Thermal ablation therapies have been used for a long time under clinical investigation as a potential alternative to traditional surgery. Being minimally invasive treatment of localized tumors, thermal therapies can be used to treat patients who are not eligible for surgery or who refuse surgery and are increasingly used as a bridge to liver transplantation in patients with hepatocellular carcinoma. Hyperthermal thermal ablation techniques uses heat to thermally destroy cancer cells, and include mainly microwave, radiofrequency and laser ablation. Over microwave and radiofrequency, the laser holds good promises for clinical application of thermal therapy, taking advantage of the small and flexible fiber optic applicators guiding laser energy into deep-lying tumors, which makes the procedure also safe and feasible. LA utilizes very fine needles to insert the fibers (< 1mm) into the lesion, and such a characteristic makes LA particularly safe for the treatment of nodules with difficult location. However, there are still some challenges to be faced. The tissue-specific characteristics, including blood perfusion, can affect in unpredictable ways the final therapeutic outcome. Additionally, as always happens for any thermal ablation procedure, the laser parameters (power, position, and treated shape) are usually set before the procedure without any modulation during the procedure. This approach can cause both the insufficient delivery of the therapeutic heat to the tumor boundary and the uncontrollable heating of delicate and healthy structures close to the target, such as blood vessels and nerves. For all these reasons, the availability of a system for real-time monitoring of the effects of the treatment is highly demanded. Improvements in all these fields will bring to a more accurate and safe tumor removal.
