Combination of Minimally Invasive Treatments Effective as Surgery for Solitary Liver Cancers

“This new treatment takes two well-established interventional radiology procedures and combines them to optimize treatment for patients with primary liver cancer. Although surgical resection has historically been considered the gold standard for the treatment of patients with single lesions, the survival data is promising, and we remain cautiously optimistic that these results will hold up in the long-term,” says study investigator Anne M. Covey, MD, an interventional radiologist at Memorial Sloan Kettering Cancer Center in New York.

Primary liver cancer most commonly occurs in the setting of underlying liver disease or cirrhosis due to hepatitis. Currently surgery offers the best chance for a cure. However, patients with primary liver cancer often present with other medical problems or liver disease that make surgery very risky. In fact, surgical resection is possible in less than 20 percent of cases, making alternative therapies imperative. Chemotherapy drugs are generally inactive against primary liver cancer.

“Although more studies are needed, this study is significant because it compares the combined interventional radiology techniques to surgical resection within a tertiary care facility with equal experience in tumor embolization and surgery, broadening the applicability of the interventional techniques in the treatment of primary liver cancer. A multi-disicplinary approach is imperative,” says Covey.

About the Study

This study included all patients with solitary hepatocellular carcinoma undergoing either surgical resection or embolization followed by radiofrequency (RF) ablation between January 1996 and August 2002. Only patients with liver tumors less than 7 cm were included. The study involved 40 patients who had surgical resection and 33 who had embolization plus ablation. There were significantly more patients with more advanced liver disease (Okuda stage II) in the embolization group compared to the surgery group (36 percent versus 0 percent). The median follow-up was 22 months for the embolization group and 23 months for the surgery group. The 1,2, 4 and 5 year survivals for the combined treatment were 97 percent, 83 percent, 77 percent and 56 percent, versus 81 percent, 70 percent, and 57 percent for the surgery group.

Of the 19 surgical patients that had recurrence of their tumor, seven subsequently underwent embolization in order to attempt to prolong survival. Quite notably, despite the advanced stage of the liver tumors, four out of these seven are currently alive with no evidence of active disease at 12, 16, 19 and 30 months from the date of recurrence, two are currently alive with disease and remain candidates for further embolization and/or ablation.

“The majority of the patients who have surgery will have recurrence of their cancer, because they still have cirrhosis and hepatitis. Repeat surgery is often not possible, so finding another way to treat them is important,” says Covey.

About Embolization and Radiofrequency Ablation

Embolization is a well-established non-surgical interventional radiology technique that blocks the blood supply feeding a tumor, causing it to shrink. Using imaging for guidance, the interventional radiologist makes a tiny nick in the skin and inserts a catheter in the femoral artery in the groin. The physician guides the catheter through to the arteries supplying the liver and finally the tumor. Tiny particles the size of grains of sand are then released into the blood vessels feeding the liver tumor. The particles mechanically block the flow of blood to the tumor.

Radiofrequency ablation (RFA) is a non-surgical, localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Radiofrequency energy can be given without affecting the patient’s overall health and most patients are discharged within 24 hours. In this procedure, the interventional radiologist uses imaging to guide a small needle through the skin into the tumor. From the tip of the needle, a tiny umbrella shaped array of thin wires opens within the tumor. Then a mild radiofrequency energy (similar to microwaves) is transmitted to the tip of the needle, where it is converted into heat. The umbrella shape allows the RFA device to heat and kill a precise round “ball” of tumor with very little risk of damaging adjacent normal structures. The dead tumor tissue shrinks and slowly forms a scar.

Source: Society of Interventional Radiology

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