Treatment Of Malignant Liver Tumors Research Articles

US-Guide Microwave and Radiofrequency Ablation for Liver Tumors

Hepatocellular carcinoma and hepatic metastases are the common malignancy in Taiwan. Surgical resection remains the reference standard in the treatment of malignant liver tumors; however, a large number of patients have disease that is not amenable to surgical therapy. Therefore, several ablative treatment modalities have been developed for local control of liver tumors in patients with malignant hepatic tumors. Radiofrequency ablation (RFA) is the most frequently used of these methods because of its effectiveness, safety in both percutaneous and surgical settings, and relative ease of use. However, RFA is fundamentally restricted by the need to conduct electric energy into the body. The majority of tissue heating is thus due to thermal conduction, which decreases exponentially away from the source. RFA is most effective in the treatment of the hepatic tumors smaller than 3cm. Using multi-probes with switch-controller RFA system can create a larger ablated area for the malignant tumor and can enhance the therapeutic effect in the treatment of medium size (3 to 5 cm) malignant hepatic tumors. Microwave (MW) ablation offers many of the advantages of RF ablation while possibly overcoming some of the limitations. Since MW ablation does not rely on conduction of electricity into tissue, it is not limited by charring. Therefore, temperatures greater than 100°C are readily achieved, which potentially results in a larger zone of ablation, faster treatment time, and more complete tumor kill. In addition, MW ablation has a much broader power field than does RF ablation. This may allow for larger zones of thermal ablation and a more uniform tumor kill. Because the cooling effect of blood flow is most pronounced within the zone of conductive rather than active heating, a larger power field may also enhance treatment of perivascular tumors. MW ablation and multiple-probes RFA with switch controller are both promising new options in the treatment of malignant hepatic neoplasms.

CEUS in the Diagnosis and Treatment for Malignant Liver Tumors

Outline of the Lecture1.CEUS with Sonazoid is useful in the characterization of Liver Tumors.2.In RFA treatment, there are some HCC lesions, that are demonstrated or CT or MRI, can not be visualized by B-mode US alone.3.However, using defect re-perfusion imaging technique (re-injection of sonazoid for the defect at Kupffer phase, HCC nodules can be clearly demonstrated, resulting in making the RFA procedure possible.4.In addition, overlay imaging by use of CEUS, correct judgement of ablative margin becomes possible.

Comparison of percutaneous ablation technologies in the treatment of malignant liver tumors.

Tumor ablation is a minimally invasive technique used to deliver chemical, thermal, electrical, or ultrasonic damage to a specific focal tumor in an attempt to achieve substantial tumor destruction or complete eradication. As the technology continues to advance, several image-guided tumor ablations have emerged to effectively manage primary and secondary malignancies in the liver. Percutaneous chemical ablation is one of the oldest and most established techniques for treating small hepatocellular carcinomas. However, this technique has been largely replaced by newer modalities including radiofrequency ablation, microwave ablation, laser-induced interstitial thermotherapy, cryoablation, high-intensity-focused ultrasound ablation, and irreversible electroporation. Because there exist significant differences in underlying technological bases, understanding each mechanism of action is essential for achieving desirable outcomes. In this article, the authors review the current state of each ablation method including technological and clinical considerations.

Comparison of Percutaneous Ablation Technologies in the Treatment of Malignant Liver Tumors

Comparison of Percutaneous Ablation Technologies in the Treatment of Malignant Liver Tumors

Treatment of Malignant Liver Tumors by Radiofrequency Ablation Combined with Low-Frequency Ultrasound Radiation with Microbubbles

