Unresectable Liver Tumors Research Articles

Long Term Follow-Up of Patients of Intrahepatic Malignancies Treated with Iodine-125 Brachytherapy

Purpose/Objective: The prognosis of patients with unresectable primary and metastatic liver tumors is extremely poor. We investigated the role of intraoperative Iodine-125 (I-125) brachytherapy as a treatment option.

Preliminary experience with arterial chemoembolization for hepatoblastoma and hepatocellular carcinoma in children

The objective of this work was to test feasibility and efficacy of hepatic artery chemoembolization (HACE) in unresectable malignant liver tumors. Five patients aged from 1-12 years were treated in the Medical University of Gdansk from 1999 to 2002. All had locally advanced tumors, which did not respond to systemic chemotherapy: four, hepatoblastoma (HB) and one, hepatocellular carcinoma (HCC). Arteriography was performed and chemoembolization suspension (cisplatin + doxorubicin + mitomycin mixed with lipiodol) was injected, followed by gelatin foam particles. The procedure was performed one to three times in each patient. In four patients (three, HB, one, fibrolamellar HCC), tumor response was observed, with decrease in the diameter of the mass of 25-33% and fall in the AFP level of 83-99%. One child with HB was non-evaluable due to early death caused by systemic myelotoxicity. Two patients (2 HB) underwent macroscopically complete tumor resection, 1 is alive and well, and 1 died at the end of surgery for an unknown reason (possibly related to cardiotoxicity of earlier systemic chemotherapy). One HB patient was successfully transplanted after two HACE courses. The only HCC patient died because of pulmonary oil embolism immediately after the third HACE course. HACE can lead to tumor regression in most cases and may be considered an alternative for patients with unresectable liver tumors who do not respond to primary systemic chemotherapy and are not candidates for liver transplantation for various reasons.

Chirurgische Therapie von Lebertumoren: Resektion vs. Ablation

A few years ago surgical resection was the only treatment modality for primary and metastatic liver tumors. However, most of the liver tumors are diagnosed at advanced stage and are unresectable. Criteria for unresectability are: uncontrolled extrahepatic disease, extensive intrahepatic tumor growth, insufficient remnant liver volume and severe co-morbid disease. Several therapeutic strategies have been developed to deal with primarily unresectable tumors. A downstaging ("downsizing") of hepatocellular carcinoma (HCC) can be reached by transarterial chemoembolisation (TACE) or local tumor ablation using ethanol injection, cryosurgery and radiofrequency. Preoperative unilateral portal vein embolization resulting in hypertrophy of the remnant liver volume permits to resect some patients with former unresectable liver tumors. Furthermore, liver transplantation is an option for patients with early stage HCC and liver cirrhosis. Preoperative downstaging of colorectal metastases can be achieved with neoadjuvant chemotherapy, whereas TACE, ethanol injection and liver transplantation are no established options for these patients. So far, there are no standardized guidelines for the treatment of patients with unresectable primary or metastatic liver tumors. In this review we aim to describe the different approaches suggested in the literature and to present our algorithms for the management of patients with liver tumors.

Role of radiofrequency ablation for liver malignancies

Radiofrequency ablation (RFA) is commonly used to treat unresectable malignant liver tumours. It can achieve effective local tumour control and the maximal normal liver parenchyma can be preserved. In recent years, there has been a tremendous expansion in the application of RFA for patients with malignant liver tumours. However, the therapeutic effect of this local ablation treatment needs to be balanced against its risks and possible local failure. The present review focuses on the role of RFA for liver malignancies, with special attention to the indication, approaches, complications, survival benefits, combination therapies and comparison with other treatment modalities. Despite favourable results of most clinical studies of RFA, the associated risks and tumour recurrence of this treatment modality should not be underestimated. Careful patient selection, meticulous RFA techniques, and prompt treatment of residual and recurrent tumours are necessary to ensure a better outcome after RFA. Until recently, there has been no strong evidence showing that RFA can replace any other treatment modalities in the management of liver tumours. Nonetheless, more convincing evidence by randomized trials is required for the establishment of a treatment protocol of RFA for patients with liver malignancies.

