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TREATMENTS FOR TUMOURS AND METASTASES OF THE LIVER

There are various treatment options available for tumours and metastases of the liver. These must be tailored to the individual patient’s requirements, however. The treatment depends on numerous factors, including the type of tumour, the spread of malignant cells, the condition of the liver itself and the patient’s age and general state of health. Treatments are often also used in combination. Commonly used treatment methods include:

 


During partial liver resection or surgical resection, the surgeon does not just remove the tumour itself, but rather also the part of the liver containing the tumour with a margin of safety around it. For the liver to be resected in this way, the liver tissue left after the operation must be able to function adequately. This is the only way that the liver can regenerate itself following the procedure. The pressure in the portal vein, the main supply of blood to the organ, must also not be too high.

A transplant is considered for patients with primary hepatocellular carcinoma (HCC) if they have liver cirrhosis and their tumours do not exceed a certain number and size. However a suitable donor organ must be available for this to happen. Before a patient is added to the waiting list for a liver transplant, special preliminary investigations must be carried out first. In some cases, the wait for a donor organ can be considerable, so local treatment methods are recommended in order to bridge this waiting period. Following the transplantation of a new liver, there is also a wait to see whether the organ is accepted by the recipient’s body.

Local ablative procedures are especially ideal for treating individual, smaller tumours. These procedures include radio-frequency ablation (RFTA or RFA), laser-induced thermal therapy (LITT) and microwave therapy (MW). When these procedures, which are limited only to the actual tumour, are used, the tumour tissue is heated using radio-frequency, laser or microwaves to such a high degree that the malignant cells are killed.

With trans-arterial chemo-embolisation (TACE), a chemotherapy agent is injected via a catheter directly into the tumour. To prevent the agent from flowing away with the blood a doughy liquid or small particles block off the blood supply to the tumour by occluding the vene. That way the chemotherapy agent may work specifically on the malignant cells and destroy them.

Where tumours of the liver are clearly demarcated, external radiotherapy can be used. Since the liver is an organ that is highly sensitive to radiation, radiotherapy can only be used for tumours that are below a certain size. Often, patients are given chemotherapy alongside the radiotherapy.

Drug-based tumour therapy, especially cytotoxic chemotherapy, is frequently used for advanced tumours. Doctors are also increasingly combining this with other forms of treatment, such as surgical resection. In Germany, the drug Sorafenib is licensed for the drug-based treatment of hepatocellular carcinoma (HCC).

 

 

 
NEWS & DATES
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The new ESMO guidelines recommend SIRT for people with metastatic colorectal cancer if the metastases are limited to the liver and are not responding to chemotherapy.
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Metastatic colorectal cancer: the SIRFLOX, FOXFIRE and FOXFIRE Global studies are investigating the benefits of combining SIRT with chemotherapy. The data from the three studies regarding overall survival is expected by the end of 2017. The SARAH and SIRveNIB studies on advanced liver cell cancer are now complete. Both compared Y90 radio-embolisation with sorafenib chemotherapy. The initial results are set to be published at the end of 2016 (SARAH) and 2017 (SIRveNIB).
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