ObjectiveTo explore the therapeutic efficacy and safety of malignant liver tumor treatment by radiofrequency ablation (RA) combined with low frequency ultrasound radiation with microbubbles (LFURM).MethodsRetrospective analysis of 25 patients with malignant hepatic tumors treated by RA/LFURM in the Department of Hepatobiliary Surgery of Kunming General Hospital affiliated to Chengdu Military District, PLA from January 2010 to June 2011. Ultrasound guided RA was performed, which was followed one week later by LFURM. Basal contrast ultrasound, liver function tests, and serum alpha fetoprotein (AFP) were obtained, and repeated 3 and 6 months after treatment. T-test and chi-square were used to compare parametric and non-parametric variables respectively.ResultsIn 17 cases, gross tumor volume was significantly reduced 6 months after treatment while mean tumor showed a reduction of 50% compared to pre-treatment values. In 7 cases gross tumor volumes reduction was partial, but surrounding tumor tissue showed blood flow signals. One patient had no reduction in gross tumor volume. Levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alpha fetoprotein (AFP) decreased significantly 6 months after treatment (all p<0.05). No tumor recurrence was seen during the 6 month follow-up. Quality of life scores (QOL) were good in 21 patients (84%), improved in 2 patients (8%), unchanged in 1 patient (4%) and got worst in 1 patient (4%). Karnofsky scores (KPS) improved in 19 patients (76%), remained unchanged in 5 patients (2%) and got worst in 1 patient (4%). Both QOL and KPS changes were statistically significant (P<0.05).ConclusionRA/LFURM treatment of liver tumors is efficient and safe, and can reduce the gross tumor volumes and protect liver function.

Dual-phase CT angiography through the port-catheter system for hepatic arterial infusion chemotherapy using multislice CT: assessment of system dysfunction and impact on predicting clinical problems

Hepatic arterial infusion (HAI) chemotherapy is being explored for treatment of malignant liver tumors. Maintenance of HAI systems is important for effective treatment. To prospectively evaluate the efficacy of dual-phase CT angiography through the port-catheter system for HAI chemotherapy. This study enrolled 47 patients receiving HAI chemotherapy for malignant liver tumors who underwent dual-phase CT angiography through the port-catheter system using multislice CT. Using maximum intensity projection images reconstructed from vascular-phase CT imaging, hepatic arterial patency and catheter location were assessed. Using a combination of vascular- and perfusion-phase CT imaging, system dysfunction and clinical problems were evaluated. Dual-phase CT angiography was conducted 156 times. Stenosis and obstruction of the hepatic artery and catheter dislodgment were observed seven times in four patients and four times in three patients, respectively. Diagnostic accuracy using vascular-phase CT imaging was 100%. In addition, development of collateral blood supply to the liver and extrahepatic perfusion to the stomach were observed three times in three patients and twice in two patients, respectively. Overall, system dysfunction occurred 16 times in 12 patients, and system correction and treatment modification were required 11 times in 10 patients. In assessing system dysfunction and predicting clinical problems, the accuracy of dual-phase CT imaging was 100%. Dual-phase CT angiography through the port-catheter system is helpful for assessing catheter system dysfunction and predicting clinical problems in HAI chemotherapy.

Image Fusion as a New Postprocessing Method to Evaluate the Radiofrequency Ablation Zone After Treatment of Malignant Liver Tumors

We describe a manual segmentation and image fusion method to assess the relationship between liver tumors and the radiofrequency ablation zone depicted on cross-sectional imaging. Manual fusion of segmented images of hepatic tumors from a preprocedural scan with the ablation zone depicted on the postinterventional imaging examination may be used to create a composite image demonstrating the ablation margin. This technique may improve evaluation of the size of the ablation margin around the circumference of the tumor, thereby predicting which patients are more likely to incur local tumor recurrence.