A mouse model for developing treatment for secondary liver tumors

Metastatic colorectal cancer is the second most common cause of cancer mortality. The liver is a common site of metastasis and only a minority of patients with liver metastases are candidates for potentially curative surgical resection. The treatment of patients with unresectable liver tumors is a major clinical problem and survival remains low. Many animal models of hepatic metastasis do not result in disease which resembles the advanced cancer setting. The purpose of this study was to establish a murine model for use in the evaluation of therapy for secondary liver cancer. Human colon cancer cells were injected directly into the portal vein of nude mice. Magnetic resonance imaging (MRI), performed weekly, was used to follow the time-course and characteristics of tumor growth. As expected, tumor size increased proportionately with time, following inoculation, and the MRI images correlated well with gross pathology findings at necropsy with respect to both tumor size and location. The tumors retained important morphology and biological characteristics of human colon cancer. Mice bearing liver metastasis were treated with irinotecan or drug vehicle. MRI evaluation pre/post-therapy gave an objective measure of therapeutic response. Irinotecan therapy was able to double the survival (median 76-93 days) compared to vehicle alone (median 43-46 days). This murine model is reproducible, rapid, inexpensive and has an excellent success rate for the development of liver metastasis (100%). When used in conjunction with small animal MRI, this model allows the efficient evaluation of the therapeutics of liver metastasis without the use of repeated laparotomy or splenectomy and without requiring large numbers of animals undergoing terminal experiments.

Immunoembolization of malignant liver tumor with granulocyte/macrophage colony stimulating factor (GM-CSF) and ethiodized oil followed by gelatin sponge pledgets: The final results of phase I/IIa study

2514 Background We have developed a novel treatment approach for liver tumors: Immunoembolization with GM-CSF. In this approach, liver tumors are embolized with gelatin sponge particles after infusing a mixture of ethiodized oil and recombinant human GM-CSF (Leukine, Berlex Laboratories). A phase I/IIa study was conducted to investigate the safety and effectiveness of this treatment. Methods Patients with surgically unresectable malignant liver tumors were enrolled. The treatments were given every four weeks until maximum clinical benefit. Toxicity was assessed using the WHO criteria. The primary endpoint included dose limiting toxicity and maximum tolerated dose (MTD). Various dose levels of GM-CSF (25 mcg-2,000 mcg) were tested. Results In 39 patients with liver tumors (34 uveal melanoma, 4 skin melanoma, 1 hepatocellular carcinoma), there was no substantive toxicity observed up to the 1,000 mcg dose level. One of 6 patients at the 1,500 mcg dose level and 2 of 10 patients at the 2,000 mcg dose level developed grade 3/4 toxicity (transient elevation of alkaline phosphatase, n=1; significant liver pain, n=2; acute respiratory failure related to narcotics, n=1). There were no treatment-related deaths and MTD was not reached up to the dose level of 2,000 mcg. Subset analyses on uveal melanoma patients demonstrated 9 PR and 12 SD in 31 evaluable patients. With median follow-up of 29.8 months, the median overall survival of “intent to treat” patients was 14.5 months (range 1.5–42.6 months) and the projected one-year survival rate was 61.4% (CI 43.0–79.7%). In 3 of 6 patients whose extra-hepatic metastases were removed after immunoembolization, significant inflammatory changes were found in remote metastases. Conclusions Immunoembolization with GM-CSF is a safe and feasible approach. Encouraging preliminary results in metastatic uveal melanoma patients warrants a further clinical study for this disease. No significant financial relationships to disclose.

Image-guided Tumor Ablation: Standardization of Terminology and Reporting Criteria

The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency (RF), laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's intention that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes. The intent of this standardization of terminology is to provide an appropriate vehicle for reporting the various aspects of image-guided ablation therapy.

Radiofrequency ablation for malignant liver tumor

Radiofrequency ablation (RFA) has been widely practiced to treat unresectable malignant liver tumors. It has the merits of localized tumor ablation and preservation of maximal normal liver parenchyma. In recent years, there has been a tremendous expansion in the application of RFA for patients with malignant liver tumors. However, the therapeutic effect of this local ablation treatment needs to be balanced against its risks and possible local failure. This review focuses on the current status of RFA for malignant liver tumors, with special attention to the indication, approaches, complications, survival benefits, combination therapies, and comparison with other treatment modalities. Although the results of most clinical studies of RFA seem favorable, the associated risks and tumor recurrence should not be underestimated. Careful patient selection, meticulous RFA techniques, and prompt treatment of residual and recurrent tumors are necessary to ensure a better outcome after RFA. Until recently, there has been no strong evidence showing that RFA can replace any other treatment modalities in the management of liver tumors. Nonetheless, more convincing evidence by randomized trials is required for the establishment of a treatment protocol of RFA for patients with malignant liver tumors.

