There are many treatment options

During Hepatic Arterial Infusion (HAI) chemotherapy, a high dose of chemotherapy drugs are pumped into the hepatic artery — the main source of blood and nutrients for liver tumors — through a tiny pump under the skin in the lower abdomen. Additional chemotherapy medicine is injected into the pump, as needed, on an outpatient basis. Because HAI chemotherapy is delivered regionally (only to the tumor site), it causes fewer toxic side effects and has been associated with better physical functioning than systemic chemotherapy.

In a number of patients who cannot have liver metastases removed because of their number, size, or location, HAI plus systemic therapy can reduce tumors so resection can become possible.

COMMON SIDE EFFECTS

Because the chemotherapy in the pump is quickly extracted by the liver, the HAI is rarely associated with the side effects of systemic chemo. The major side effect from HAI is liver toxicity, so liver enzymes should be monitored every two weeks. Other side effects may include stomach ulcers and biliary sclerosis or inflammation/thickening of the bile ducts.

RECOVERY

Typically, the patient will go home the same day. If a laparoscopic procedure is selected, the patient usually goes home the following day. An open surgical procedure requires an incision be made in the abdomen, general anesthesia is needed and the recovery period will be longer.

Small particles or beads, ranging in size from 100 to 900 microns made of a biocompatible resin, are injected into selected vessels to block the blood flow feeding the tumors, causing the tumor to shrink.Over a series of months, the embolized vessels will permanently shrink and the tumor will decrease in size. Embolization can be performed with bland particles (without drug added), or with drug added which is called TACE (Transarterial Chemoembolization). Cutting off the blood supply to the tumor allows for higher doses of chemotherapy to be delivered and remain in contact with the tumor, and preventing the chemotherapy from reaching healthy tissue.

COMMON SIDE EFFECTS

The side effects will differ depending upon the type of embolization used. The most common complications reported are pain, nausea and severe post-embolization syndrome (fever, pain, extreme fatigue, nausea/vomiting), hepatic injury and liver abscess.

RECOVERY

Most patients can be discharged a few hours after the procedure. If post embolization syndrome occurs, an overnight stay is normally required.

SIRT (Selective Internal Radiation Therapy) is a targeted radiation therapy that uses SIR-Spheres® microspheres to treat metastatic liver cancer.During the procedure, a small flexible tube is guided through the artery into the liver and millions of microscopic spheres (each about a third of the width of a human hair) are delivered directly into the tumor where they become trapped. The SIR-Spheres microspheres emit beta radiation for a period of about two weeks.This targeted therapy delivers a dose of internal radiation up to 40 times higher than conventional external beam therapy. Normal liver tissue takes about 90% of its blood supply from the veins, while liver tumors receive about 90%of their blood supply from arteries. This allows SIR-Spheres microspheres to target the liver tumors with a tumor-killing dose of radiation via the hepatic artery, while sparing surrounding healthy liver tissue.

COMMON SIDE EFFECTS

Some patients may experience abdominal pain or tightness in their abdomen, nausea and loss of appetite which normally subsides within a week. Many patients may develop a mild fever that may last for up to a week and fatigue which may last for several weeks. As a precaution, specific medications are prescribed to control these symptoms.

RECOVERY

The treatment normally takes about 60 to 90 minutes. Patients will be sleepy during the procedure but able to communicate with the doctor and the team. Most patients return home 4-6 six hours following treatment.

With conventional therapy, radiation is delivered in relatively small doses over the course of several weeks, with patients receiving daily treatments during that time. With Steriotactic Body Radiation Therapy (SBRT), physicians are able to deliver a greater combined dose of radiation over the course of far fewer treatments. SBRT has shown dramatically better outcomes than conventional radiation therapy. Whereas two-year success rates for conventional treatment range from 30 to 40 percent, the success rates for SBRT range from 80 to 90 percent — comparable to those of resection surgery but with far fewer risks.

COMMON SIDE EFFECTS

Despite the fact that SBRT delivers higher biological dosage of radiation, patients have experienced fewer side effects, including radiation pneumonia. Slight fatigue for one week following treatment is SBRT’s most common side effect.

RECOVERY

After the procedure, you will be comfortable enough to walk out of the treatment room.

Cryotherapy or cryosurgery uses super cooled nitrogen or argon gas to freeze liver lesions thereby destroying the tumor. Similar to Radiofrequency Ablation (RFA), the procedure can be performed through a needle. A doctor will use MRI or ultrasound to guide the probe and monitor the formation of an “ice ball” in the tumor, limiting damage to surrounding tissue. The procedure may also be performed using an open surgical procedure. Clinical and laboratory research suggest that hepatic cryotherapy is effective in patients with inoperable tumors, which are located in a difficult section of the liver (near large vessels).

COMMON SIDE EFFECTS

Complications of cryotherapy may include bleeding, mild fever, increased liver enzymes due to damage to the bile ducts, infection or abscess.

RECOVERY

Typically, the patient will go home the same day. An open surgical procedure requires an incision be made in the abdomen, general anesthesia is needed and the recovery period will be longer.

Microwave Ablation (MA) uses microwave energy and an antenna to cause coagulation of tissue by creating heat due to friction and vibration of water molecules in the cells. The advantage of MA over other heating systems, such as RFA, is that the microwave technique is quicker (it can be completed in 10 minutes) and does not cause collateral damage.

COMMON SIDE EFFECTS

Many patients experience a low grade fever and pain for a few days following the procedure. Major complications include liver abscess, bile duct injury, infections, bleeding and skin burn.

RECOVERY

Typically, the patient will go home the same day. If a laparoscopic procedure is selected, the patient often goes home the following day. An open surgical procedure requires that an incision be made in the abdomen, general anesthesia is used, and the recovery time will be longer.

Radiofrequency Ablation (RFA) uses electrical energy to “super heat” and attack the tumor. The procedure can be performed by inserting a needle through the skin under x-ray guidance, then placing a probe through the needle and positioning it in the liver tumor. The procedure is usually performed by an interventional radiologist under local anesthesia. Alternatively, the procedure can be done laparoscopically, using a laparoscope that is inserted through a tiny incision in the abdomen. It may also be done as an open surgical procedure. The laparoscopic and open surgical procedures are performed by a surgeon.

COMMON SIDE EFFECTS

Many patients experience a low grade fever for a few days following the procedure. There is a very low risk of infection, bleeding and skin burn.

RECOVERY

Typically, the patient will go home the same day. If a laparoscopic procedure is selected then the patient usually goes home the following day. An open surgical procedure requires that an incision be made in the abdomen, general anesthesia is needed and the recovery period will be longer.