Alternative Treatment Approaches to Early Stage or Unresectable Hepatocellular Carcinoma Confined to the Liver

Izzo, Francesco; Fiore, Francesco; Werra, Carlo De; Curley, Steven A.

doi:10.1007/978-1-4612-1666-7_5

Cited by 4 publications

(12 citation statements)

References 43 publications

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“…Different physical mechanisms are involved in the hepatic hyperthermic treatments in order to generate a lethal temperature in situ (range, 60–100°C). First, MCT relies on high‐frequency electromagnetic radiation (2000–3000 MHz) that is generated to heat the intracellular water molecules of the surrounding tissue by dielectric loss effects 64 . The resulting heat energy will lead to irreversible cellular damage 65 .…”

Section: Hepatic Hyperthermic Treatmentsmentioning

confidence: 99%

“…Second, the laser (light amplification by the stimulated emission of radiation) beam consists of a coherent, monochromatic and highly collimated beam of light. Focusing such light energy onto the liver tumor results in heat production, vaporization, necrosis and coagulation 64 . The neodymium yttrium : aluminum garnet laser is commonly used clinically and has been shown to produce thermal lesions in biological tissue 66 .…”

Section: Hepatic Hyperthermic Treatmentsmentioning

confidence: 99%

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Thermal ablative therapy for malignant liver tumors: A critical appraisal

Ng¹,

Lam²,

Poon³

et al. 2003

J of Gastro and Hepatol

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The management of primary and secondary malignant liver tumors poses a great challenge to clinicians. Although surgical resection is the gold-standard treatment, most patients have unresectable malignant liver tumors. Over the past decade, various modalities of loco-regional therapy have gained much interest. Among them, thermal ablative therapy, including cryotherapy, microwave coagulation, interstitial laser therapy, and radiofrequency ablation (RFA), have been proven to be safe and effective. Despite the effective tumor eradication achieved within cryotherapy, the underlying freeze/thaw mechanism has resulted in serious complications that include bleeding from liver cracking and the 'cryoshock' phenomenon. Thermal ablation using microwave and laser therapy for malignant liver tumors is curative and is associated with minimal complications. However, this treatment modality is effective only for tumors < 3 cm diameter. Radiofrequency ablation seems to be the most promising form of thermal ablative therapy in terms of a lower complication rate and a larger volume of ablation. However, its use is restricted by the difficulty encountered when using imaging studies to monitor the areas of ablation during and after the procedure. Moreover, the techniques of RFA need to be refined in order to achieve the same oncological radicality of malignant liver tumors as achieved by surgical resection. As each of the loco-regional therapies has its own advantages and limitations, a multidisciplinary approach using a combination of therapies will be the future trend for the management of malignant liver tumors.

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Section: Hepatic Hyperthermic Treatmentsmentioning

confidence: 99%

Section: Hepatic Hyperthermic Treatmentsmentioning

confidence: 99%

Thermal ablative therapy for malignant liver tumors: A critical appraisal

Ng¹,

Lam²,

Poon³

et al. 2003

J of Gastro and Hepatol

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“…Laser interstitial thermotherapy (LIT) induces tissue necrosis by the heating effect of a beam of coherent, monochromatic light 68. When focussed at the correct wavelength, this light energy is absorbed by the tissue, resulting in heating, vaporization, and consequent coagulative necrosis 68,69. The most commonly used laser is the Nd:YAG system, which uses low‐power light (3 to 15W) for between 20 and 60 min.…”

Section: Thermal “In Situ” Techniquesmentioning

confidence: 99%

“…68 When focussed at the correct wavelength, this light energy is absorbed by the tissue, resulting in heating, vaporization, and consequent coagulative necrosis. 68,69 The most commonly used laser is the Nd : YAG system, which uses low-power light (3 to 15 W) for between 20 and 60 min. This system maximizes energy distribution and tissue penetration due to its low absorption, high scatter characteristics.…”

Section: Laser Interstitial Thermotherapymentioning

confidence: 99%

“…Microwaves have a greater ability to localize the deposition of energy, but this is at the cost of very much reduced tissue penetration. 69,81 Microwaves cause water molecules to become polarized within the rapidly alternating electromagnetic field. This, in turn, leads to the heating of intracellular water and consequent coagulative necrosis.…”

Section: Microwave Coagulation Therapymentioning

confidence: 99%

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Local ablation for unresectable liver tumors: is thermal best?

Wemyss‐Holden

Dennison

Berry

et al. 2004

Journal of Hepato-Biliary-Pancreatic Surgery

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Hepatic resection remains the "gold standard" for patients with resectable disease. Nevertheless, for a variety of reasons this is not feasible for the majority of patients. A wide range of locally ablative techniques has been developed for use in these patients with the aim of improving survival. Unfortunately, as with many recent techniques in surgery, much of the development of these methods, and particularly their introduction clinically, has not been based on sound scientific data. The relative merits and limitations of the more commonly used techniques are discussed, although this lack of prospective, randomized data precludes firm conclusions to be drawn from many of the studies reported. By far the most popular methods now employed, thermal techniques have certain limitations, particularly when treating tumors adjacent to major vascular or biliary structures. The authors believe that this situation represents the "niche" for which ablative techniques may ultimately find their logical application, where a single awkwardly placed metastasis deems a patient unresectable. If such a metastasis can be completely and safely ablated, a potentially curative resection may then become a realistic option. The relatively new, nonthermal technique of hepatic electrolysis has been extensively studied and shown to be safe and effective in close proximity to major intrahepatic veins due to a subtle electrochemical action rather than a rapid "burn". This technique is discussed in the context of other, more traditional thermal methods of ablation.

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Status of hyperthermia in the treatment of advanced liver cancer

Moroz

Jones

Gray

2001

Journal of Surgical Oncology

105

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The vast majority of patients with malignant liver tumors have inoperable disease. These patients must rely on chemotherapy, radiotherapy, and various locoregional treatments. Although these treatments have demonstrated encouraging response rates, symptom palliation and occasional down staging of tumors, their impact on survival is minor. As a result there has been renewed interest in hyperthermia as a treatment option. This study reviews the current modalities of hyperthermia in terms of clinical results, side effects, limitations, and therapeutic standing.

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Alternative Treatment Approaches to Early Stage or Unresectable Hepatocellular Carcinoma Confined to the Liver

Cited by 4 publications

References 43 publications

Thermal ablative therapy for malignant liver tumors: A critical appraisal

Thermal ablative therapy for malignant liver tumors: A critical appraisal

Local ablation for unresectable liver tumors: is thermal best?

Status of hyperthermia in the treatment of advanced liver cancer

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