Complications of radiofrequency ablation in hepatocellular carcinoma

Radiofrequency thermal ablation has been accepted as a promising technique to treat unresectable liver tumors. However, any interventional procedure should be performed only if the procedure is safe, with minimal morbidity and mortality rates. Recently, three separate multicenter surveys have reported acceptable morbidity and mortality rates for a minimally invasive technique. The mortality rate ranged from 0.1% to 0.5%, the major complication rate ranged from 2.2% to 3.1%, and the minor complication rate ranged from 5% to 8.9%. The most common causes of death were sepsis and hepatic failure, and the most common complications were intraperitoneal bleeding, hepatic abscess, bile duct injury, hepatic decompensation, and grounding pad burns. Minor complications and side effects are more common than major complications, but most of them are transient and self-limiting. Several strategies for avoiding or limiting the impact of complications after radiofrequency ablation are recommended: (a) careful patient selection, (b) combined treatment with other techniques when appropriate, (c) selection of the most appropriate guiding modality and approach, and (d) early detection and appropriate management of any major complications. Knowledge of the broad spectrum of complications and relevant management enables the operator to minimize the incidence and effect of any complications that occur after radiofrequency ablation.

Internal radiation therapy of liver tumors: Qualitative and quantitative magnetic resonance imaging of the biodistribution of holmium‐loaded microspheres in animal models

In internal radiation therapy of unresectable liver tumors, microspheres containing a radionuclide are injected in the hepatic artery to achieve a preferential deposition of microspheres in the lesions. In this study, MR imaging techniques for qualitative and quantitative assessment of the biodistribution of holmium-loaded microspheres (HoMS) were investigated for their use in selective internal radiation therapy of liver tumors. To achieve this goal, the relaxivity of HoMS was first investigated in gel experiments. The resultant calibration curve was subsequently employed to quantify the biodistribution of HoMS administered to 13 excised rabbit livers and to the livers of 3 live rabbits with an implanted tumor. Finally, the feasibility of MR imaging of the biodistribution during treatment of a large animal was investigated by MR imaging of hepatic administration of HoMS to a live pig. Overall, the study showed that MRI can clearly depict the biodistribution of HoMS, but that quantification by means of the gel calibration curve yields an underestimation that increases for higher amounts of HoMS. The observed underestimation is tentatively attributed to accumulations of HoMS in larger liver vessels. The exploratory quantification experiments suggest the feasibility of MR dosimetry.

Review of Asian experience of thermal ablation techniques and clinical practice

The field of image-guided tumour ablation has gained great attention from Asian physicians because it represents a safe and effective technique for many commonly seen tumours in this population, showing minimal morbidity and excellent local control rates. Based on the current survey data from Asian physicians who are currently performing image-guided tumour ablation, thermal ablation has been mainly performed for patients with unresectable liver tumours. Radiofrequency ablation has replaced many other local ablation techniques such as microwave or ethanol ablation in treating small focal hepatic tumours for the last 5 years. Surgery and transcatheter arterial chemoembolization also have a unique role as curative and palliative treatment options for patients with more extensive tumour burden. Although radiofrequency ablation represents a paradigm shift in local therapy, more sophisticated strategies to enhance the therapeutic efficacy are necessary and more randomized and controlled investigations to estimate its clinical benefit are warranted.

Real-time spectroscopic assessment of thermal damage: implications for radiofrequency ablation.

