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Minimally invasive local therapies for liver cancer.

Li D, Kang J, Golas BJ, Yeung VW, Madoff DC - Cancer Biol Med (2014)

Bottom Line: Systemic treatment options for HCC remain limited, with Sorafenib as the only prospectively validated agent shown to increase overall survival.For patients with low volume disease, these therapies have now been established into consensus practice guidelines.In addition, the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.

View Article: PubMed Central - PubMed

Affiliation: 1 Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA ; 2 Department of Medicine, NYU Langone Medical Center, New York, NY 10016, USA ; 3 Flushing Radiation Oncology Services, Flushing, New York, NY 11354, USA ; 4 Department of Surgery, Division of Surgical Oncology, New York-Presbyterian Hospital/Weill Cornell Medical Center New York, New York, NY 10065, USA.

ABSTRACT
Primary and metastatic liver tumors are an increasing global health problem, with hepatocellular carcinoma (HCC) now being the third leading cause of cancer-related mortality worldwide. Systemic treatment options for HCC remain limited, with Sorafenib as the only prospectively validated agent shown to increase overall survival. Surgical resection and/or transplantation, locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments, providing improved survival outcomes for both primary and metastatic tumors. Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors. For patients with low volume disease, these therapies have now been established into consensus practice guidelines. This review highlights technical aspects and outcomes of commonly utilized, minimally invasive local therapies including laparoscopic liver resection (LLR), radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and stereotactic body radiation therapy (SBRT). In addition, the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.

No MeSH data available.


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A 56-year-old male with hepatitis C complicated by hepatocellular carcinoma, not a surgical candidate, presenting with an isolated tumor in segment 6 of the liver. (A) T2 weighted axial MRI image demonstrates lesion in segment 6 (arrow). (B) Non-contrast axial CT image during procedure with applicator in the hypoattenuating mass. Immediate contrast-enhanced post-RFA axial CT images in arterial (C) and portal venous (D) phases show complete ablation in the area of the tumor. (E) T2 weighted axial MRI image at two year follow-up demonstrates complete necrosis of the segment 6 tumor. RFA, radiofrequency ablation.
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f4: A 56-year-old male with hepatitis C complicated by hepatocellular carcinoma, not a surgical candidate, presenting with an isolated tumor in segment 6 of the liver. (A) T2 weighted axial MRI image demonstrates lesion in segment 6 (arrow). (B) Non-contrast axial CT image during procedure with applicator in the hypoattenuating mass. Immediate contrast-enhanced post-RFA axial CT images in arterial (C) and portal venous (D) phases show complete ablation in the area of the tumor. (E) T2 weighted axial MRI image at two year follow-up demonstrates complete necrosis of the segment 6 tumor. RFA, radiofrequency ablation.

Mentions: RFA has been used extensively in the setting of both primary and metastatic liver tumors (Figure 4). Weis et al. recently published a Cochrane database analysis on the use of RFA for the treatment of HCC49. The authors identified and included 11 randomized clinical trials with a total of 1,819 participants with four comparisons: RFA vs. hepatic resection (three trials, 578 participants50-52); RFA vs. PEI (six trials, 1,088 participants53-58); RFA vs. MWA (one trial, 72 participants59), and RFA versus percutaneous laser ablation (PLA) (one trial, 81 participants60) with the primary outcome measure being overall survival. After analysis, the authors concluded that there was moderate quality of evidence that hepatic resection is superior to RFA regarding survival; however, RFA might be associated with fewer complications and shorter hospital stay. They also found moderate quality evidence that RFA is superior to PEI in regards to survival. There was insufficient evidence to make firm conclusions regarding RFA, in comparison to locally ablative techniques such as MWA or PLA. Similar conclusions can be drawn regarding the clinical utility of RFA for treatment of metastatic lesions to the liver. A summary of studies comparing RFA versus surgery for liver metastases published since 2007 is shown in Table 261-72. Surgical resection was found to be superior to RFA in overall survival when feasible.


