title: Minimally invasive techniques in the treatment of liver tumors.
abstract: 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.
authors.affiliation: Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. kesslera@tasmc.health.gov.il
authors.forename: Ada
authors.initials: A
authors.lastname: Kessler
authors.forename: Annat
authors.initials: A
authors.lastname: Blank
authors.forename: Hadar
authors.initials: H
authors.lastname: Merhav
authors.forename: Dan
authors.initials: D
authors.lastname: Orron
authors.forename: Fred
authors.initials: F
authors.lastname: Konikoff
authors.forename: Ran
authors.initials: R
authors.lastname: Oren
authors.forename: Arie
authors.initials: A
authors.lastname: Figer
authors.forename: Nissim
authors.initials: N
authors.lastname: Marouani
authors.forename: Judith
authors.initials: J
authors.lastname: Weiss
authors.forename: Mordechai
authors.initials: M
authors.lastname: Gutman
authors.forename: Moshe
authors.initials: M
authors.lastname: Graif
mesh_terms: 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
chemical_list: D000431:Ethanol