Radiofrequency ablation (RFA) is an evolving technology used to treat unresectable liver tumors. Currently, there is no accurate method to determine RFA margins in real-time during the procedure. We hypothesized that a fiber-optic based spectroscopic monitoring system could detect thermal damage from RFA in real-time. Fluorescence (F) and diffuse reflectance (Rd) spectra were continuously acquired from within the expected ablation zone during canine hepatic RFA using a fiber-optic microinterrogation probe (MIP). The F and Rd spectral feedback were continuously monitored and ablations were stopped based on changes in spectra alone. After each ablation, the MIP tract was marked with India ink and the ablation zone was excised. The relationship of the MIP to the zone of ablation was examined grossly and microscopically. F and Rd spectral changes occurred in three characteristic phases as the ablation zone progresses past the MIP. Phase 1 indicates minimal deviation from normal lives. Phase 2 occurs as the MIP lies within the hemorrhagic zone of the ablated tissue. Phase 3 correlates with complete tissue coagulation. The absolute magnitude of spectral change correlates with the gross and histologic degree of thermal damage. Optical spectroscopy is a technology that allows real-time detection of thermal tissue damage. In this study, both F and Rd spectroscopy accurately defined the advancing hemorrhagic edge of the zone of ablation and the central coagulation zone. These results suggest that F and Rd spectroscopy can be used to create a real-time feedback system to accurately define RFA margins.

Phase II study of lipiodol chemoembolization with cisplatin and thiotepa with oral thalidomide for primary liver cancer and liver metastases

4137 Background: Lipiodol chemoembolization of the liver (LCE) can result in tumor shrinkage in part by causing abrupt devascularization and hypoxia in tumor-bearing regions. Regrowth of tumors is accompanied by neovascularity. Adding an antiangiogenesis agent like thalidomide after LCE may potentially improve the antitumor response. We have previously reported on LCE using cisplatin (DDP) and thiotepa(TT) in patients (pts). with unresectable liver tumors (LT) In this pilot trial we studied the feasibility of combining LCE with DDP and TT followed by oral thalidomide in pts with LT. Methods: Pts with LT with measurable disease by CT/MRI scan had LCE. DDP 100 mg/m2 and TT 24 mg/m2 were infused via hepatic artery over 15–20 min. On days 4–59 thalidomide was given at an initial dose of 100 mg po daily with weekly increments of 100 mg to a maximum of 400 mg daily. Followup CT/MRI scans were repeated every 2–3 months. LCE was repeated every 2–3 months in stable/responding pts. Results: 18 pts were entered into the study. Diagnoses included hepatoma ( HB 14 pts), ocular melanoma (3), and adenocarcinoma (1). 6 pts could not have embolization due to portal vein occlusion and received chemotherapy only. 12 pts had LCE. 9 pts had 1 course, 2 pts had 2 courses, and 1 pt had 4 courses of therapy. 5 pts had prior chemotherapy. All 12 pts with LCE were evaluable for response and toxicity. 2 HB pts had response 18 and 12 months. 1 melanoma pt had stable disease 5 months. Toxicity was reversible, usually mild and included abdominal pain, leukopenia and thrombocytopenia, nausea, fatigue, transient transaminase elevation, skin rash, and fever. Other toxicities include ototoxicity, and peripheral neuropathy. Conclusions: LCE with cisplatin and thiotepa followed by thalidomide is feasible and toxicity manageable. Durable responses observed in HB is encouraging and accrual is continuing. No significant financial relationships to disclose.

Phase II study of lipiodol chemoembolization with cisplatin and thiotepa with oral thalidomide for primary liver cancer and liver metastases

