Non-Surgical Minimally Invasive Techniques for Treating Primary (Hepatocellular Carcinoma) and Metastatic Liver Tumors

Treatment with Transcatheter Arterial Chemoembolization (TACE)

The occurrence of hepatocellular carcinoma (HCC) is rising globally, and the demand for its effective treatment is increasing. Liver cancer ranks as the fifth most prevalent cancer worldwide and the third leading cause of cancer-related mortality. Given its aggressive nature and poor prognosis, innovative approaches are imperative. In recent years, minimally invasive interventional radiological therapies have established efficacy in treating both primary and metastatic liver tumors, hinting at a shift away from traditional surgical resection methods.

What is Chemoembolization for Liver Tumor?

Many patients with hepatocellular carcinoma (HCC) are diagnosed when the cancer is already at a late stage, making treatment challenging. Surgery isn’t usually an option because the tumors have spread too much and there are often multiple tumor sites. Even when surgery is possible, there’s a high chance of the cancer coming back afterward.

This is why transarterial chemoembolization, pioneered by Interventional Radiologists, has emerged as a promising alternative. This procedure involves blocking the blood vessels that feed the tumor while delivering chemotherapy drugs directly to it. This method helps patients with HCC live longer and may become the standard treatment in the future.

A breakthrough in this field is the introduction of PRECISION TACE, which utilizes drug-eluting beads (DC beads) loaded with chemotherapy agents. These beads offer precise delivery of medication to the tumor site, reducing systemic toxicity and enhancing treatment efficacy. This innovative approach allows for higher drug concentrations within the tumor for an extended duration, improving outcomes while minimizing adverse effects. Overall, TACE is a combination treatment that blocks the tumor’s blood supply and delivers concentrated chemotherapy drugs to fight the cancer.

What Is the Procedure for Chemoembolization?

It is a minimally invasive Interventional Radiological procedure used to treat liver tumors, particularly hepatocellular carcinoma (HCC). The procedure begins with the patient receiving local anesthesia and sedation to ensure comfort. Through a small incision, typically in the groin area, an interventional radiologist inserts a catheter into the femoral artery.

Once the catheter is properly positioned, a contrast dye is injected to visualize the blood vessels and identify the arteries feeding the tumor. With precise guidance, chemotherapy drugs, often mixed with a contrast medium, are infused directly into the tumor’s blood supply through the catheter. This allows for targeted delivery of chemotherapy, maximizing its concentration at the tumor site while minimizing systemic side effects.

Following the chemotherapy infusion, the interventional radiologist injects embolic agents, such as tiny beads or particles, into the arteries supplying the tumor. These agents block blood flow to the tumor, causing it to shrink and preventing further growth. The procedure typically requires a short hospital stay for observation and post-procedural care. Overall, TACE offers a targeted and effective treatment option for patients with liver tumors, aiming to improve survival and quality of life.

Who Are the Ideal patients for Transarterial chemoembolization?

Ideal patients for PRECISION TACE (Transarterial Chemoembolization) should meet the following basic requirements:

• Patients should have a confirmed diagnosis of unresectable hepatocellular carcinoma (HCC), a type of liver cancer.
• The tumor size should be 5 cm or more. However, tumors sized between 3-5 cm may also be eligible for treatment, although radiofrequency ablation (RFA) could be considered for smaller tumors.
• Patients with hepatic metastases, particularly those with neuroendocrine tumors, may also be suitable candidates for PRECISION TACE.
• The bilirubin concentration in the blood should be less than 3 mg/dl.
• Patients should undergo evaluation by a specialized team consisting of interventional radiologists, oncologists, and gastroenterologists to determine the appropriateness of PRECISION TACE for their condition.

Meeting these criteria ensures that patients are optimally positioned to benefit from PRECISION TACE, maximizing the effectiveness of the treatment while minimizing potential risks.

Before Procedure, Certain Steps Are Taken:

• Confirming the presence of cancer through tissue diagnosis.
• Using CT or MRI scans with contrast to see detailed images of the liver and confirm the presence of cancer.
• Conducting various blood tests, including Complete Blood Count (CBC), Prothrombin Time (PT), Partial Thromboplastin Time (PTT), Creatinine, liver function tests, and tumor marker tests, to assess overall health and tumor characteristics.

After-Procedure Care Involves:

• Post-procedural care involves managing the expected post-embolization syndrome, characterized by pain, nausea, and vomiting. Medications are given to manage these symptoms.
• Patients receive vigorous hydration, IV antibiotics, and anti-nausea medication.
• In cases of neuroendocrine tumors, more than two sessions of chemoembolization may be needed.

Conditions That Make the Procedure Unsuitable:

• Poor liver function
• High bilirubin levels (> 2–3 mg/dl)
• Blocked main portal vein leading to inadequate blood flow

The Procedure Is Commonly Used For:

• Liver cancer that can’t be removed surgically (hepatoma)
• Other cancers that have spread to the liver include colorectal metastases, ocular melanoma, and neuroendocrine tumors.

What Are the Advantages of Chemoembolization?

Advantages of chemoembolization include:

• Chemoembolization allows for drug levels in the liver to be much higher compared to a simple infusion.
• Follow-up scans often show a significant decrease in the size of liver tumors.
• The treatment may have a lasting effect, with detectable drug levels in the tumor for up to a month after infusion.
• Embolization helps deliver drugs directly to the tumor while sparing healthy liver tissue.
• Despite high drug doses, systemic side effects are minimized.
• Chemoembolization enhances the effect of chemotherapy drugs on tumor cells.

