Van Der Lei S, Puijk RS, Dijkstra M, Schulz HH, Vos DJW, De Vries JJJ, et al. Thermal ablation versus surgical resection of small-size colorectal liver metastases (COLLISION): an international, randomised, controlled, phase 3 non-inferiority trial. Lancet Oncol 2025; 26: 187-99. doi: 10.1016/S1470-2045(24)00660-0
  43. Vissing M, Pervan M, Pløen J, Schnefeldt M, Rafaelsen SR, Jensen LH, et al. Calcium electroporation in cutaneous metastases – a non-randomised phase II multicentre clinical trial. Eur J Surg Oncol 2023; 49: 106925. doi: 10.1016/j.ejso.2023.04.024
  44. Falk H, Lambaa S, Johannesen HH, Wooler G, Venzo A, Gehl J. Electrochemotherapy and calcium electroporation inducing a systemic immune response with local and distant remission of tumors in a patient with malignant melanoma – a case report. Acta Oncol 2017; 56: 1126-31. doi: 10.1080/0284186X.2017.1290274
  45. Frandsen SK, Gissel H, Hojman P, Tramm T, Eriksen J, Gehl J. Direct Therapeutic applications of calcium electroporation to effectively induce tumor necrosis. Cancer Res 2012; 72: 1336-41. doi: 10.1158/0008-5472.CAN-11-3782
  46. Tong H, Sun J, Fang J, Zhang M, Liu H, Xia R, et al. A machine learning model based on PET/CT radiomics and clinical characteristics predicts tumor immune profiles in non-small cell lung cancer: a retrospective multicohort study. Front Immunol 2022; 13: 859323. doi: 10.3389/fimmu.2022.859323
  47. Taeprasartsit P, Pathompatai C, Jusomjai K, Wibowo H, Sebek J, Prakash P. A personalized approach for microwave ablation treatment planning fusing radiomics and bioheat transfer modeling. In: Fei B, Linte CA, editors. Medical imaging 2020: image-guided procedures, robotic interventions, and modeling [Internet]. Houston, United States: SPIE; 2020 [cited 2025 Nov 12]. p. 105. Available at: https://www.spiedigitallibrary.org/conference-proceedings-of-spie/11315/2549790/A-personalized-approach-for-microwave-ablation-treatment-planning-fusing-radiomics/10.1117/12.2549790.full doi:10.1117/12.2549790
  48. Gordon JWH, Goel A, Martin RCG. Evaluation of recurrence risk in irreversible electroporation-treated pancreatic adenocarcinoma patients using radiomics signatures. Cancers 2025; 17: 2338. doi: 10.3390/cancers17142338
  49. Sang J, Ye X. Potential biomarkers for predicting immune response and outcomes in lung cancer patients undergoing thermal ablation. Front Immunol 2023; 14: 1268331. doi: 10.3389/fimmu.2023.1268331
  50. Reierson MM, Acharjee A. Unsupervised machine learning-based stratification and immune deconvolution of liver hepatocellular carcinoma. BMC Cancer 2025; 25: 853. doi: 10.1186/s12885-025-14242-5
  51. Giannone F, Sangiuolo F, Cassese G, Palucci M, Del Basso C, Lapergola A, et al. The impact of KRAS status on long-term outcomes after thermal ablation and hepatic resection for liver-only colorectal metastases: a new clue for tailoring surgical strategy on tumor biology? World J Surg 2025; 49: 1573-82. doi: 10.1002/wjs.12616
  52. Ni Z, Wu B, Li M, Han X, Hao X, Zhang Y, et al. Prediction model and nomogram of early recurrence of hepatocellular carcinoma after radiofrequency ablation based on logistic regression analysis. Ultrasound Med Biol 2022; 48: 1733-44. doi: 10.1016/j.ultrasmedbio.2022.04.217
