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Guidelines Support Ablation Techniques for Unresectable Liver Cancer: Presented at NCCN

By Ed Susman

HOLLYWOOD, Fla -- March 12, 2008 -- Tumour ablation techniques should play a major role in treating tumours of the liver that are not suitable for resection, according to updated treatment guidelines for hepatocellular carcinoma presented on March 8th here at the National Comprehensive Cancer Network (NCCN) 13th Annual Conference on Clinical Practice Guidelines and Quality Cancer Care.

"Ablation is a good alternative for small volume disease in cirrhotic liver," said Al B. Benson III, MD, Professor of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

The new treatment algorithm -- now used throughout the world -- suggests ablation be used in patients who agree to surgery and in those who refuse open surgery.

If the patient is amenable to surgery, but the lesion is found to be unresectable, Dr. Benson said the guidelines suggest ablation therapy and then further treatment, with the possibility of liver transplantation.

For patients who are willing to undergo surgery, the guidelines suggest resection and then ablation, if and where necessary.

Patients who do not agree to an open surgical procedure could be treated with chemotherapy or radiation or could undergo ablation therapy, generally performed percutaneously under radiological guidance.

In cases where a patient is not a candidate for transplantation, ablation may be considered along with chemoembolisation techniques or enrolment in a clinical trial.

Dr. Benson said that ablation procedures in localised hepatocellular carcinoma could employ several techniques, including radiofrequency ablation, cryoablation, microwave ablation, interstitial laser therapy, ethanol injection, or acetic acid injection.

"Chemical or thermal ablation techniques require shorter hospitalisation and cause less damage to the cirrhotic liver," Dr. Benson said. Several studies appear to favour radiofrequency ablation over alcohol ablation therapy, he added.

Minimally invasive techniques to tackle regional cancers include infusional therapy, chemoembolisation, bland embolisation, radioembolisation, and drug-eluting microspheres.

"The embolisation therapies are designed to cut off blood supply to the tumour and allow for a longer dwell time of chemotherapeutic agents, and decrease systemic toxicity," he said.

Selecting the best ablative or embolisation therapy, however, remains more art than science. "Well-performed comparative studies are needed," Dr. Benson concluded.

[Presentation title: Update Hepatocellular Carcinoma Guidelines.]

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