Treatment With Radiofrequency Ablation (RFA):

In parallel, radiofrequency ablation (RFA) has emerged as a non-surgical alternative for treating liver tumors. By delivering localized thermal energy, RFA destroys tumor cells while sparing healthy tissue. Treatment with Multipolar RFA (Radiofrequency Ablation) is a non-surgical interventional procedure used to address various medical conditions, including:

• Liver Cancer (HCC and metastasis): Effective for tumors sized between 3-5 cm; larger tumors may require combination therapy with chemoembolization.
• Treatment for other cancers (such as kidney and lung cancer).
• Management of varicose veins.
• Relief from bone pain caused by osteoid osteoma.

Performed by interventional radiologists, these procedures utilize advanced imaging techniques like X-rays, ultrasound, CT scans, MRI scans, and Digital Subtraction Angiography (DSA) to guide flexible catheters to the treatment site, similar to heart angioplasty. With real-time imaging displayed on a monitor, the interventional radiologist can precisely target the affected area without the need for invasive surgery, ensuring minimal impact on surrounding tissues.

Radiofrequency Ablation (RFA) and Liver Cancer

Patients with inoperable liver cancer, until recently, solely relied on systemic treatments such as chemotherapy. However, due to their life-threatening toxic effects, these medications often fail to provide adequate control over most liver cancers.

Radiofrequency Ablation (RFA) offers a localized treatment approach for liver cancer, especially for tumors that are inoperable. Unlike chemotherapy, which poses risks due to systemic toxicity, RFA targets tumors directly. Ideally suited for tumors up to 5 cm, it can be paired with chemoembolization for larger ones, enhancing chemotherapy’s effectiveness while minimizing its dosage and side effects.

RFA’s Role in Treating Various Cancers and Other Issues

Radiofrequency ablation (RFA) is a valuable option for cancers that are inoperable due to size, location, or patient health limitations. Its applications extend beyond tumor eradication to lessening cancer-related pain.

The versatility of RFA extends beyond liver cancer, encompassing applications in bone pain management, kidney tumors, lung tumors, and varicose vein treatment. This minimally invasive approach offers numerous advantages over traditional surgery, including reduced risk, shorter recovery times, and enhanced patient comfort.

RFA for relieving Cancer Pain

RFA effectively reduces cancer-related pain and relieves the symptoms experienced by many patients. While tumors themselves are not painful, their pressure on nerves or vital organs can induce significant suffering. Following RFA treatment, pain relief is commonly achieved within 1-4 weeks for the majority of cases.

RFA’s Role in Cancer Therapy

RFA can be utilized independently or in combination with various treatments such as chemotherapy, surgery, and chemoembolization. Post-RFA treatment, patients have maintained disease-free status for several years. Current strategies employing RFA include:

• Reducing large tumor sizes to render them surgically removable
• Offering a localized treatment alternative when surgery is unfeasible or risky
• Alleviating pain and mitigating other side effects to enhance cancer patients’ quality of life

RFA in Varicose Vein Treatment

RFA, or Radiofrequency Ablation, serves as a highly effective treatment for varicose veins. This minimally invasive procedure involves inserting a catheter into the affected vein, delivering radiofrequency energy to heat and seal the vein shut. By closing off the diseased vein, blood is rerouted to healthier veins, alleviating symptoms such as pain, swelling, and discomfort. RFA offers several advantages over traditional surgical options, including faster recovery times, minimal scarring, and a reduced risk of complications. Overall, RFA presents a safe and efficient solution for improving the appearance and relieving symptoms associated with varicose veins.

RFA for Osteoid Osteoma Treatment

RFA, or Radiofrequency Ablation, is an effective treatment for osteoid osteoma, a painful bone condition typically found in the lower leg. By utilizing CT scans or MRIs for detection, RFA provides complete pain relief without the necessity of surgery. This minimally invasive procedure deactivates the abnormal bone cells causing the pain, offering patients relief from discomfort and enhancing their quality of life.

What are the Advantages of Interventional Non-surgical Treatment?

• Reduced risk compared to surgery
• Minimal scarring on the skin
• Procedures conducted under local anesthesia
• Outpatient procedures or short hospital stays
• Proven safety
• Fast relief from pain and suffering, particularly for cancer patients
• Quick recovery allows patients to resume normal activities promptly
• Lower cost compared to traditional surgical procedures

Advanced Non-Surgical Liver Tumor Treatment: TACE and RFA in India

Non-surgical, minimally invasive techniques, such as PRECISION TACE and multipolar RFA, represent significant advancements in the management of primary and metastatic liver tumors. By exploring innovative technologies, these approaches offer improved outcomes, reduced morbidity, and enhanced quality of life for patients battling liver cancer and other malignancies.

For the most effective non-surgical treatment of liver tumors, consider visiting India, where advanced techniques like TACE and RFA are readily available. TACE and RFA for liver tumor treatment in India offer cutting-edge solutions with promising outcomes. Additionally, the cost of TACE and RFA for liver tumor treatment in India is comparatively lower than in many other countries. By opting for treatment in India, patients can receive top-notch medical care while also saving on expenses.