Treatment of Primary Liver Tumors and Liver Metastases, Part 2: Non–Nuclear Medicine Techniques

Abstract

Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the mechanisms of actions of the most used ablation techniques; (2) discuss the potential advantages and disadvantages of each thermal ablation modality; (3) discuss the differences between current transarterial therapies; and (4) describe the rationale and treatment selection of the appropriate locoregional modality for the specific clinical indications. Financial Disclosure: The authors were supported in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. Dr. Solomon received research grants from AngioDynamics and GE Healthcare; serves as a consultant for Medtronic, Inc., Johnson and Johnson, BTG, XACT, and Adgero; and has investment interest in Johnson and Johnson. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through December 2021. Image-guided procedures are used worldwide in the management of primary liver tumors and liver metastases. These locoregional therapies include local tumor ablation and transarterial therapies and can occasionally downstage an inoperable patient to an operable status. In hepatocellular carcinoma, data have suggested that for tumors smaller than 2 cm ablation may be preferable to surgery. Similar results are emerging for colorectal cancer liver metastases. Catheter-directed therapies such as bland embolization, transarterial chemoembolization, and drug-eluting beads represent potential techniques that can provide survival benefit for inoperable patients. In this review we highlight the most used techniques and the evidence supporting their current indications for the treatment of liver tumors. We briefly review upcoming developments in combination strategies with temperature-sensitive liposomes or immunotherapy for enhancing ablation efficacy.

Initial experience of drug-eluting bead transarterial chemoembolization with CalliSpheres® microspheres in treating liver metastases patients

“…For instance, the DEB-TACE treated melanoma liver metastasis presents tumor response rate of 55% and DCR of 80% (18). The existing evidence suggests that DEB-TACE is more effective in treating tumors lacking blood supply compared with cTACE (5,12,(18)(19)(20)(21).…”

“…For instance, the DEB-TACE treated melanoma liver metastasis presents tumor response rate of 55% and DCR of 80% ( 18 ). The existing evidence suggests that DEB-TACE is more effective in treating tumors lacking blood supply compared with cTACE ( 5 , 12 , 18 - 21 ). In our study, the CR, PR, SD and PD of total treated cycles were 1.6%, 34.4%, 54.7% and 9.4% respectively, and 5.0%, 26.7%, 57.8% and 10.6% of total treated nodules respectively, which showed a better prognostic value compared with that of cTACE in previous studies.…”

Interventional Oncology: 2024 Update

“…Techniques such as functional magnetic resonance imaging (MRI), positron emission tomography (PET), dual-energy computed tomography (CT), and dynamic contrast-enhanced imaging offer intricate insights into tumour morphology, vascularity, and metabolic activity. 8-12 These modalities play a crucial role in pre-procedural planning, helping to target tumours with increased accuracy. Furthermore, with improved applications of (18)F-FDG, coupled with introduction of new molecular probes beyond (18)F-FDG, advancements in molecular imaging presents four major interventional opportunities: guiding target localization, confirming target access through tissue analysis, in-room post-therapy assessment, and delivering therapeutics (Figure 1).…”

Percutanous Electrochemotherapy (ECT) in Primary and Secondary Liver Malignancies: A Systematic Review

“…The choice depends on lesion numbers, their localization, size, and local tumour environment. Both RFA and MWA cause a 3-fold elevation of temperature in the target tissue causing the coagulative necrosis of targeted cells directly or indirectly with desiccation of the tissue and destruction of microvasculature [21]. CRYO causes a drop in temperature below −40 • within the target tissues and induces a freeze-thaw cycle due to the expansion of argon gas, leading to cell death in a small radius near the probe [21].…”

“…Each technique has its advantages and disadvantages and the choice of which to employ depends on the size of the tumour that must be at a maximum of 3.5 cm to be treated with RFA, or 5 cm with MWA and CRYO [21][22][23][24][25].…”