Critical review of multidisciplinary non-surgical local interventional ablation techniques in primary or secondary liver malignancies

Abstract

Local non-surgical interventional percutaneous ablation represents nowadays an important part of the potential treatment strategies. Although surgical ablation represents the gold standard, in the past decade there was an expansion in the use of non-surgical ablative techniques: radiofrequency, microwave, laser, cryoablation, irreversible electroporation, and interventional radiotherapy (brachytherapy) in primary as well as secondary liver cancers. With the growing experience in the field, there was implemented a new pillar for cancer treatment, together with surgery, chemotherapy as well as radiotherapy, so-called interventional oncology (IO). To date, there are no published papers regarding a comparative interdisciplinary evaluation of all these non-surgical interventional local ablation therapies. Our paper offers a critical interdisciplinary overview of the treatments in both primary and secondary liver tumors, including from a cost-effective point of view. Furthermore, the present status of education in IO and a comparison of actual economic aspects of the treatments are also provided.

Keywords: education; interventional oncology treatment costs; liver brachytherapy; liver percutaneous ablation.

Fig. 1

Single liver metastasis from adrenal cancer in the VIIIs, close to inferior cava vein in a 43-year-old man. Contrast enhanced CT image in axial plane (A) shows hypervascular focal lesion 2 cm in size (arrow). The patient underwent percutaneous MWA ablation of the lesion (B). Contrast-enhanced CT examinations performed 3 months (C) and 12 months (D) after the procedure demonstrate complete necrosis without residual enhancing tissue in the ablated area, also preserving patency of inferior cava vein (post-treatment complete response)

Fig. 2

Ovarian metastatic implants in the perihepatic visceral peritoneum mimicking hepatic metastases in a 58-year-old woman. Axial post-contrast CT image (A) shows two subserosal hepatic deposits of ovarian cancer with rounded, well-defined margins, 12 mm in size (circles). In order to obtain displacement of neighboring right kidney and duodenum, preventing untargeted ablation, a percutaneous hydrodissection using a Chiba needle (arrow) was performed (B). Thus, a simultaneous ablation of the two lesions was performed using two different cryoprobes (IceSphere, 2 freezing/thawing cycles) (C) obtaining, on 6-month follow-up contrast-enhanced CT examination (D), a complete response, without signs of residual viable tumor (arrowhead)

Fig. 3

A) Recurrent colorectal liver metastasis at the resection margin after hemihepatectomy. Systemic chemotherapy was exhausted and not well tolerated. B) After intravenous administration of bleomycin electric pulses were deployed through the ECT electrodes. C) 48 hours after intervention contrast enhanced MRI reveals extended destruction of the complete metastasis respecting the tumor margins

Fig. 4

Confluent colorectal liver metastases rapidly advancing under systemic chemotherapy and immunotherapy. Calculated radiation dose distribution after implantation of 11 brachytherapy applicators in transverse (A), coronal (B) and sagittal (C) planes