Minimally invasive techniques in the treatment of liver tumors.
BACKGROUND
Despite advances in cancer therapy the treatment of liver tumors remains a challenge. Most patients are poor candidates for surgical resection; both chemotherapy and irradiation have a low success rate and neither is without complications. New minimally invasive techniques for ablation of unresectable tumors have gained attention as effective treatment alternatives. Among these are percutaneous ethanol injection and radiofrequency ablation; both are effective for primary liver tumors and RFA is also effective for hepatic metastases.


OBJECTIVE
To report our experience with PEI and RFA in the treatment of hepatic lesions.


METHODS
The study included 49 lesions in 27 patients: 23 primary lesions in 13 patents treated with PEI and 26 lesions (22 secondary and 4 primary) in 14 patients treated with RFA. PEI was performed on an outpatient basis in the ultrasound suite; RFA was done in hospitalized patents (9 in the ultrasound suite and 4 in the operating room). Patients were followed with triphasic spiral computerized tomography 1 month after treatment and every 3-6 months thereafter.


RESULTS
Complete necrosis was achieved with PEI on the first attempt in 11 of 23 primary lesions (91.3%). In 8.7% (2/23) a second series of treatments was required. Using RFA, complete necrosis was achieved in 85% of lesions (22/26) and partial necrosis in 15% (4/26). Complications included low fever (3 patients), high fever and abscess formation (1 patient), peri-tumoral necrosis (1 patient) and portal vein thrombosis (1 patient).


CONCLUSIONS
Our preliminary results confirm that PEI and RFA are an effective and safe option for treating hepatic tumors in patients unfit for surgery.
Kessler
Ada
A
Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. kesslera@tasmc.health.gov.il
Blank
Annat
A
Merhav
Hadar
H
Orron
Dan
D
Konikoff
Fred
F
Oren
Ran
R
Figer
Arie
A
Marouani
Nissim
N
Weiss
Judith
J
Gutman
Mordechai
M
Graif
Moshe
M
D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects; D000431:Ethanol / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000431:Ethanol