An Alternative Liver Cancer Therapy
by John C. Martin
Article Date: 07-20-05

Doctors are touting the benefits of an alternative treatment approach for people
with inoperable liver cancer that they claim can be an effective option in these
cases. The latest study to test the efficacy of radiofrequency ablation, or RFA,
was released at a meeting of the Society of American Gastrointestinal and
Endoscopic Surgeons this past spring.1

Increased RFA Scrutiny
There have been many studies testing the effectiveness of RFA. But this research
went one step further, to determine if the procedure could effectively treat
liver tumors from cancers that originated elsewhere in the body. While there has
been "increasing experience" with RFA for treating patients with liver tumors
that originated from colorectal and neuroendocrine cancer; "little is known
about the outcome of patients with other tumor types," wrote Alan Siperstein,
MD, in the department of General Surgery at the Cleveland Clinic Foundation, and
his colleagues.

Radiofrequency ablation is primarily advised for patients who cannot have their
liver cancer removed through surgery, either because the tumor is larger,
involves more than one lobe of the liver, or has grown into blood vessels or
other vital structures. It's a relatively new procedure aimed at destroying the
tumor using electro currents passed through a small needle inserted into the
tumor.2

There are two types of needles that are used commonly in RFA; one needle with an
active tip is water-cooled to avoid charring or overcooking, and a second
coaxial needle system houses hot hooks that are released once the needle enters
the tumor.3

RFA doesn't rule out other treatment options, and in fact, it can be used before
or after surgery or radiation therapy, as well as with systemic treatments like
chemotherapy. It’s used in combination because certain sections of tumors can’t
always be heated effectively using RFA alone.3

No long-term randomized, controlled clinical trials have been conducted to
evaluate the benefits of the procedure, but preliminary research has been
positive.4 While RFA is not considered a cure for liver cancer, studies have
suggested it can prolong and improve a patient's quality of life.5

Effective for Various Liver Metastases?
In their study, Siperstein and his team prospectively followed 517 patients who
underwent RFA using laparoscopy (a form of minimally invasive surgery in which
slender, telescope-like instruments are inserted through small incisions)
between 1996 and 2005. Of those patients, 53 had lesions related to sarcoma,
breast cancer, esophageal cancer, lung cancer, melanoma, ovarian cancer,
pancreatic cancer, cholangiocarcinoma, rectal squamous cell carcinoma, kidney
cancer, and hemangioendothelioma.

All patients had evidence of exclusive liver disease and had failed
chemotherapy. Each underwent RFA, with eight requiring repeat treatment. The
average hospital stay for all the patients in the study was one day with no
deaths within 30 days after the procedure, Siperstein's group found.
Postoperative complications included one hemorrhage, one liver abscess, and one
wound infection.

RFA Outcomes Were Positive
After two years of follow-up, the research team found about one-fifth of the
tumors recurred. The overall, median length of survival was 33 months, with 51
months for those diagnosed with breast cancer and 25 months for patients with
sarcoma.

The rates of recurrence and disease following RFA were similar to those seen in
patients who underwent the procedure for other tumor types, explained study
investigator Eren Berber, MD, chief surgical resident at the Cleveland Clinic
Foundation. And that was the case in these patients who had presented with more
non-conventional tumor types, Berber said.

"Laparoscopic RFA is able to safely and effectively treat hepatic metastasis in
these unusual tumor types," the researchers wrote. ”We feel that this
heterogeneous group of patients, selected for their unusual presentation of
liver exclusive disease, may benefit from [reduction] of their tumor by
laparoscopic RFA when other treatment methods have failed."

1. Berber E, Ari E, Herceg N, Siperstein A. Laparoscopic radiofrequency thermal
ablation for unusual hepatic tumors: operative indications and outcome. The
Society of American Gastrointestinal and Endoscopic Surgeons 2005 Annual
Meeting. 2005 April 13-16. Fort Lauderdale, Florida.
2. American Liver Foundation. Liver Tumors. Available at:
http://www.liverfoundation.org/db/articles/1040.
3. National Institutes of Health (NIH). Radiofrequency Ablation Background.
Available at: http://www.cc.nih.gov/drd/rfa/frame-background.html . Accessed
July 20, 2005.





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