Minimally invasive local therapies for liver cancer.

Li D, Kang J, Golas BJ, Yeung VW, Madoff DC - Cancer Biol Med (2014)

A 56-year-old male with hepatitis C complicated by hepatocellular carcinoma, not a surgical candidate, presenting with an isolated tumor in segment 6 of the liver. (A) T2 weighted axial MRI image demonstrates lesion in segment 6 (arrow). (B) Non-contrast axial CT image during procedure with applicator in the hypoattenuating mass. Immediate contrast-enhanced post-RFA axial CT images in arterial (C) and portal venous (D) phases show complete ablation in the area of the tumor. (E) T2 weighted axial MRI image at two year follow-up demonstrates complete necrosis of the segment 6 tumor. RFA, radiofrequency ablation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296086&req=5

f4: A 56-year-old male with hepatitis C complicated by hepatocellular carcinoma, not a surgical candidate, presenting with an isolated tumor in segment 6 of the liver. (A) T2 weighted axial MRI image demonstrates lesion in segment 6 (arrow). (B) Non-contrast axial CT image during procedure with applicator in the hypoattenuating mass. Immediate contrast-enhanced post-RFA axial CT images in arterial (C) and portal venous (D) phases show complete ablation in the area of the tumor. (E) T2 weighted axial MRI image at two year follow-up demonstrates complete necrosis of the segment 6 tumor. RFA, radiofrequency ablation.
Mentions: RFA has been used extensively in the setting of both primary and metastatic liver tumors (Figure 4). Weis et al. recently published a Cochrane database analysis on the use of RFA for the treatment of HCC49. The authors identified and included 11 randomized clinical trials with a total of 1,819 participants with four comparisons: RFA vs. hepatic resection (three trials, 578 participants50-52); RFA vs. PEI (six trials, 1,088 participants53-58); RFA vs. MWA (one trial, 72 participants59), and RFA versus percutaneous laser ablation (PLA) (one trial, 81 participants60) with the primary outcome measure being overall survival. After analysis, the authors concluded that there was moderate quality of evidence that hepatic resection is superior to RFA regarding survival; however, RFA might be associated with fewer complications and shorter hospital stay. They also found moderate quality evidence that RFA is superior to PEI in regards to survival. There was insufficient evidence to make firm conclusions regarding RFA, in comparison to locally ablative techniques such as MWA or PLA. Similar conclusions can be drawn regarding the clinical utility of RFA for treatment of metastatic lesions to the liver. A summary of studies comparing RFA versus surgery for liver metastases published since 2007 is shown in Table 261-72. Surgical resection was found to be superior to RFA in overall survival when feasible.

Bottom Line: Systemic treatment options for HCC remain limited, with Sorafenib as the only prospectively validated agent shown to increase overall survival.For patients with low volume disease, these therapies have now been established into consensus practice guidelines.In addition, the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.

View Article: PubMed Central - PubMed

Affiliation: 1 Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA ; 2 Department of Medicine, NYU Langone Medical Center, New York, NY 10016, USA ; 3 Flushing Radiation Oncology Services, Flushing, New York, NY 11354, USA ; 4 Department of Surgery, Division of Surgical Oncology, New York-Presbyterian Hospital/Weill Cornell Medical Center New York, New York, NY 10065, USA.

ABSTRACT
Primary and metastatic liver tumors are an increasing global health problem, with hepatocellular carcinoma (HCC) now being the third leading cause of cancer-related mortality worldwide. Systemic treatment options for HCC remain limited, with Sorafenib as the only prospectively validated agent shown to increase overall survival. Surgical resection and/or transplantation, locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments, providing improved survival outcomes for both primary and metastatic tumors. Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors. For patients with low volume disease, these therapies have now been established into consensus practice guidelines. This review highlights technical aspects and outcomes of commonly utilized, minimally invasive local therapies including laparoscopic liver resection (LLR), radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and stereotactic body radiation therapy (SBRT). In addition, the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.

No MeSH data available.


Related in: MedlinePlus