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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: 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.

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

A 40-year-old female with metastatic breast carcinoma who presents with a focal metastatic tumor to segment 7 of the liver. (A) Axial post-contrast MRI image demonstrates 1.7×1.1 cm2 hypointense mass in segment 7 (arrow). Intraprocedural ultrasound images (B) During needle placement (arrow), (C) During ablation. Note the hyperechoic area which represents microbubble formation during heating (arrow). (D) Non-contrast axial CT image during procedure demonstrates applicator in place. (E) Non-contrast axial CT image immediately after ablation shows a hypodense region with focal air bubbles indicative of the ablation zone. (F) Fused axial PET-CT image 3 months post-ablation demonstrating ablation cavity with no evidence of residual FDG-avidity (arrow).
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f5: A 40-year-old female with metastatic breast carcinoma who presents with a focal metastatic tumor to segment 7 of the liver. (A) Axial post-contrast MRI image demonstrates 1.7×1.1 cm2 hypointense mass in segment 7 (arrow). Intraprocedural ultrasound images (B) During needle placement (arrow), (C) During ablation. Note the hyperechoic area which represents microbubble formation during heating (arrow). (D) Non-contrast axial CT image during procedure demonstrates applicator in place. (E) Non-contrast axial CT image immediately after ablation shows a hypodense region with focal air bubbles indicative of the ablation zone. (F) Fused axial PET-CT image 3 months post-ablation demonstrating ablation cavity with no evidence of residual FDG-avidity (arrow).

Mentions: Given its increased efficacy of ablation and shorter time to achieve ablations, MWA has increasingly been used in the treatment of both primary and metastatic tumors of the liver (Figure 5). Ding et al. recently evaluated a series of 198 patients (85 RFA/113 MWA) with HCC meeting Milan criteria and found similar disease-free survival, cumulative survival, and complication rates between the two groups75,76. In their series, all patients were BCLC Stage A, and tumor size was equivalent between the two groups (mean tumor diameter 2.38±0.81 cm RFA cohort; 2.55±0.89 MWA cohort). Shibata et al. compared the efficacy of MWA versus RFA in a series of 72 patients (36 RFA/36 MWA) in a randomized fashion from a cohort of patients with equivalent background demographics and mean tumor size and concluded that therapeutic effects, complication rates, and rates of residual untreated disease were equivalent between the two modalities59. Zhang et al. evaluated overall survival, complete ablation, local tumor progression and distant recurrence in a series of 155 patients (mean tumor size 2.3±0.4 cm RFA cohort and 2.2±0.4 cm MWA cohort) and also found that RFA and MWA were equivalent77.


Minimally invasive local therapies for liver cancer.

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

A 40-year-old female with metastatic breast carcinoma who presents with a focal metastatic tumor to segment 7 of the liver. (A) Axial post-contrast MRI image demonstrates 1.7×1.1 cm2 hypointense mass in segment 7 (arrow). Intraprocedural ultrasound images (B) During needle placement (arrow), (C) During ablation. Note the hyperechoic area which represents microbubble formation during heating (arrow). (D) Non-contrast axial CT image during procedure demonstrates applicator in place. (E) Non-contrast axial CT image immediately after ablation shows a hypodense region with focal air bubbles indicative of the ablation zone. (F) Fused axial PET-CT image 3 months post-ablation demonstrating ablation cavity with no evidence of residual FDG-avidity (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5: A 40-year-old female with metastatic breast carcinoma who presents with a focal metastatic tumor to segment 7 of the liver. (A) Axial post-contrast MRI image demonstrates 1.7×1.1 cm2 hypointense mass in segment 7 (arrow). Intraprocedural ultrasound images (B) During needle placement (arrow), (C) During ablation. Note the hyperechoic area which represents microbubble formation during heating (arrow). (D) Non-contrast axial CT image during procedure demonstrates applicator in place. (E) Non-contrast axial CT image immediately after ablation shows a hypodense region with focal air bubbles indicative of the ablation zone. (F) Fused axial PET-CT image 3 months post-ablation demonstrating ablation cavity with no evidence of residual FDG-avidity (arrow).
Mentions: Given its increased efficacy of ablation and shorter time to achieve ablations, MWA has increasingly been used in the treatment of both primary and metastatic tumors of the liver (Figure 5). Ding et al. recently evaluated a series of 198 patients (85 RFA/113 MWA) with HCC meeting Milan criteria and found similar disease-free survival, cumulative survival, and complication rates between the two groups75,76. In their series, all patients were BCLC Stage A, and tumor size was equivalent between the two groups (mean tumor diameter 2.38±0.81 cm RFA cohort; 2.55±0.89 MWA cohort). Shibata et al. compared the efficacy of MWA versus RFA in a series of 72 patients (36 RFA/36 MWA) in a randomized fashion from a cohort of patients with equivalent background demographics and mean tumor size and concluded that therapeutic effects, complication rates, and rates of residual untreated disease were equivalent between the two modalities59. Zhang et al. evaluated overall survival, complete ablation, local tumor progression and distant recurrence in a series of 155 patients (mean tumor size 2.3±0.4 cm RFA cohort and 2.2±0.4 cm MWA cohort) and also found that RFA and MWA were equivalent77.

Bottom Line: 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.

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