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Michael E. DeBakey VA Medical Center - Houston, Texas

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Houston VA Uses One-Two Punch Against Liver Cancer

January 9, 2007

New minimally invasive procedures are more effective against very aggressive tumors.

HOUSTON – The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) is the first VA hospital to perform laparoscopic Radiofrequency Catheter Ablation (RFA) to treat a primary liver tumor (hepatocellular carcinoma). According to the American Cancer Society, about 14,000 cases of primary liver cancer are diagnosed each year.

Cancer in the liver usually is not detected until it reaches an advanced stage, and most liver cancers cannot be treated with surgery. This is because the tumor may be too large or has grown into blood vessels or other vital structures. Sometimes, many small tumors are spread throughout the liver, making surgery too risky or impractical. In fact, surgical removal is not possible for more than two-thirds of primary liver cancer patients and 90 percent of patients with secondary liver cancer.

Until recently, chemotherapy and systemic treatment were the only options for patients with inoperable liver cancer. Unfortunately, these types of treatments usually cannot be given in doses high enough to control most liver cancers because of their toxic effects, many of which are life-threatening.

Laparoscopic RFA is a minimally invasive procedure performed under real-time intra-operative laparoscopic ultrasound guidance. There is considerably less discomfort for the patient, a much shorter hospital stay, and a considerably faster return to normal activities compared with traditional open surgical techniques. RFA may be the only local treatment option for many cancers that cannot be surgically removed. Because it does not have the bad side effects of other options, RFA can be performed without affecting the patient’s overall health or quality of life. Although RFA is not considered a cure for liver cancer, preliminary research has shown that it can prolong and improve the quality of life.

“We are very excited about offering laparoscopic Radiofrequency Catheter Ablation to our veteran patients. This treatment modality is not only more effective against these very aggressive tumors, but also allows us to treat patients who would be otherwise untreatable. It is also applicable to other forms of liver cancer,” said Daniel Albo, M.D., Ph.D., chief of General Surgery and Surgical Oncology at the MEDVAMC.

RFA treats disease with heat, a technique preferred by many cancer experts because it can reliably destroy a small, targeted area of tissue without affecting healthy structures beyond the treatment site. With RFA, the doctor can pinpoint target areas with accuracy and monitor and control the temperature of heat therapy.

In RFA, energy is delivered through a metal tube or probe inserted into tumors or other tissues. When the probe is in place, metal prongs pop open to extend the reach of the therapy. RF energy causes atoms in the cells to vibrate and create friction. This generates heat and leads to the death of the cancerous cells.  Radiofrequency energy is safer than many cancer therapies because it is absorbed by living tissues as simple heat. Regardless of the heat source, cells will die when they reach a certain temperature, but RF energy and the heat it generates do not alter the basic chemical structure of cells.

“Laparoscopic RFA has many advantages for our patients. It is less risky and has fewer complications compared to traditional, open surgery.  Most patients can resume normal activities within a few days and the procedure may be combined with other treatment options,” said Albo.

Along with laparoscopic RFA, the MEDVAMC is also using preoperative liver-directed (intra-arteria) chemoembolization. This procedure, also minimally-invasive, allows physicians to remove the blood supply from a tumor and deliver high-dose chemotherapy directly into the tumor with minimal toxicity.

“We perform the preoperative chemoembolization in a multidisciplinary fashion with our Vascular Surgery Section. Working with Peter Lin, M.D., chief of Vascular Surgery, the preoperative chemoembolization makes the laparoscopic RFA even more effective, sort of a one-two punch against the liver tumor,” said Albo, who is also an associate professor of Surgery at Baylor College of Medicine.

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