Malignant Liver Tumors: Treatment with Percutaneous Microwave Ablation—Complications among Cohort of 1136 Patients

To report the complications for percutaneous microwave (MW) ablation for the treatment of malignant liver tumors and the possible risk factors for complications in a large series of patients. The study was approved by the institutional review board; informed consent was waived because of the retrospective design. Over a 13-year period, 1136 patients with 1928 malignant liver tumors underwent ultrasonographically guided percutaneous MW ablation (583 with a noncooled-shaft antenna and 553 with a cooled-shaft antenna). A total of 3697 MW ablation sessions (average, 1.8 sessions per patient) were performed. Mortality and treatment-related major and minor complications were documented. Data were subsequently analyzed to determine whether the major complication rate was related to antenna type, tumor size, tumor location, or number of MW sessions. Two deaths not directly attributable to MW ablation were encountered. Major complications occurred in 30 (2.6%) patients and included liver abscess and empyema (n = 5), bile duct injury (n = 2), perforation of the colon (n = 2), tumor seeding (n = 5), pleural effusion requiring thoracentesis (n = 12), hemorrhage requiring arterial embolization (n = 1), and skin burn requiring resection (n = 3). Minor complications included fever; pain; asymptomatic pleural effusion, gallbladder wall thickening, and arterioportal shunt; small stricture of the bile duct; and skin burn requiring no treatment. Use of noncooled-shaft antenna and an increased number of MW ablation sessions were associated with a higher rate of major complications (P < .05). MW ablation is a well-tolerated technique with an acceptably low rate of major complications for treatment of malignant liver tumors. Use of a cooled-shaft antenna, as well as fewer MW sessions, may help minimize major complications.

Image-guided thermal ablation of nonresectable hepatic tumors using the Cool-Tip™ radiofrequency ablation system

Percutaneous thermal ablation techniques have gained considerable attention as an alternative to surgery for the treatment of malignant liver tumors in selected patients. In particular, image-guided radiofrequency ablation (RFA) is increasingly being used for the local treatment of hepatocellular carcinoma, as well as for metastases to the liver. As a minimally invasive treatment option, this technique has several advantages compared with surgical resection. Benefits include reduction in morbidity and mortality, lower cost, suitability for real-time imaging guidance, use in an outpatient setting and use in patients who are not surgical candidates. The Cool-Tip™ RFA system has recently received US FDA approval for use in ablating nonresectable liver tumors. This article describes the principles and application of radiofrequency ablation for the treatment of nonresectable hepatic tumors along with the unique features of the Cool-Tip™ RFA system. Finally, a view into the future suggests that, as the trend towards minimally invasive treatment options for hepatic malignancies continues, RFA will assume increasing clinical application.

The contribution of transplantation to the treatment of liver tumors in children

Major progress has been achieved during the last decades in the treatment of malignant liver tumors in children, both in chemotherapy and surgical management. Chemosensitivity varies between tumor types, and radical resection remains essential to effect a cure. In tumors extensively involving a normal liver, in a diffuse or multifocal manner, radical resection cannot be accomplished with a partial hepatectomy. This has been the case for some instances of advanced hepatoblastoma and epithelioid hemangioendothelioma. In hepatoblastoma, current experience shows that results of primary liver transplantation with neoadjuvant chemotherapy are excellent with around an 80% 5-to-10-year disease-free survival rate. Epithelioid hemangioendothelioma is very rarely seen in children and may have a more malignant behavior than in adult patients, and liver transplantation may not be the best management option. In nonresectable hepatocellular carcinoma (HCC) developed on an otherwise normal liver, the results of liver transplantation are similarly poor to those obtained in adult patients, except in a few highly selected series fulfilling the Milano criteria. The experience with HCC is still very scarce in children. Incidental HCC associated with chronic liver disease does not seem to impact posttransplant survival. When they are symptomatic, however, indications for transplantation should be very selective regarding tumor size, multi-focality, vascular invasion and distant metastases.

Recommendations for the Reporting of Tissues Removed as Part of the Surgical Treatment of Malignant Liver Tumors

The Association of Directors of Anatomic and Surgical Pathology has developed recommendations for the surgical pathology report for primary and metastatic epithelial tumors in the liver. The recommendations are reported herein.

Recommendations for the Reporting of Tissues Removed as Part of the Surgical Treatment of Malignant Liver Tumors

The Association of Directors of Anatomic and Surgical Pathology has developed recommendations for the surgical pathology report for primary and metastatic epithelial tumors in the liver. The recommendations are reported herein.

