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PERCUTANEOUS TREATMENT OF HEPATIC TUMORS
Category: Diagnostic Radiology
Abstract : THE TREATMENT OF PRIMARY AND SECONDARY HEPATIC TUMOURS BY PERCUTANEOUS
METHODS In patients with colorectal carcinoma the presence of liver
metastasis is the most accurate predictor of survival. Resection of liver
metastases is known to increase the lifespan of patients, with good quality of
life and an overall 5-year survival of 20–45%, and up to 60% in unifocal
disease.
THE TREATMENT OF PRIMARY AND SECONDARY HEPATIC TUMOURS BY PERCUTANEOUS
METHODS
In patients with colorectal carcinoma the presence of liver
metastasis is the most accurate predictor of survival. Resection of liver
metastases is known to increase the lifespan of patients, with good quality of
life and an overall 5-year survival of 20–45%, and up to 60% in unifocal
disease.
Without surgery the 5-year survival in this patient group is
effectively zero. However, not all patients with liver metastases are deemed
suitable for resection, being poor surgical risks or having lesions which are
either too large or affect too many hepatic segments. Percutaneous ablation of
liver tumours is now a viable and rapidly developing option for control of liver
metastases, prolonging survival time after initial diagnosis and, in some cases,
shrinking tumours to enable future curative resection.
Various methods
have been investigated, using ultrasound guidance.
● Alcohol injection has
proved highly effective for hepatocellular carcinoma (HCC), shrinking tumours
over a period of time and causing necrosis within them, but has not proved as
effective for metastatic liver disease. This is thought to reflect the fact that
HCC is a ‘soft’ tumour and so the alcohol can be instilled effectively into the
tumour whereas metastases are ‘hard’ lesions and often the alcohol seeps out of
the lesion.
● Radiofrequency (RF) thermal ablation and laser ablation are
also developing as minimally invasive percutaneous therapeutic techniques and
are becoming increasingly popular. Ablation of liver metastases using RF is a
recent method of ultrasound-guided therapy for liver metastases and HCC in which
RF, applied to monopolar electrodes either individually or with multiprobe
arrays, is guided into the lesion to be treated. RF tissue ablation through an
18G needle uses fewer probes than laser.
It is an outpatient procedure:
1–4 sessions has been reported to achieve complete necrosis of liver metastases
in 67% of lesions.34 It is a simple, safe and potentially effective treatment
for liver metastases, associated with a low rate of complications (in one study
only one small area of haemorrhage was observed in 75 sessions) together with a
significant rate of shrinking or stabilization of the metastases.
Hit: 207 times
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