  53. Wada Y, Takami Y, Ryu T, Uchino Y, Kugiyama T, Nomura Y, et al. Predictive factors for local recurrence after intraoperative microwave ablation for colorectal liver metastases. Cancers 2022; 15: 122. doi: 10.3390/cancers15010122
  54. Jiang H, Li B, Zheng T, Qin Y, Wu Y, Wu Z, et al. MRI-based prediction of microvascular invasion/high tumor grade and adjuvant therapy benefit for solitary HCC ≤ 5 cm: a multicenter cohort study. Eur Radiol 2024; 35: 3223-37. doi: 10.1007/s00330-024-11295-1
  55. Choi GH, Yun J, Choi J, Lee D, Shim JH, Lee HC, et al. Development of machine learning-based clinical decision support system for hepatocellular carcinoma. Sci Rep 2020; 10: 14855. doi: 10.1038/s41598-020-71796-z
  56. Séguier D, Adams ES, Kotamarti S, D’Anniballe V, Michael ZD, Deivasigamani S, et al. Intratumoural immunotherapy plus focal thermal ablation for localized prostate cancer. Nat Rev Urol 2024; 21: 290-302. doi: 10.1038/s41585-023-00834-y
  57. Sersa G, Teissie J, Cemazar M, Signori E, Kamensek U, Marshall G, et al. Electrochemotherapy of tumors as in situ vaccination boosted by immunogene electrotransfer. Cancer Immunol Immunother 2015; 64: 1315-27. doi: 10.1007/s00262-015-1724-2
  58. Xie L, Meng Z. Immunomodulatory effect of locoregional therapy in the tumor microenvironment. Mol Ther 2023; 31: 951-69. doi: 10.1016/j.ymthe.2023.01.017
  59. Sersa G, Ursic K, Cemazar M, Heller R, Bosnjak M, Campana LG. Biological factors of the tumour response to electrochemotherapy: review of the evidence and a research roadmap. Eur J Surg Oncol 2021; 47: 1836-46. doi: 10.1016/j.ejso.2021.03.229
  60. Li H, Zhou Y, Guo X, Zhang Q, Ding X. The effects of irreversible electroporation triggering anti-tumor immunity and the value of its combination with immunotherapy. J Interv Med 2023; 6: 107-10. doi: 10.1016/j.jimed.2023.07.005
  61. Haen SP, Pereira PL, Salih HR, Rammensee HG, Gouttefangeas C. More than just tumor destruction: immunomodulation by thermal ablation of cancer. Clin Dev Immunol 2011; 2011: 1-19. doi: 10.1155/2011/160250
  62. Llovet JM, Pinyol R, Yarchoan M, Singal AG, Marron TU, Schwartz M, et al. Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma. Nat Rev Clin Oncol 2024; 21: 294-311. doi: 10.1038/s41571-024-00868-0
  63. Chalabi M, Fanchi LF, Dijkstra KK, Van Den Berg JG, Aalbers AG, Sikorska K, et al. Neoadjuvant immunotherapy leads to pathological responses in MMR-proficient and MMR-deficient early-stage colon cancers. Nat Med 2020; 26: 566-76. doi: 10.1038/s41591-020-0805-8
  64. Patel SP, Othus M, Chen Y, Wright GP, Yost KJ, Hyngstrom JR, et al. Neoadjuvant–adjuvant or adjuvant-only pembrolizumab in advanced melanoma. N Engl J Med 2023; 388: 813-23. doi: 10.1056/NEJMoa2211437
  65. Hodi FS, Chesney J, Pavlick AC, Robert C, Grossmann KF, McDermott DF, et al. Combined nivolumab and ipilimumab versus ipilimumab alone in patients with advanced melanoma: 2-year overall survival outcomes in a multicentre, randomised, controlled, phase 2 trial. Lancet Oncol 2016; 17: 1558-68. doi: 10.1016/S1470-2045(16)30366-7
  66. Altun I, Demirlenk YM, Atar D, Cevik E, Gunduz S, Albadawi H, et al. Advances and challenges in interventional immuno-oncology locoregional therapies. J Vasc Interv Radiol 2024; 35: 164-72. doi: 10.1016/j.jvir.2023.10.009
