A novel treatment combination involving radiofrequency enhances the sensitivity of detecting cancer cells in the liver, according to a recent study published in the journal Cancer. Enhanced detection allows for the destruction of cancer cells that may be responsible for cancer recurrences.
The liver is the largest organ in the body and is responsible for over 500 functions, including the secretion of glucose, proteins, vitamins and fats, the production of bile, the processing of hemoglobin and detoxification of numerous substances. Primary liver cancer, sometimes called hepatocellular carcinoma, starts in the cells of the liver and can spread, through blood or lymph vessels, to different parts of the body. The treatment of liver cancer depends on the size, and specific stage, or extent, of cancer.
Radiofrequency ablation (RFA) is a technique that is currently being refined to produce optimal outcomes for the treatment of liver cancer. Percutaneous RFA entails the use of high-energy radio waves that can be administered through the skin by inserting a probe that is about the size of a needle into the tumor(s) in the liver. The surgeon uses an imaging scan, such as an ultrasound or a computerized tomography (CT) scan, to guide the probe to the correct locations in the liver. The high-energy radio waves heat the cancer cells until they become coagulated and destroyed. Often, small undetectable masses of cancer cells surround the large tumor(s) and can hinder the achievement of a cure. These undetectable cancer cells are left untreated and are responsible for cancer recurrences.
In response to this, researchers from Japan recently devised a new treatment combination involving RFA that allows for easier detection and eradication of small masses of cancer cells existing outside the larger tumor(s). The procedure involves the injection of a dye into the main artery of the liver prior to a CT scan (angio-CT). The dye enhances the contrast on CT scans, allowing physicians to visualize the small masses of cancer cells. Angio-CT is performed prior to RFA and immediately following RFA so that real-time results may be evaluated. Surgeons are able to continue RFA if the angio-CT reveals cancer cells that have not been destroyed by the initial RFA treatment.
These researchers recently conducted a clinical trial evaluating angio-CT and RFA in 10 patients with liver cancer. Eight of the 10 patients were successfully treated with only one RFA session. Two patients underwent repeat procedures. Ten months following treatment, only one patient had a local recurrence. An additional component that was evaluated in this trial involved the occlusion of the main artery to the liver with a small balloon prior to RFA (BoRFA). BoRFA allows for greater exposure of cancer cells to RFA as the blood volume is diminished. In this clinical trial, the 4 patients receiving BoRFA had a larger area of ablation per application compared with standard RFA. All patients in this trial tolerated treatment very well with a short recovery period.
These results are promising for the treatment of liver cancer and warrant additional clinical trials in order to further define the clinical role of angio-CT RFA. Patients with liver cancer may wish to speak with their physician about the risks and benefits of participating in a clinical trial evaluating this procedure or other promising treatments.
(Cancer, Vol 91, No 7, pp 1342-1348, 2001)
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