4137 Background: Lipiodol chemoembolization of the liver (LCE) can result in tumor shrinkage in part by causing abrupt devascularization and hypoxia in tumor-bearing regions. Regrowth of tumors is accompanied by neovascularity. Adding an antiangiogenesis agent like thalidomide after LCE may potentially improve the antitumor response. We have previously reported on LCE using cisplatin (DDP) and thiotepa(TT) in patients (pts). with unresectable liver tumors (LT) In this pilot trial we studied the feasibility of combining LCE with DDP and TT followed by oral thalidomide in pts with LT. Methods: Pts with LT with measurable disease by CT/MRI scan had LCE. DDP 100 mg/m2 and TT 24 mg/m2 were infused via hepatic artery over 15–20 min. On days 4–59 thalidomide was given at an initial dose of 100 mg po daily with weekly increments of 100 mg to a maximum of 400 mg daily. Followup CT/MRI scans were repeated every 2–3 months. LCE was repeated every 2–3 months in stable/responding pts. Results: 18 pts were entered into the study. Diagnoses included hepatoma ( HB 14 pts), ocular melanoma (3), and adenocarcinoma (1). 6 pts could not have embolization due to portal vein occlusion and received chemotherapy only. 12 pts had LCE. 9 pts had 1 course, 2 pts had 2 courses, and 1 pt had 4 courses of therapy. 5 pts had prior chemotherapy. All 12 pts with LCE were evaluable for response and toxicity. 2 HB pts had response 18 and 12 months. 1 melanoma pt had stable disease 5 months. Toxicity was reversible, usually mild and included abdominal pain, leukopenia and thrombocytopenia, nausea, fatigue, transient transaminase elevation, skin rash, and fever. Other toxicities include ototoxicity, and peripheral neuropathy. Conclusions: LCE with cisplatin and thiotepa followed by thalidomide is feasible and toxicity manageable. Durable responses observed in HB is encouraging and accrual is continuing. No significant financial relationships to disclose.

Local ablation for unresectable liver tumors: is thermal best?

Hepatic resection remains the "gold standard" for patients with resectable disease. Nevertheless, for a variety of reasons this is not feasible for the majority of patients. A wide range of locally ablative techniques has been developed for use in these patients with the aim of improving survival. Unfortunately, as with many recent techniques in surgery, much of the development of these methods, and particularly their introduction clinically, has not been based on sound scientific data. The relative merits and limitations of the more commonly used techniques are discussed, although this lack of prospective, randomized data precludes firm conclusions to be drawn from many of the studies reported. By far the most popular methods now employed, thermal techniques have certain limitations, particularly when treating tumors adjacent to major vascular or biliary structures. The authors believe that this situation represents the "niche" for which ablative techniques may ultimately find their logical application, where a single awkwardly placed metastasis deems a patient unresectable. If such a metastasis can be completely and safely ablated, a potentially curative resection may then become a realistic option. The relatively new, nonthermal technique of hepatic electrolysis has been extensively studied and shown to be safe and effective in close proximity to major intrahepatic veins due to a subtle electrochemical action rather than a rapid "burn". This technique is discussed in the context of other, more traditional thermal methods of ablation.

A mathematical model for preoperative planning of radiofrequency ablation of hepatic tumors.

Radiofrequency ablation (RFA) is rapidly evolving as an effective minimally invasive technique for the treatment of small and unresectable liver tumors. A potential cause of treatment failure is the inability to determine the optimum number of overlapping ablations needed to completely destroy tumors larger than the size of a single ablation. To clarify this relationship, we performed a mathematical evaluation that enables us to accurately estimate the number of ablations needed to completely ablate larger tumors. This estimation is based on the assumptions that complete ablation of the surface of a target tumor, including its blood supply, would completely destroy the tumor and that the tumor and ablations produced are perfectly spherical. The smallest possible number of partially overlapping ablations that would completely cover the surface of the target tumor is the same as the number of faces on a regular polyhedron that has a circumscribing diameter equal to or greater than the diameter of the target sphere. This mathematical analysis shows that for a 5-cm ablation device, tumors with diameters ranging between 3.01 and 3.30 cm will require at least four ablations. Tumors between 3.31 and 4.12 cm require six overlapping ablations, and tumors between 4.13 and 6.23 cm require 12 overlapping ablations. The number of ablations needed for larger tumors and for 3-, 4-, 6-, and 7-cm ablation devices are also determined. The smallest number of ablations required to completely ablate a spherical target tumor larger than the size of the ablation sphere increases dramatically as tumor size increases. Because this model is geometrically optimized, even a small change in the position of the ablation spheres with respect to the target sphere can leave potentially unablated tumor and thus result in treatment failure.

Die Radiofrequenz-Koagulation bei der nicht-anatomischen Resektion der Milz -Ein Fallbericht

Radiofrequency ablation is used in our Department of Surgery in cases of unresectable liver tumors. The case of a 22-year old male, who underwent nonanatomical resection of the spleen for trauma, is briefly reported. Splenic resection with the use of the radiofrequency needle could be performed safely and easily without complications. We use radiofrequency coagulation routinely in cases of blunt trauma of the spleen and liver.

