Radiofrequency Ablation of Liver Tumors…a minimally invasive procedure for liver biopsy.

Radiofrequency ablation is a treatment that can be applied to some liver tumors that are unresectable. The technique involves placement of a thin electrode (similar to a needle) into the center of a liver tumor, usually with the assistance of either CAT scan or ultrasound imaging. The electrode can be inserted through the skin often times, such that an operation is not required, much as a liver biopsy can be performed without the need for an operation. Local anesthesia is commonly used to minimize the discomfort of electrode insertion. The electrode is then connected to an electrical generator, and as current passes from the electrode tip to a grounding pad, the tumor is heated to a point where it is destroyed. This portion of the procedure generally does not produce any discomfort. During the procedure, vital signs, tumor temperature, and electrical properties of the tumor are monitored. The efficacy of treatment is assessed by CAT scan one month following treatment. Re-treatments are often necessary. Risks of the procedure include bleeding, although this is extremely rare.

In November of 1996, Dr. Kenneth Tanabe and Dr. Nahum Goldberg performed the first radiofrequency ablation of a patient with a liver tumor in the United States. This history-making procedure was performed in the operating rooms of the Massachusetts General Hospital as part of an Institutional Research Board approved clinical research protocol. The experimental procedure was deemed a success in both efficacy and safety. Following this initial trial, researchers in the Division of Surgical Oncology at the Massachusetts General Hospital have continued to lead the way in making cutting edge advances in this field. Nonetheless, it is important to point out that:

1. Radiofrequency ablation remains experimental
2. Radiofrequency ablation is not a substitute for resection (surgical removal) whenever possible, as removal of the tumor is considered the "gold standard" for treatment in appropriate patients
3. The chances of successful (complete) tumor destruction is about 75% -- less for tumors larger than 3 cm and more for tumors smaller than 3 cm
4. It is exceedingly rare that pateints with liver metastases from cancer of the pancreas, lungs, stomach, or esophagus are candidates for radiofrequency ablation unless they have no more than two tumors measuring no more than 4.0 cm in size.

Dr. Tanabe and colleagues are setting up a national trial of this technique sponsored by the American College of Surgeons and the National Cancer Institute.

If you feel that you may be a candidate for radiofrequency ablation of your liver tumor, please have your physician contact Kenneth Tanabe, MD at 617-724-3868 or James C. Cusack, MD at 617-724-4093.

Hepatic Arterial Infusion Chemotherapy for Colon and Rectal Carcinoma Liver Metastases to enhance the effectiveness of chemotherapy.

Colon and rectal cancers unfortunately often spread to the liver. However, it is well known that these cancers may spread to the liver and only the liver, without spread to other sites. Chemotherapy agents such as Camptosar® (CPT-11; irinotecan), 5-FU, and leucovorin are used most commonly to treat this form of cancer. These agents are commonly administered into a vein (intravenously). An attractive alternative is to administer chemotherapy directly into the arteries that feed the liver. The advantages of this approach are:

1. A high rate (99%) of chemotherapy drug extraction by the liver on first passage of blood through the liver leads to higher chemotherapy drug concentrations in the tumors than can be achieved with intravenous drug administration.
2. A high rate (99%) of chemotherapy drug extraction by the liver on first passage of blood through the liver leads to lower levels of drug in tissues outside the liver (e.g. bone marrow and gut), which reduces side effects of bone marrow suppression or nausea.
3. Liver tumors are supplied principally by the arteries in the liver, which are the blood vessels into which the active chemotherapy agent is administered.
4. The likelihood of tumor shrinkage is greater following intra-arterial chemotherapy administration directly into the liver compared to intravenous adminisration.
5. Patients whose tumors have increased in size despite treatment with 5-FU or Camptosar® (CPT-11; irinotecan) still shrink in response to intraarterial chemotherapy in roughly 50% of instances.

In an attempt to improve upon past results with intra-arterial administration of chemotherapy, we have initiated a clinical trial that combines intra-arterial chemotherapy with systemic (intravenous) chemotherapy administration. FUDR (floxuridine) and 5-FU are administered intra-arterially, while Camptosar® (CPT-11; irinotecan) is adminstered intravenously. It is hoped that this treatment will be more effective than administration of any of these compounds alone or together via an intravenous route. Patients with colon or rectal cancer spread to the liver that are eligible for this clinical trial will have a small infusion pump (roughly the size of a hockey puck) inserted surgically into their abdomen to administer the chemotherapy. Patients that are not eligible for this trial may still benefit from intra-arterial administration of FUDR (without systemic administration of Camptosar).

If you feel that you may be a candidate for hepatic arterial infusion chemotherapy for your liver tumor, please have your physician contact Kenneth Tanabe, MD at 617-724-3868 or James C. Cusack, MD at 617-724-4093.

For more information, contact the Division of Surgical Oncology.