Update of laser-induced thermotherapy for liver tumors

Surgical resection generally offers the only chance of long-term survival f or patients with primary or secondary liver tumors. Difficulties relating t o the stage of the tumor, the extent of underlying liver cirrhosis and the general condition of the patient make this technique unsuitable for the maj ority of patients. Many nonresectional methods of in-situ tumor ablation ha ve been recently described. These include alcohol injection, cryotherapy, r adiofrequency and intraoperative radiotherapy. Recently more interest has b een directed to the use of laser as a source of ablative energy. Laser-indu ced interstitial thermotherapy is an experimental technique used to destroy tumors within the liver. Initially this was in the form of bare-tipped pho tocoagulation but the development of a diffuser tip has enabled the formati on of larger diameter lesions using heat to produce an area of coagulative necrosis. Less heat is lost if hepatic vascular inflow is occluded during t he procedure and consequently a larger area of tumor necrosis is produced. The prospect of a simpler, more efficient system of tumor ablation is attra ctive so we undertook a review of the current issues surrounding this emerg ing treatment.