Ablative Technologies in the Management of Patients with Primary and Secondary Liver Cancer: An Overview

Khan, Nasir A.; Baerlocher, Mark O.; Owen, Richard J.T.; Ho, Stephen; Kachura, John R.; Kee, Stephen T.; Liu, Dave M.

doi:10.1016/j.carj.2009.12.009

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Volume 61, Issue 4 , Pages 217-222, October 2010

Ablative Technologies in the Management of Patients with Primary and Secondary Liver Cancer: An Overview

Nasir A. Khan, HBSc
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Mark O. Baerlocher, MD
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Richard J.T. Owen, MD
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
Stephen Ho, MD
- Department of Radiology, Interventional Radiology Section, Vancouver General Hospital, Vancouver, British Columbia, Canada
John R. Kachura, MD
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Stephen T. Kee, MD
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
Dave M. Liu, MD
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, Interventional Radiology Section, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Address for correspondence: Dave M. Liu, MD, Department of Radiology, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada.

published online 02 March 2010.

Abstract

Interventional ablative technologies have played an increasingly important role in the management of patients with primary or secondary liver malignancies. Ethanol and acetic acid ablation were the primary modalities available 2 decades ago. Today, several new technologies are available, including radiofrequency ablation, cryoablation, and microwave ablation. Radiofrequency ablation is the most widely practiced, however, cryoablation and microwave ablation are reasonable choices in certain situations. Irreversible electroporation is a newer technique, which has yet to enter clinical practice, but shows promising preliminary results. Herein, we provide a brief overview of the above-mentioned technologies with a focus on principles of ablation and technique. We also describe the use of these techniques in the context of cytoreduction, a noncurative approach aimed at reducing the overall tumour burden and providing concomitant survival benefit.

Résumé

Les technologies d'ablation interventionnelles (percutanées) jouent un rôle de plus en plus important dans la gestion des patients atteints d'un cancer primitif ou secondaire du foie. L'ablation à l'éthanol et à l'acide acétique ont été les premières techniques utilisées il y a deux décennies. Aujourd'hui, plusieurs nouvelles technologies sont disponibles, dont l'ablation par radiofréquence, la cryo-ablation et l'ablation par micro-ondes. L'ablation par radiofréquence est la technique la plus couramment utilisée, mais la cryo-ablation et l'ablation par micro-ondes se révèlent des choix sensés dans certaines situations. L'électroporation irréversible est une technique plus récente qui n'est pas encore utilisée en pratique clinique, mais dont les résultats préliminaires sont prometteurs. Le présent article fournit un bref aperçu des technologies mentionnées ci-dessus en mettant l'accent sur les principes d'ablation et la technique utilisée. Il décrit également l'utilisation des techniques en cytoréduction, une approche novatrice visant à réduire le fardeau tumoral global et à produire un avantage concomitant de survie.

Key Words: Liver, Hepatocellular carcinoma, Metastasis, Ablation, Ethanol, Cryoablation, Microwave, Radiofrequency, Cytoreduction