Image-guided ablation for pediatric malignant solid tumors: a review of modalities, evidence, and clinical applications.

Image-guided percutaneous ablation has evolved into an increasingly utilized approach in selected pediatric oncologic indications. The evidence base remains thinner than clinical adoption would suggest. Most published series are small, retrospective, and limited to single institutional experiences. This review synthesizes evidence from 1995 through early 2025 on radiofrequency ablation (RFA), cryoablation, microwave ablation (MWA), irreversible electroporation (IRE), and electrochemotherapy across malignant solid tumors in patients aged 18 years or younger. Hepatoblastoma has shown the steepest rising incidence among ablation-relevant solid tumors with an annual percent change of +2.17%. Five-year survival for bone tumors and soft tissue sarcomas remains near 60%. For malignant solid tumors, the evidence remains limited to small retrospective series with heterogeneous populations and short follow-up, precluding conclusions about survival benefit. Surgical resection and systemic chemotherapy remain the primary treatment for all malignant solid tumors discussed; ablation is reserved for relapsed, refractory, or surgically limited scenarios. A coordinated multicenter registry with standardized survival endpoints remains the most urgent unmet need in the field.