Recommendations for the reporting of tissues removed as part of the surgical treatment of malignant liver tumors

The Association of Directors of Anatomic and Surgical Pathology (ADASP) has developed recommendations for the surgical pathology report for primary and metastatic epithelial tumors in the liver. These recommendations are reported herein.

Recommendations for the reporting of tissues removed as part of the surgical treatment of malignant liver tumors

The Association of Directors of Anatomic and Surgical Pathology (ADASP) has developed recommendations for the surgical pathology report for primary and metastatic epithelial tumors in the liver. These recommendations are reported herein.

Cryotherapy for liver tumors: current status, perspectives, clinical results, and review of literature.

Cryotherapy has gained importance as a locally ablative treatment option for patients with non-resectable liver tumors, especially metastases from colorectal cancer. We have used this technique since 1996 for the treatment of 77 patients with malignant liver tumors. Patient data was prospectively recorded and follow-up was until September 2002 or death. Fifty-five patients had colorectal cancer liver metastases, 16 metastases from other primaries and 6 had hepatoma. Forty patients had cryotherapy only and 37 had an additional liver resection. Morbidity and mortality were 22% and 1.3%, respectively. In 68% of patients with colorectal liver metastases and an elevated serum carcinoembryonic antigen-level preoperatively, it returned to the normal range following cryosurgery. For all 77 patients, median survival was 28 months with a 3- and 5-year-survival rate of 39% and 26%, respectively, and median survival was 29 months with a 3- and 5-year-survival rate of 44% and 26%, respectively, for the 55 patients with colorectal liver metastases. Local recurrence at the cryosite was observed in 13 of 65 patients (20%) with initially complete treatment. For cryotherapy to further establish as a treatment for malignant liver tumors in a time where many new local ablative techniques are developing, different goals need to be achieved. The trauma of the procedure and local treatment failure need to be minimized and survival results need to be optimized. Published studies and new possible fields of research regarding these goals are discussed.

Stereotactic body radiation therapy: an ablative treatment option for primary and secondary liver tumors.

Only a subset of patients with primary and secondary liver tumors are eligible for surgical resection because of either the presence of extrahepatic disease, increased number of hepatic lesions, the anatomical distribution of tumors within the liver, and/or general medical inoperability. Nonsurgical, ablative tumor treatment may benefit selected patients by preserving normal liver function. This review presents the concept and technology of stereotactic body radiation therapy and summarizes available clinical data describing applications in the treatment of malignant liver tumors. We present predominantly peer-reviewed data but also summarize recent clinical developments along with discussions of current ongoing and planned multicenter studies.

Ultrasound-guided percutaneous radiofrequency ablation for benign and malignant liver tumors

目的 评价经皮射频(PRFA)治疗肝脏良恶性肿瘤的效果、安全性及实用性.方法应用RF-2000射频仪和10电极LeVeen射频针经皮穿刺治疗肝脏恶性肿瘤114例153个病灶和良性肿瘤13例16个病灶,共计127例169个病灶.B超引导监测,局麻配合全身镇痛处理,对于肿瘤病灶大于2.5 cm者进行分层多点叠合毁损,大于5.0 cm或多发的恶性肿瘤配合肝动脉导管化疗栓塞术,随访观察治疗效果、并发症和生存情况.结果实施成功率100%,PRFA治疗肝脏恶性肿瘤并发症发生率6.14%(7/114),均保守治愈,无相关死亡.PRFA治疗肝脏良性肿瘤未遇并发症,病人均健在.114例肝脏恶性肿瘤病人的3个月、6个月、1年、2年、3年生存率分别为100%(114/114)、97.4%(111/114)、74.6%(85/114)、59.4%(41/69)和36.8%(7/19).结论 PRFA微创、有效、简捷、实用、可重复、相对安全,在肝脏恶性肿瘤的综合治疗中有重要价值,亦可作为肝脏良性肿瘤的一种选择疗法。

Viral oncolysis for malignant liver tumors.

