Liver ablation therapy

The first description of percutaneous ethanol injection (PEI) was published in 1986, a small series of just 14 patients with small, non-resectable hepatocellular carcinoma (HCC) [1]. Thermal techniques were first performed in the liver at our institution in 1989, initially using single bare tip neodymium yttrium aluminium garnet (NdYAG λ 1064 nm) laser fibres placed under ultrasound guidance [2]. 15 years on there are hundreds of centres performing thousands of ablations mostly using radiofrequency (RF). The most common site for treatment remains the liver but ablation has been performed in many other sites including lung, renal, adrenal, pleura, bone, pelvic tumours and nodal masses. Two particularly promising areas of development are RF ablation for inoperable lung cancer and as a minimally invasive, nephron sparing technique in renal cell carcinoma. This article looks at liver ablation; the different technologies available, the clinical results and current status of ablation in patients with colorectal liver metastases, neuroendocrine metastases and non-colorectal, non-neuroendocrine metastases, e.g. breast, and HCC. © 2004 The British Institute of Radiology.