  67. Kwak K, Yu B, Lewandowski RJ, Kim DH. Recent progress in cryoablation cancer therapy and nanoparticles mediated cryoablation. Theranostics 2022; 12: 2175-204. doi: 10.7150/thno.67530
  68. Ahmad MU, Walsh A, Kirane A. Review of tole of surgery with electroporation in melanoma: chemotherapy, immunotherapy, and gene delivery. J Clin Med 2024; 13: 3828. doi: 10.3390/jcm13133828
  69. Hong CW, Libutti SK, Wood BJ. Liposomal doxorubicin plus radiofrequency ablation for complete necrosis of a hepatocellular carcinoma. Curr Oncol 2013; 20: 274-7. doi: 10.3747/co.20.1266
  70. CIRSE - Cardiovascular and Interventional Radiological Society of Europe [Internet]. [cited 2026 Mar 18]. CIRSE. Available at: https://www.cirse.org/
  71. ESSO - European Society of Surgical Oncology [Internet]. [cited 2026 Mar 18]. ESSO. Available at: https://www.essoweb.org/
  72. Homepage - European Union of Medical Specialists [Internet]. UEMS Radiology. Available at: https://www.uemsradiology.eu/
  73. ESR | European Society of Radiology [Internet]. [cited 2026 Mar 18]. ESR. Available at: https://www.myesr.org/education/
  74. IASIOS - International Accreditation System for Interventional Oncology Services [Internet]. [cited 2026 Mar 18]. IASIOS. Available at: https://www.iasios.org
  75. Crocetti L, De Baére T, Pereira PL, Tarantino FP. CIRSE standards of practice on thermal ablation of liver tumours. Cardiovasc Intervent Radiol 2020; 43: 951-62. doi: 10.1007/s00270-020-02471-z
  76. Adam A, De Baére T, Bilbao JI, Gangi A, Helmberger T, Kenny L, et al. CIRSE standards of quality assurance in interventional oncology. [Standards of quality assurance]. 1st edition. Vienna: CIRSE; 2018.
  77. Home - European Cancer Organisation [Internet]. 2026 [cited 2026 Mar 17]. European Cancer Organisation. Available at: https://www.europeancancer. org/
  78. Gehl J, Sersa G, Matthiessen LW, Muir T, Soden D, Occhini A, et al. Updated standard operating procedures for electrochemotherapy of cutaneous tumours and skin metastases. Acta Oncol 2018; 57: 874-82. doi: 10.1080/0284186X.2018.1454602
  79. Insp-ECT - purposes and history [Internet]. 2026 [cited 2026 Mar 31]. Insp-ECT. Available at: https://www.insp-ect.org/
  80. He Z, Song G, Yang G, Fu X, Tian M, Zhu Y. Liver resection versus radiofrequency ablation for hepatocellular carcinoma: a systemic review and metaanalysis. Front Oncol 2025; 15: 1607338. doi: 10.3389/fonc.2025.1607338
  81. Kaufmann NC, Pereira PL. Real-world evidence: better than nothing or the future? A perspective on clinical evidence generation in interventional oncology. Cardiovasc Intervent Radiol 2025. Epub ahead of print. doi: 10.1007/s00270-025-04179-4
DOI: https://doi.org/10.2478/raon-2026-0030 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 153 - 165
Submitted on: May 4, 2026
Accepted on: May 11, 2026
Published on: Jun 26, 2026
In partnership with: Paradigm Publishing Services

© 2026 Julie Gehl, Philippe L Pereira, Colin P Cantwell, Frédéric Deschamps, Anja Kocijancic, Nina Schmidt, Rok Dezman, Greta Chlebopasevienė, Andrei Roman, Maja Cemazar, Gregor Sersa, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.