Radiofrequency Ablation of Liver Tumours

Abstract

Surgery remains the only potentially curative treatment option for patients with primary hepatocellular cancer or secondary liver cancer. In selected patients with colorectal liver metastases, for example, a curative resection can provide a 25-40% 5-year disease-free survival rate, accompanied by good quality of life. However, only 10-20% of the patients with liver tumours are suitable for curative procedures, including resection or liver transplantation for early hepatocellular cancer. This low value is due to constraints such as: • tumour size • tumour location • extent of tumour • potential impacts on functional reserve • presence of cirrhosis (in patients with primary tumours) • poor general health. Since major hepatic resections still incur significant morbidity (5-15%) and mortality (1-3%), surgery is usually reserved for patients who are potentially curable. Of those patients who are not candidates for liver resection, a significant number die from ‘liver failure’, caused by tumour replacing functional hepatic parenchyma. In addition, the greater the ‘tumour-load’, the more likely is the chance of lung metastases. Therefore, local tumour control (by whatever means) may offer benefit. Treatment options currently available to patients with unresectable disease include: • tumour size • tumour location • extent of tumour • potential impacts on functional reserve • presence of cirrhosis (in patients with primary tumours) • poor general health. • Systemic or regional chemotherapy and hepatic artery embolization which have a limited effect on disease progression even with the newer drugs available, and are often accompanied by significant morbidity. • Ablative therapies including: chemical ablation (ethanol injection), cryotherapy, and thermal ablation, of which radiofrequency ablation is one example.