Thermal and Nonthermal Liver Ablation: Mechanistic Foundations, Clinical Implementation, Immunologic Trial Design, and Artificial Intelligence

Recent advancements in ablative therapies within interventional radiology have revolutionized the management of various pathologic conditions, particularly in cancer treatment. These techniques offer precise and effective local-regional treatment, and their mechanisms of action could have important implications for treatment efficacy and potential applications. This review article evaluates thermal approaches such as cryoablation, radiofrequency ablation, microwave ablation, laser-induced thermotherapy, and high-intensity focused US as well as nonthermal methods such as irreversible electroporation and histotripsy. This article examines the bioeffects of these technologies, including their impact on the immune system. The effectiveness of various ablative technologies is evaluated, particularly in treating primary and secondary liver tumors. Technologic advancements in real-time imaging and minimally invasive techniques have greatly improved treatment precision, offering substantial advantages over traditional surgical approaches. Combining ablation with systemic therapies, such as chemotherapy or immunotherapy, can improve outcomes, and guidance is provided to inform future ablation-immunotherapy trials. Future directions include integrating artificial intelligence to provide real-time feedback during procedures, perform certain procedural tasks, and optimize treatment regimens. This article emphasizes the critical role of interventional radiology in advancing oncologic care, highlighting its potential for further innovation and improvement of therapeutic strategies.