Integrating interventional oncology in the treatment of liver tumors

Abstract

Background: Percutaneous ablation techniques offer a vast armamentarium for local, minimally invasive treatment of liver tumors, nowadays representing an established therapeutic option, which is integrated in treatment algorithms, especially for non-resectable liver tumors. The results of ablative treatment compare very well to surgical treatment in liver lesions, and confirm that these techniques are a valuable option for bridging for transplantation. Different techniques have been established to perform tumor ablation, and the feasibility varies according to the procedure and technical skills of the operator, depending on the size and location of the liver lesion. In recent years, stereotactic multi-needle techniques using 3D trajectory planning, general anesthesia, and tube disconnection during needle placement have had a strong impact on the application range of ablation for liver tumors.

Conclusion: It is well known that creating a sufficient ablation margin and overlapping ablation zones is one key issue to enable ablation of large liver lesions with tumor-free margins (A0 ablation in analogy to R0 resection). Image fusion during treatment and follow-up assure highly accurate staging procedures and interventional planning.

Novel aspects: Review on the standards in ablation techniques for the treatment of liver tumors. Update on different ablation techniques, indications, and contraindications for percutaneous liver tumor treatment. Summary of recently published reports on liver tumor ablation.

Keywords: Interventional oncology; Liver tumor treatment; Minimally invasive oncology; Percutaneous tumor treatment; Radiofrequency ablation.

Fig. 1

63-year-old female patient with inoperable intrahepatic cholangiocellular carcinoma (ICC) measuring 10 cm in diameter diagnosed in 2010 (a). Patient underwent radiofrequency ablation (RFA) 02/2010 using 12 coaxial needles (b). Follow-up 05/2010 showed complete ablation (c). Follow-up in 2017 showed no sign of recurrence (d)

Fig. 2

72-year-old male patient. First diagnosis of an moderately differentiated adenocarcinoma of the stomach, grade II, TNM pT3N1(1/26)L1V0R0, UICC stage IIIA. Patient underwent gastrectomy in 2012. MRI Follow up on 21/07/2015 showed solitary liver metastasis, which was histologically confirmed (a). SRFA on 11/12/2015 (b). Needle placement (c). Postinterventional control CT, showing sufficient ablation margin (d). Follow-up 7/09/2016, with no sign of recurrent disease (e)