Percutaneous Treatment of Hepatic Neoplasms: A Review of Current Techniques

ABSTRACT

Primary and secondary hepatic neoplasms are major causes of cancer death worldwide. Although surgical resection traditionally has been considered the only curative therapy, only a minority of patients are operative candidates. Percutaneous methods of local tumor ablation are important and efficacious alternatives to surgical management in nonoperative candidates, as they spare normal liver and can be repeated to treat local recurrence or metachronous lesions. Current techniques of percutaneous, local hepatic tumor ablation are considered in two major categories: intralesional injection techniques (percutaneous ethanol injection, percutaneous acetic acid injection, and hot saline injection) and lesional heating techniques (percutaneous radiofrequency electrocautery, interstitial laser photocoagulation, percutaneous microwave coagulation, and high-intensity focused ultrasound). As the well-established percutaneous ablative method of choice for unresectable hepatocellular carcinoma (HCC), percutaneous ethanol injection therapy (PEIT) will be emphasized. Metastases are relatively resistant to percutaneous injection therapies, as their firm texture resists diffusion of these agents. Thus, the more technically complex and costly methods of lesional heating will be considered, as they have been developed with an emphasis on achieving success for treatment of metastases similar to that achieved with PEIT for HCC.

KEYWORDS:

Percutaneous ethanol injection therapy - radiofrequency electrocautery - interstitial laser photocoagulation - microwave coagulation therapy - liver neoplasms, therapy