LJR Medical Group - Oncological Therapies

Regional Tumor Therapy
Chemoembolization
Radiofrequency Ablation
SIRT / Yttrium Microsphere Radioembolization
Conclusion

Regional Tumor Therapy

Surgical resection of liver tumors offers the best chance for cure. Unfortunately, the majority of liver tumors are unresectable (cannot be removed surgically) because of impaired liver function, large tumor size, too many small tumors present throughout the liver, or the tumor is in an inoperable location. Our interventional radiologists may offer other treatments, either alone or in combination, to control disease and extend life.

An interventional radiologist is a specially trained physician that uses x-rays or other imaging techniques to guide small tubes called catheters and miniature tools directly to the site of disease. The doctor can treat the cancer from inside the body without affecting other parts of the body. Using either chemotherapy, radiation, or radiofrequency, the interventional radiologist is able to specifically target and kill tumor cells. Follow-up CT, MRI, ultrasound, or PET scans will then be performed to assess the response of the tumor to these therapies. It should be emphasized that regional tumor therapy is not a cure but a palliative treatment designed to extend life expectancy and improve the quality of life.

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Chemoembolization

Chemoembolization is a minimally invasive treatment for cancer affecting the liver. Using x-rays for guidance, the interventional radiologist threads a tiny catheter from the artery in the groin into the blood vessels supplying the liver tumor. Next, the doctor delivers a high dose of cancer killing drug (chemotherapy) directly into the tumor. The doctor then injects embolic agents (particles) which block the blood flow to the tumor and traps the chemotherapy drug in the tumor. In addition to depriving the tumor of the blood it needs to survive, the technique allows for a higher concentration of chemotherapy and much longer contact within the tumor, increasing the probability of tumor death.

Chemoembolization is palliative, not curative. It can be extremely effective in treating primary liver cancer and shows promise with some metastatic tumors. Chemoembolization usually requires a stay of 1-2 days in the hospital. Patients typically have a lower than normal energy level following the procedure for 2-4 weeks. The treatment can be repeated as often as necessary.

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Radiofrequency Ablation

Radiofrequency ablation (RFA) is a non-surgical, localized treatment that kills the tumor cells with electric energy that creates heat while sparing the healthy tissue. During an RFA procedure, an ablation probe (specialized needle) is placed directly into the target tissue (tumor). An array of several small curved electrodes is deployed from the end of the probe into the tumor. Radiofrequency energy (similar to microwaves) is transmitted to the electrode which produces a controlled heat that kills the target tissue within minutes. The dead tumor slowly shrinks and forms a scar over time.

RFA is effective for small to medium size tumors, generally up to 5 cm in diameter. RFA is used primarily for liver tumors but can be used in other organs including the kidney, bone, and lung. RFA rarely affects the patient's overall health, so patients can resume normal activities within a couple of days. The procedure usually requires an overnight stay in the hospital. Patients may experience fatigue and low grade fever for a few days following the procedure.

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SIRT / Yttrium Microsphere Radioembolization

SIRT (selective internal radiation therapy) is similar to chemoembolization but uses radioactive microspheres (microscopic particles or beads). This therapy is used to treat both primary and metastatic liver tumors.

This treatment incorporates the radioactive isotope Yttrium-90 into the embolic microspheres to deliver radiation directly to the tumor. Each sphere is about the size of five red blood cells. The spheres are injected through a catheter from the groin into the liver artery supplying the tumor. The beads become lodged within the tumor vessels where they deliver local radiation that causes tumor death. This technique allows for a higher dose of radiation to be used to kill the tumor without subjecting adjacent healthy tissue to harmful levels of radiation. The Yttrium-90 exerts its effect from within the body, and thus it is referred to as internal radiation. In former treatment of liver tumors, a beam of radiation was directed through the skin from an external source resulting in higher doses to normal surrounding tissue.

SIRT is a palliative, not curative, treatment, but patients benefit by improvement in the quality and duration of life. It is a relatively new therapy that has been effective in treating primary and metastatic liver cancer. The patient is often discharged on the same day as the procedure, but occasionally an overnight stay is required. There are fewer side effects from this treatment compared to standard cancer treatment, so normal activity can be resumed in a few days. However, the patient may experience fatigue following the procedure for 7-10 days.

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Conclusion

There are several new and effective treatment options for tumors of the liver that can deliver intense but focused therapy while sparing normal tissue. Depending on the type and extent of your liver tumor, your oncologist and interventional radiologist may elect to use one or more of these techniques to more effectively kill and shrink your tumor.

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