Liver Tumor Ablation: RFA and MWA for Primary and Metastatic Cancer

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• Ablation Techniques Explained
• Ideal Candidates for Ablation
• Clinical Applications and Benefits
• Procedure and Success Factors
• Comparing Ablation to Resection
• The Future of Liver Cancer Treatment
• Full Transcript

Ablation Techniques Explained

Radiofrequency ablation (RFA) and microwave ablation (MWA) are minimally invasive techniques for destroying liver tumors. Dr. Christoph Maurer, MD, describes the process as applying heat directly to the tumor via a needle inserted into the liver. This heat, generated by radiofrequency or microwave energy, causes necrosis of the cancerous cells. A small rim of normal surrounding liver tissue is also necrosed to create a crucial safety margin around the resected tumor.

Ideal Candidates for Ablation

The most appropriate patients for liver tumor ablation are those with small lesions. Dr. Christoph Maurer, MD, emphasizes that these techniques are best for tumors up to three centimeters in diameter. This size limitation is key for achieving a high rate of complete tumor necrosis. Ablation is particularly valuable for tumors located centrally in the liver, where a traditional surgical resection would be a major and complex operation.

Clinical Applications and Benefits

Liver tumor ablation is effective for both primary liver cancer, like hepatocellular carcinoma, and secondary metastatic disease, such as from colorectal cancer. A significant benefit is the ability to combine ablation with surgical resection. As Dr. Christoph Maurer, MD, explains, a surgeon can perform an ablation on one liver lobe and a resection on another. This combination therapy dramatically enlarges the spectrum of treatable cancers and improves overall resectability, offering patients another chance at a cure.

Procedure and Success Factors

The ablation procedure relies heavily on precision and experience. It is not simply about placing a needle and applying heat. Dr. Christoph Maurer, MD, stresses that the surgical team must be sure the needle is in the correct position, which is verified using intraoperative ultrasound guidance. The reliability and success of radiofrequency ablation or microwave ablation are directly tied to the operator's skill and comfort with the technology.

Comparing Ablation to Resection

For the right tumors, the results of ablation can be equivalent to surgical resection. Dr. Maurer confirms that for small liver cancer tumors under three centimeters, ablation is considered just as effective. This makes it an elegant and less invasive alternative to a major hepatic resection. The conversation with Dr. Anton Titov, MD, highlights that the choice between techniques often comes down to the specific clinical scenario and the surgical team's expertise.

The Future of Liver Cancer Treatment

These novel ablation tools represent a major advancement in liver cancer surgery. Dr. Christoph Maurer, MD, describes them as amazing methods that are very important for patients. By providing a minimally invasive option that can be used alone or in combination with surgery, ablation technology expands treatment possibilities. As Dr. Anton Titov, MD, discussed, this progress offers new hope and curative potential for individuals with both primary and metastatic liver tumors.

Full Transcript

There are many options for treatment of liver and lung metastases in colorectal cancer. When to use radiofrequency ablation (RFA) and microwave ablation (MWA) in liver tumor treatment? Primary liver cancer and metastatic lesions in the liver from colon cancer can be effectively treated.

Dr. Anton Titov, MD: Let's talk about liver cancer. There is primary liver cancer, such as hepatocellular carcinoma. There is secondary liver cancer, such as metastatic colorectal cancer. Their incidence is high and increasing in frequency. Surgical resection of liver tumors is the primary treatment choice. But radiofrequency ablation of liver tumors has also made a lot of progress recently.

You co-authored a comprehensive review on best treatment practices in radiofrequency ablation of liver tumors. We discussed with Dr. Graeme Poston, a prominent liver cancer surgeon, progress in liver metastatic tumor resection. He mentioned that microwave ablation can eliminate 15 liver tumors in two hours or less. Which patients benefit most from radiofrequency ablation of liver tumors? And what is the future for radiofrequency ablation of primary liver cancer and metastatic liver cancer?

Dr. Christoph Maurer, MD: Yes, indeed. These liver tumor ablation techniques are a very important novel tool in liver cancer surgery. The most appropriate indication for these tumors are small tumors up to three centimeters in diameter. Microwave ablation best treats liver tumors that are located centrally in the liver. Because the alternative to radiofrequency ablation of liver cancer would be a major hepatic resection.

So, in small tumors, radiofrequency ablation is very elegant to do. You go into the liver with a needle and apply heat to the tumor. Because radio frequency applies heat by the same principle as microwave ovens heat up food. Heat is applied and produces necrosis of liver cancer tumor. There is also necrosis of a small rim of normal surrounding tissue of the liver.

Dr. Christoph Maurer, MD: You have a safety margin around resected liver cancer tumor. So with this technique, you can avoid a major hepatic resection. Radiofrequency ablation procedure is best for tumors up to three centimeters. So you have a high rate of complete necrosis and elimination of these liver tumors.

Radiofrequency ablation works well for metastatic liver tumors from colorectal cancer. It also works well for primary liver cancer. You can combine microwave ablation or radiofrequency ablation with liver resections. For instance, on one liver lobe you do an ablation, and on the other side of the liver you do a resection of tumors.

Microwave ablation enlarges the spectrum of cancers you can treat. It enlarges the resectability of liver tumors. Radiofrequency ablation is a useful novel tool. So it's an amazing method to treat liver cancer for liver surgeons. It's very important, especially for liver cancer patients, because they have another chance to get cured just by this new microwave tumor ablation technique.

Dr. Anton Titov, MD: So, it's also important for patients to realize that radiofrequency ablation and microwave ablation are equally good for the patient. But it's important to select the method that the surgical team is feeling most comfortable with using. Is that correct?

Dr. Christoph Maurer, MD: Yes, absolutely. You need to have experience. Otherwise, it's not so easy. It's not just putting a needle into the liver and applying heat. But you have to be sure to be at the correct position with your needle, and you have to check this by ultrasound. But if you have experience with radiofrequency ablation or microwave ablation, it's a very good technique to treat liver cancer. It is also a reliable technique.

Dr. Anton Titov, MD: So in experienced hands, such as yours, the results of radiofrequency ablation of liver tumors is as good as the surgical resection of the particular lesion?

Dr. Christoph Maurer, MD: We think so, yes. We think so for smaller liver cancer tumors.

Dr. Anton Titov, MD: For liver tumors that are less than 3 centimeters, as you mentioned.

Dr. Christoph Maurer, MD: Correct.

Liver cancer radiofrequency ablation (RFA) and microwave ablation of liver tumors (MWA) are being used together with hepatic resection by many surgeons today. Percutaneous radiofrequency ablation of liver tumors is common technology for multiple liver metastases from colorectal cancer. RFA for liver tumors: does it really work? Yes, radiofrequency ablation is a fast and effective method for liver tumor removal.