Percutaneous treatment of hepatic neoplasms: A review of current techniques

Percutaneous local hepatic tumor ablation is an important alternative to surgical therapy for primary and secondary hepatic neoplasms in patients who are not operative candidates. In contrast to surgery, these percutaneous local tumor ablative methods spare functioning liver and may be repeated during therapy of the index lesion or for treatment of locally recurrent or metachronous lesions. The salient aspects of each of the percutaneous ablative methods discussed herein are summarized in Table 4, adapted from the work of D'Agostino and Solinas [1]. High-intensity focused ultrasound will require further animal studies before application in patients is feasible. Percutaneous acetic acid and hot saline injection have been described in a single report each, in 1994, as potential alternatives to percutaneous ethanol injection for HCC [76, 77], but have not been pursued further, likely due to the established success of PEIT. Thus, the dominant techniques of percutaneous tumor ablation are PEIT and the local heating methods (RF, laser, and microwave). PEIT is unequivocally the percutaneous ablative technique of choice for unresectable HCC. It combines technical simplicity with ready availability, low cost, a low rate of complications, lack of need for routine periprocedural hospital admission, and extensively established efficacy with survival approximating that of surgical resection. Metastases are more resistant to percutaneous therapy than is HCC due to their firm texture, resistance to uniform and reliable distribution of injectable agents such as ethanol, and limitation of lesion size attainable by lesional heating techniques. Efforts are in progress, particularly with respect to RF, laser, and microwave therapy, to design modifications that will enable uniform ablation of adequate size to treat metastases with the same success as that achieved with PEIT for HCC.