Chemoembolization is a form of regional control of hepatic tumors. The hepatic arterial supply to individual tumors in the liver, or in some instances where tumors may be diffused to an entire hepatic lobe, is catheterized and then embolized using a prolonged exposure to a high concentration of chemotherapeutic agents. This treatment is most effective in patients with adequate and borderline (Childs-Pugh A and B) hepatic reserve and who suffer from hepatic only or hepatic dominant involvement with hepatocellular cancer, metastatic carcinoid and neuroendocrine tumors, as well as other tumor types that have a rich hepatic arterial supply. The specialists at The Center for Cancer Prevention and Treatment at St. Joseph Hospital, however, have worked on and popularized a safe technique that can treat patients with poor hepatic function (Child-Pugh C) with similar efficacy.
This type of local chemotherapy is used to treat tumors that spread to the liver. An anticancer drug mixed with a substance that embolizes (blocks) blood vessels is injected into the hepatic artery. As the artery is blocked off, the drug is tapped near the tumor for maximum effect.
More than 1.25 million worldwide cases of primary liver cancer occur each year, making it the leading global cause of cancer-related deaths in men and women. Incidence of the disease is increasing in North America, partially due to the rise in hepatitis C infection. While surgical removal of the affected portion of the liver offers the best chance for disease-free survival, fewer than 15 percent of patients are eligible for surgery.
In cases where liver cancer cannot be removed by surgery, patients may receive localized radiation treatment using very small particles (microspheres) that have been loaded with radioactive yttrium-90. These are infused into the affected area, destroying the tumor but leaving most of the health tissue relatively unaffected. Treatment is primarily outpatient and is generally well tolerated.
Radiofrequency ablation (RFA) is a minimally invasive treatment for primary and metastatic liver cancer that uses specialized radiologic or surgical techniques. RFA offers patients more targeted care and reduced blood loss. The RFA procedure uses an electrical current to burn liver tumors while protecting healthy tissues. Because patients recover sooner and suffer less discomfort during their treatment, they return to their normal lives earlier. The procedure also provides a treatment option for patients who are otherwise too ill for surgery.
Radiofrequency ablation can be performed during an abdominal operation using laparoscopic surgical guidance (minimally invasive surgery), or by placing the needle through the skin directly into the tumor. Laparoscopic or percutaneous (through the skin) RFA treatments are used most often in patients with one to three small tumors located near the surface of the liver. Patients with larger, more numerous tumors, or tumors located near large blood vessels within the liver are usually treated with traditional open surgery. Additionally, some patients are best treated by a combination of removal of the largest liver tumors and RFA of any smaller tumors during the same open operation. The success of RFA is dependent on the size and location of the tumor and the approach (through the skin, laparoscopic image guided, or open incision).