Semin intervent Radiol 2010; 27(3): 255-260
DOI: 10.1055/s-0030-1261783
© Thieme Medical Publishers

Percutaneous Ablation of Hepatic Tumors

James R. McCarley1 , Michael C. Soulen1
  • 1Division of Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
20 August 2010 (online)

ABSTRACT

The liver is a common site of both primary and secondary malignancy resulting in significant morbidity and mortality. Careful patient evaluation and triage allows for optimal utilization of all oncologic therapies, including radiation, systemic chemotherapy, surgery, transarterial therapies, and ablation. Although the role of interventional oncologists in the management of hepatic malignancies continues to evolve, the use of percutaneous ablation therapies has proven to be an effective and minimally invasive modality for treatment. Percutaneous ablation therapies have diversified from direct ethanol injection to multiple modalities including radiofrequency ablation (RFA), cryoablation, acetic acid injection, laser ablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation. RFA is the most commonly utilized modality for hepatic interventions and has proven efficacy in both hepatocellular carcinoma and colorectal carcinoma metastases. Although tumor size remains a challenge, combination therapies and new device innovations continue to allow for improved ablation zones and more durable results.

REFERENCES

  • 1 Livraghi T, Festi D, Monti F, Salmi A, Vettori C. US-guided percutaneous alcohol injection of small hepatic and abdominal tumors.  Radiology. 1986;  161(2) 309-312
  • 2 El-Serag H B, Rudolph K L. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis.  Gastroenterology. 2007;  132(7) 2557-2576
  • 3 World Health Organization .Health statistics and health information systems. Available at: http://www.who.int/healthinfo/morttables/en/index.html Accessed October 1, 2009
  • 4 Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun M J. Cancer statistics, 2009.  CA Cancer J Clin. 2009;  59 225-249
  • 5 Solbiati L, Livraghi T, Goldberg S N et al.. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients.  Radiology. 2001;  221(1) 159-166
  • 6 Avadhani A, Tuite C, Sun W. Evaluation of the cancer patient. In: Geschwind JH, Soulen MC Interventional Oncology Principles and Practice. Cambridge; Cambridge University Press 2008: 23-27
  • 7 Sørensen J B, Klee M, Palshof T, Hansen H H. Performance status assessment in cancer patients. An inter-observer variability study.  Br J Cancer. 1993;  67(4) 773-775
  • 8 Gomaa A I, Khan S A, Leen E L, Waked I, Taylor-Robinson S D. Diagnosis of hepatocellular carcinoma.  World J Gastroenterol. 2009;  15(11) 1301-1314
  • 9 Bose D, Pawlik T M. Staging systems for hepatocellular carcinoma. In: Geschwind JH, Soulen MC Interventional Oncology Principles and Practice. Cambridge; Cambridge University Press 2008: 107-114
  • 10 Gervais D A, Goldberg S N, Brown D B, Soulen M C, Millward S F, Rajan D K. Society of Interventional Radiology position statement on percutaneous radiofrequency ablation for the treatment of liver tumors.  J Vasc Interv Radiol. 2009;  20(7, Suppl) S342-S347
  • 11 Lencioni R, Crocetti L, Della Pina C, Cioni D. Image-guided ablation of hepatocellular carcinoma. In: Geschwind JH, Soulen MC Interventional Oncology Principles and Practice. Cambridge; Cambridge University Press 2008: 145-159
  • 12 Elias D, Di Pietroantonio D, Gachot B, Menegon P, Hakime A, De Baere T. Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure.  Gastroenterol Clin Biol. 2006;  30(6-7) 823-827
  • 13 Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs A K. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC.  Cancer Treat Rev. 2007;  33(5) 437-447
  • 14 Solbiati L, Cova L, Ierace T. US-CT fusion for performing radiofrequency ablation of small or poorly visualized liver tumors.  Eur Radiol. 2005;  15(Suppl 3) C45
  • 15 Hinshaw J L, Laeseke P F, Winter III T C, Kliewer M A, Fine J P, Lee Jr F T. Radiofrequency ablation of peripheral liver tumors: intraperitoneal 5% dextrose in water decreases postprocedural pain.  AJR Am J Roentgenol. 2006;  186(5, Suppl) S306-S310
  • 16 Hines-Peralta A, Goldberg S N. Image-guided interventions: Fundamentals of radiofrequency tumor ablation. In: Geschwind JH, Soulen MC Interventional Oncology Principles and Practice. Cambridge; Cambridge University Press 2008: 55-66
  • 17 de Baere T, Bessoud B, Dromain C et al.. Percutaneous radiofrequency ablation of hepatic tumors during temporary venous occlusion.  AJR Am J Roentgenol. 2002;  178(1) 53-59
  • 18 Anderson G S, Brinkmann F, Soulen M C, Alavi A, Zhuang H. FDG positron emission tomography in the surveillance of hepatic tumors treated with radiofrequency ablation.  Clin Nucl Med. 2003;  28(3) 192-197
  • 19 Yamamoto J, Okada S, Shimada K et al.. Treatment strategy for small hepatocellular carcinoma: comparison of long-term results after percutaneous ethanol injection therapy and surgical resection.  Hepatology. 2001;  34(4 Pt 1) 707-713
  • 20 Daniele B, De Sio I, Izzo F CLIP Investigators et al. Hepatic resection and percutaneous ethanol injection as treatments of small hepatocellular carcinoma: a Cancer of the Liver Italian Program (CLIP 08) retrospective case-control study.  J Clin Gastroenterol. 2003;  36(1) 63-67
  • 21 Chen M S, Li J Q, Zheng Y et al.. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma.  Ann Surg. 2006;  243(3) 321-328
  • 22 Vogl T J, Straub R, Eichgler K, Söllner O, Mack M G. Colorectal carcinoma metastases in liver: laser-induced interstitial thermotherapy—local tumor control rate and survival data.  Radiology. 2004;  230(2) 450-458
  • 23 Solbiati L. Colorectal metastases: ablation. In: Geschwind JF, Soulen MC Interventional Oncology Principles and Practice. Cambridge; Cambridge University Press 2008: 264-272

Michael C SoulenM.D. 

Division of Interventional Radiology, Department of Radiology

3400 Spruce Street, Philadelphia, PA 19104

Email: Michael.soulen@uphs.upenn.edu

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