Ablative therapy for liver cancer - Standards, limitations, results

Liver resection done on a patient with liver cancer after radiofrequency ablation has been performed at a different institution. The lower greenish colored portion denotes the viable portion of the tumour that was missed by the ablation.

Ablative treatments for liver cancer are useful adjuncts in the effective management of liver cancer. Ideally, ablative therapies must be limited to tumours of less than or equal to 3 cm in size because of the limitations of ablation. The above tumour was 4.0 cm and was ablated by interventional radiology using radiofrequency ablation. This patient came over to my clinic to discuss about 3 months after the procedure, having a concern that nothing else was done for the tumour.

We followed our regular, standardised evaluation for liver cancer and we found viable tumour in the liver after ablation as was suspected. We evaluated his liver disease and found him suitable for resection. Removal of the tumour with good margins, with intra operative ultrasound has given him a chance to win the battle against cancer.

Key principles that must be remembered when doing ablative treatment for liver cancer are:

1. It is a bridge procedure in most patients and must be followed by a definitive treatment, usually transplant.
2. There is a size limitation to RFA. The tumours must be less than 3 cm in size.
3. If large blood vessels lie close to tumour, ablation may not work.
4. Always follow up with a CT scan at 3 months following RFA to look for residual disease.

Knowing all the treatment options and their limitations is important for successful cancer treatments.