Radiotherapy of liver malignancies. From whole liver irradiation to stereotactic hypofractionated radiotherapy.

Until recently radiotherapy of hepatic malignancies has played a limited role due to the well-known limited radiotolerance of the liver. The aim of this paper is to review the available data on the risk of radiation-induced liver disease (RILD) and to define the modern role of radiotherapy in the management of patients with metastatic or primary liver malignancies. The advent of three-dimensional conformal treatment planning with dose-volume histogram analysis has made the study of partial liver irradiation possible. Limited portions of the liver may withstand high doses of radiation with minimal risk of RILD. Patients with solitary unresectable liver tumors may be treated with high-dose radiotherapy with curative intent. Recently, the feasibility of stereotactically guided treatment techniques with a single fraction or few treatment sessions has been explored in numerous institutions. The radiation tolerance of the whole liver found by several investigations is in the order of approximately 30 Gy, which seriously restricts its clinical application. The role of whole liver irradiation therefore appears of limited benefit in the palliation of patients with multiple liver metastases. The use of three-dimensional conformal techniques has made partial liver irradiation possible to doses in the 70-80 Gy range with conventional fractionation. At least two published series have reported improved local control and survival rates with dose escalation with three-dimensional conformal radiotherapy in patients with unresectable liver metastases. Similar outcomes have been recently reported with single dose (or hypofractionated) stereotactic radiotherapy both in metastatic and primary hepatic malignancies with minimal morbidity. Accurate target delineation and treatment reproducibility are the key to the success of this novel treatment approach, and specific treatment planning techniques and patient setup procedures must be developed to implement it. Stereotactic high-dose radiotherapy is technically feasible for the treatment of inoperable liver malignancies, with the potential of high local control and low morbidity. Definitive evidence on the clinical advantages of this technique over other more established treatments can only be gathered from well-designed clinical studies.

Neoadjuvant Transarterial Chemoembolization (TACE) before Percutaneous MR-guided Laser-induced Thermotherapy (LITT): Results in Large-sized Primary and Secondary Liver Tumors

Summary Objectives: To evaluate the clinical value of neoadjuvant transarterial chemoembolization (TACE) before MR-guided laser-induced thermotherapy (LITT) for different large-sized liver tumors. Materials and methods : Repeated TACE were performed in 289 patients (mean 4.1 per patient) with unresectable HCC (n = 48) or liver metastases (n = 241) in a neoadjuvant intention using 10 mg/m 2 mitomycin as chemotherapeutic agent and 10 ml/m 2 lipiodol and microspheres for vessel occlusion. Tumor volume was measured by MR-imaging. As soons as the diameter of the tumor was observed to have decreased to less than 50 mm, the patients were treated with MRI-guided LITT 4 to 6 weeks after embolization. Survival rates of the different liver tumors of the combined protocol were compared to the results of the patients who were treated only with TACE or with the results of the patients who were treated directly with LITT. Results: In the neoadjuvant group repeated TACE enabled a reduction in tumor size and tumor perfusion in 166 patients (80 cases of metastases of colorectal cancer, 39 cases of metastases of breast cancer, 12 cases of metastases of other primary tumors, 3 cases of carcinoids and 32 cases of HCC), forming the basis of the performance of 322 (mean 2.0) MR-guided LITT procedures. The median survival period for patients with HCC was after the first treatment 25.0 months for the TACE group, 33.3 months for the LITT group and was statistically significant higher with 36.0 months in the patients with the combined treatment. In contrast to this the median survival for patients with colorectal liver metastases was 15.2 months for the TACE group, 23.6 months for the neoadjuvant treated patients and 32.6 months for the patients treated only with LITT. Conclusion: The combined treatment protocol (TACE followed by MR-guided LITT) appears to be a safe and effective treatment of large unresectable liver tumors. The combination of TACE and LITT results in significant superior survival rates in comparison to the results of TACE alone. HCC showed a better response to the treatment than liver metastases.

Radiofrequency ablation of unresectable liver tumours

Unresectable liver tumours have a dismal prognosis. Treatment with systemic or regional chemotherapy rarely results in a durable complete response. Radiofrequency ablation is a novel technique to achieve local destruction, which can be repeated and has been shown to be safe and effective.