Viral oncolysis represents a unique strategy to exploit the natural process of viral replication to kill tumor cells. Although this concept dates back nearly a century, recent advances in the fields of molecular biology and virology have enabled investigators to genetically engineer viruses with greater potency and tumor specificity. In this article we review the general mechanisms by which oncolytic viruses achieve their antineoplastic efficacy and specificity. We focus on the development of several classes of oncolytic viruses for the treatment of malignant liver tumors, including adenoviruses, vaccinia viruses, and herpes simplex viruses, and discuss the results of clinical trials for these viruses. We also describe results from our laboratory research program, which is focused on developing effective, liver tumor-specific Herpes simplex virus 1 mutants.

Announcing a New Series Entitled: New Approaches to the Treatment of Hepatic Malignancies

Involvement of the liver is the primary determinant of survival in patients with cancer. Over the past two decades, progress has been made in the treatment of hepatic malignancies. The number of patients that are cured of their disease continues to improve yet only the minority will achieve this end point. Active research continues with the goal of improving the outcome of patients with hepatic malignancies. This issue marks the beginning of a series of articles devoted to the new and emerging approaches to the treatment of hepatic malignancies. One topic will be reviewed in each of the next seven issues of the Annals of Surgical Oncology. In this issue, Dr. Curley 1 reviews the role of radiofrequency ablation in the treatment of hepatic malignancies. Patient selection, treatment approach, and the outcomes are described and critically assessed. Dr. Izzo will describe alternative thermal ablation techniques. The principles, clinical indications, and results of microwave and interstitial laser ablation will be critically reviewed. Drs. Mullen and Tanabe will review the cytotoxic mechanisms of oncolytic viruses and focus special attention on the development and use in the treatment of malignant liver tumors. Dr. Stoeltzing et al. will review the role of angiogenesis in colon cancer progression and metastatic spread. Clinical trials using new approaches that inhibit the angiogenic process will be discussed. Dr. Cusack will discuss the molecular mechanisms that influence cancer cell death in response to treatment. This article will explore the strategies to overcome this resistance and enhance chemotherapy sensitivity. Dr. Jaeck will review the impact of portal nodal metastases upon hepatic resection. He will present evidence to support performing hepatic resection in the presence of nodal metastases. Dr. Roh will review the changes occurring in the approach to the treatment of patients with hepatic malignancies. Classic contraindications to numerous therapies are being challenged and are leading to improved strategies to treat patients.

Kryotherapie primärer und sekundärer Lebertumoren

We assessed the morbidity, mortality and efficacy of cryotherapy for primary and secondary malignant liver tumours in a prospective case control study. Since 1996 we performed 77 cryosurgical procedures on 71 patients. 6 patients had hepatocellular carcinoma, the remainders metastases, mainly of colorectal origin (n = 49). Cryotherapy was used when a complete tumour resection was not feasible, but complete tumour destruction by cryotherapy seemed possible. Mean follow-up was 21 months. The mean number of lesions per patient was 2.6 (1-10) with a mean maximum diameter of 3.7 cm (1-11). In 36 of 71 patients cryotherapy was used in combination with liver resection. Morbidity and hospital mortality were 23 % and 2.8 %. In 25 of 34 patients with colorectal primary and preoperatively elevated CEA it returned to normal postoperatively (74 %). 40 of the 60 patients with "R0-treatment" developed tumour recurrence, 10 of these at the cryosite (17 %). Median survival for all patients (colorectal metastases) was 28 (29) months with a 3- and 5-year survival rate of 38 % (43 %) and 30 % (33 %), respectively. Cryotherapy is an effective parenchyma sparing method for the treatment of malignant liver tumours in a curative approach. It can be performed safely and a long-term local tumour control is achieved in a high percentage of patients. Survival rates following cryotherapy appear comparable to the results of liver resection. It seems justified to conduct a prospective randomised trial comparing liver resection and cryotherapy for resectable tumours.