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Radiology

Percutaneous ablation may be the best treatment option for many small liver tumors

10/01/2006

Radiology

Surgical resection, usually the first local treatment option considered for patients with liver tumors, may not be suitable for all patients. Percutaneous ablation now offers the best option in treating most small tumors, such as primary hepatocellular carcinoma. Further, percutaneous ablation offers a local treatment option to supplement systemic therapy, in those with liver metastases who might benefit from this treatment. With this minimally invasive procedure, patients usually go home the same day or after an overnight hospital stay, usually with only minor side effects if any. Major complications occur in only up to 3 percent of cases.

The UCLA Liver Tumor Ablation Program, one of the first of its kind in the United States, is among the busiest programs in the country, performing over 100 ablations annually. UCLA physicians have developed a number of innovations to improve the safety and efficacy of these minimally invasive procedures. Recently published data show excellent success at UCLA using radiofrequency ablation (RFA) to treat liver tumors. For small (¡Ü3 cm) hepatocellular carcinomas, RFA achieved a complete local cure in 83 percent of patients. Among those with large-volume non-resectable colon metastases, RFA achieved a four-year survival rate of 32 percent.

Program physicians perform tumor ablations on primary liver cancers and on metastases predominately or exclusively affecting the liver. These include metastatic colon cancer--in which approximately half of all patients develop liver metastases--along with neuroendocrine, sarcomatous and breast cancer metastases, among others.

Treating tumors with ablation

In the RFA procedure, a needle probe inserted into the liver tumor, usually under ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) guidance, produces radiofrequency oscillations, which generate heat sufficient to kill the tumor cells. To ensure treatment of the entire tumor, physicians extend the ablation 0.5 to 1 cm beyond the tumor margin.

While radiofrequency ablation is the most mature of the tumor ablation technologies offered at UCLA, others include ethanol injection, cryo-ablation, and microwave ablation. This range of treatment options ensures that program physicians can provide the ablative therapy best suited to the patient¡¯s needs.

For large tumors and multiple tumors, the probe can be placed intra-operatively or laparoscopically, and the ablation can be combined with surgical resection or hepatic arterial chemo-infusion pump placement. Although surgery is still required, the use of ablation makes the procedure a less invasive one.

The ablation program at UCLA

A multidisciplinary team of surgeons, oncologists, hepatologists and interventional radiologists from the Dumont-UCLA Liver Cancer Center evaluates patients. The evaluation includes a comprehensive history, physical examination and laboratory profile as well as detailed imaging of the liver tumor and metastatic work-up. The recommended treatment plan is discussed with the patient, family members and the referring physician.

After discharge, ULCA physicians follow the patient in conjunction with the primary and referring physicians. In addition to routine follow-up of any tumor markers, the protocol consists of a dual-phase contrast-enhanced CT scan (or contrast-enhanced multiphasic MRI) immediately after ablation to establish a baseline, and additional scans every three months thereafter. Positron emission tomography ¨C computed tomography (PET-CT) is used in PETpositive tumors such as colon cancer. Strict follow-up allows residual or recurrent tumors to be treated using another percutaneous RFA while the tumor is still small.

Team members

David S. K. Lu, M.D.C.M.
Professor, Department of Radiology
Director, Liver Tumor Ablation Program

Myron Tong, M.D.
Professor and Director, Clinical Hepatology and Liver Cancer Center
Department of Medicine

Steven Raman, M.D.
Associate Professor, Department of Radiology

Jonathan Hiatt, M.D.
Professor and Chief, Division of General Surgery. Department of Surgery

Ronald W. Busuttil, M.D., Ph.D.
Professor and Chair, Department of Surgery
Director, Dumont-UCLA Liver Cancer Center and Transplant Center

Carolyn Britten, M.D.
Assistant Professor, Division of Medical Oncology
Department of Medicine

James Economou, M.D., Ph.D.
Professor and Chief, Division of Surgical Oncology
Department of Surgery

Richard Finn, M.D.
Assistant Professor, Division of Medical Oncology
Department of Medicine

Contact 

To arrange for a consultation or evaluation, referring physicians can contact the numbers listed below at any time.

(310) 825-8526 Radiology, Tumor Ablation Program
(310) 825-1412 Liver Cancer Center
(310) 825-2644 Surgical oncology
(310) 825-6301 Emergency operator--ask to talk to one of the doctors listed above





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