Local Treatment for Metastatic Liver Tumors: Is That Your Final Answer

Abstract

ment fields vs. a single field, and a host of other technical issues vary from report to report. Patients with primary and metastatic tumors are treated. Unfortunately, the only common thread is that the patients generally represent small, nonrandomized, uncontrolled trials. If we are to make any meaningful progress toward clarifying rational treatment of such unresectable hepatic In this issue, Wemyss-Holden et al., from the Department of Surgery, University of Adelaide, Australia, describe their initial experience with electrolytic treatment of metastatic liver tumors in a rat model. They point out that Chinese physicians have been using electrolysis for several years to treat a variety of malignancies. The feasibility of using electrolysis is nicely demonstrated in their experimental model. neoplasms, then prospective, randomized trials must be implemented. Considering that perhaps only 20% of metThus, electrolysis may soon be added to the growing list of local treatments for unresectable liver tumors, inastatic liver tumors are surgically resectable, and that the best local therapy for unresectable tumors is unknown, cluding ethanol injection, cryotherapy, laser photocoagulation, and radiofrequency ablation. Each approach has accrual should not be difficult. Patients should be stratified according to primary vs. metastatic disease, as current been shown to offer some response in unresectable hepatic tumors, both primary and metastatic. The treatment is series often include a confusing mixture of both. The expenditure of precious health care dollars on the expensbeing administered intraoperatively during either laparotomy or laparoscopy, and even percutaneously. The size ive equipment alone should prompt a study to establish effective local therapy. of acceptable tumors, the margin around treated tumors, the sequence of freezing/thawing, the number of times The final answer to optimal local treatment of unresectable liver tumors ... controlled, randomized trials. the process is repeated, the energy used, multiple treat-