Minimally invasive techniques for the treatment of liver tumors

Recently, several minimally invasive, image-guided therapies have been deve loped for the local treatment of hepatocellular carcinoma (HCC) and hepatic metastases in patients who are considered poor candidates for surgical res ection, Radio-frequency ablation, microwave ablation, and laser ablation al l destroy tumor by creating a hyperthermic injury. Cryoablation and ethanol ablation achieve cellular death through freezing and direct toxicity, resp ectively. Chemoembolization is unique in that the entire liver can be treat ed over time with a combination of cyotoxic drugs and embolic agents, poten tially reducing the rate of recurrence from radiologically occult tumor. Ou tcomes for minimally invasive therapy have approached the success rate of s urgical resection in some series with considerably fewer complications. How ever, a paucity of randomized trials and variability in reporting limit ass essment of the relative role of these techniques in clinical practice. With a few exceptions, the indications, contraindications, and complications as sociated with the different techniques are similar, and success with HCC ha s exceeded that for metastatic disease independent of technique.