European Gastroenterology & Hepatology Review, 2005:72-74
Longer version of article from Reference Section:
Hepatocellular carcinomas (HCC) and colorectal cancer liver metastases are the two most common malignancies of the liver, associated with a dismal outcome of zero survival at five years if left untreated. The worldwide incidence of HCC is increasing, most noticeably in North America and Europe, as a result of increasing numbers of patients with hepatitis C virus (HCV) and chronic liver disease. In the Western world, colorectal cancer accounts for 14% and 16% of cancer deaths in men and women, respectively, with approximately 25% of patients having liver involvement at the time of initial presentation and up to 50% developing hepatic metastases during the course of their disease.1,2
Patients with early-stage HCC should be offered surgical therapeutic options of transplantation or resection.3 Transplantation offers a four-year overall survival rate of 75% and a four-year recurrence-free survival rate of 83%; however, few would benefit from transplantation given the shortage of living donors and the eligibility of patients to the ‘Milan criteria’ for transplantation (i.e. decompensated cirrhosis, solitary tumour smaller than 5cm and up to three lesions smaller than 3cm).4 Similarly, less than 5% of cirrhotic patients with HCC would be suitable for hepatic resection under current criteria (those with solitary lesion and relatively well-preserved liver function).
For patients with colorectal hepatic metastases, surgical resection is the treatment of choice, but only 10% to 20% of patients are initially candidates for potentially curative resection; resection should be considered if there is no unresectable extra-hepatic disease, if all liver deposits can be resected with a free clearance margin of 1cm and if there is adequate liver reserve. The five-year survival rates vary from 25% to 40%.5–6 Seventy-five per cent of those who undergo liver resection will develop recurrence and, of these, the liver is involved in 50%. Sixty-five per cent to 85% of all recurrences appear within the first two years.5 Repeat liver resection in these patients still has a five-year survival of 30% to 40%. While the post-operative mortality or morbidity following repeated hepatectomy is comparable with those of single hepatectomy, they are not entirely negligible and hepatectomy is associated with significant cost.7–8 Given some of the shortcomings of current surgical approaches, an effective, minimally invasive, repeatable technique for the treatment of liver tumours could potentially impact favourably in the management of patients with hepatic malignancy.
Radio frequency Ablation
The last decade has seen considerable development of the ablative techniques for oncological applications, including cryo, radiofrequency, microwave or laser ablation and high-intensity focused ultrasound (HIFU). The development of radiofrequency ablation (RFA) can be traced back to 1891 through the works of d’Arsonval and in more recent years, with the additional refinements to the design and power of the equipment, it has emerged as the most popular tool for the destruction of hepatic and other malignancies.9
RFA of liver tumours can be performed percutaneously, laparoscopically or as part of an open surgical procedure. Ultrasound (U/S) guidance remains the optimal method for the placement of the needle electrode, being more practical, rapid and cheap. For treatment monitoring and follow-up of patients, contrastenhanced U/S using non-linear imaging modes combined with contrast-enhanced dual- or triplephase computed tomography (CT) or magnetic resonance imaging (MRI) may be employed.
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