Hepatic Artery Chemoembolization and Radiofrequency Ablation from professionalradiology.com.

Hepatic Artery Chemoembolization and Radiofrequency Ablation

Hepatic Artery Chemoembolization

• What is Hepatic Artery Chemoembolization?
• How does Hepatic Artery Chemoembolization work?
• How is Hepatic Artery Chemoembolization administered?
• What should I expect after Hepatic Artery Chemoembolization?
• When should I call my doctor?

Radiofrequency Ablation

• What is Radiofrequency Ablation?
• How does Radiofrequency Ablation work?
• How is Radiofrequency Ablation administered?
• Will I need more than one Radiofrequency Ablation?
• When should I call my doctor?

Background
Liver cancer may originate in the liver or may spread from another area in the body. Surgery is the best treatment, however up to 80% of liver tumors cannot be surgically removed due to the vascular supply and potential damage that may be caused to the liver. Many liver tumors also do not respond well to traditional chemotherapy.

Your physician will order a CT Scan or MRI to determine the extent of your disease. It is also important to monitor liver function, which is done by a simple blood test. Liver function will be monitored before and after any treatment.

Your liver has two lobes (left and right). Tumors may be present in one or both lobes. If this is the case, each lobe will usually be treated separately to prevent potential damage to the liver.

The procedures are performed by an Interventional Radiologist. Interventional radiology is a medical specialty that requires special training. This training includes the use of X-rays and other imaging techniques (radiology) that “see” inside the body without surgery. Interventional Radiologists also undergo extensive training in techniques that treat diseases percutaneously (through the skin) using radiological imaging to guide their procedure.

Prior to the procedure you will not be able to eat or drink for eight hours. You may take your medications with a sip of water. Blood thinning medicine, including aspirin, needs to be stopped at least five days prior to the procedure. You should check with your physician to make sure your medications are safe to take.

An IV will be started in your arm and you will be given several medications including antibiotics and medicine to prevent nausea. During the procedure you will receive medication through your IV to make you sleepy and comfortable. The procedure takes one to two hours to perform.

Hepatic Chemoembolization
The liver is unique in that it has two sources of blood supply: the hepatic artery and the portal vein. Most of the healthy liver receives blood flow through the portal vein, while most tumors receive blood flow through the hepatic artery. Therefore, chemotherapy injected into the hepatic artery reaches the tumor(s) directly and spares the healthy liver tissue.

Chemoembolization may be contraindicated if you have:

• Severe liver or kidney damage
• Blockage of the portal vein
• Blockage of the bile ducts
• Greater than 50% of your normal liver has been replaced by tumor(s)

During the procedure, an angiogram will be performed. A small catheter is placed into the artery in your groin. Small amounts of dye are injected into the catheter. X-ray pictures are taken to identify the branches of the artery supplying blood to the tumor(s). Up to three chemotherapy drugs, mixed together, are then injected into that artery. An oil contrast added to the chemotherapy helps to keep the drugs in contact with the tumor(s). Tiny particles are added to the end of the injection to slow the blood flow to the tumor(s).

The benefits of chemoembolization include:

1. The tumor(s) becomes starved of oxygen and nutrients after the blood supply is compromised.
2. The drugs are delivered directly to the tumor(s) and are much more concentrated than standard chemotherapy.
3. The drugs can affect the tumor(s) for a longer period of time- up to a month.
4. There is a decrease in side effects because the chemotherapy does not circulate throughout the body as standard chemotherapy does.

Following the procedure, you will be treated with intravenous fluids, pain medication and antibiotics overnight in the hospital. You will need to lie flat for several hours to allow the artery in your groin to seal. You may eat following the procedure.

You will be sent home on antibiotics and medication for pain and nausea if needed. Side effects of the procedure include varying degrees of pain, fever and nausea. These symptoms usually last for several days. You may experience a decrease in appetite. It is important to drink plenty of fluids to prevent dehydration.

Serious complications following chemoembolization are rare. In less than 3% of the procedures, the tumor affected by the procedure may become infected. Severe liver damage, though extremely rare, may also occur.

Chemoembolization will not cure liver cancer. The goal of the treatments is to stop the tumor(s) from growing, reduce tumor size, decrease pain, and preserve liver function.

Following the procedure, you should call your doctor if you develop:

• Fever greater than 102.0
• Severe pain or nausea
• Bleeding or swelling at the groin site.

A CT scan or MRI will be performed one month after the procedure to determine the treatment effectiveness. Usually two to four treatments are necessary.

Radiofrequency Ablation
Radiofrequency ablation (RFA) is another treatment option for liver tumors. RFA may be performed alone or in combination with surgery or hepatic chemoembolization.

Reasons for choosing RFA include the number, size, and location of the tumor(s). Smaller tumors can be treated with RFA. RFA cannot be performed if the liver tumor(s) is near any major blood vessels or the bile duct.

After numbing the skin, a tiny probe is placed through the skin in your abdomen into the tumor(s). This is performed with the assistance of ultrasound or CT Scan. Radiofrequency ablation begins with the passing of alternating current through a tumor. Heat is applied at the site of the tumor destroying the tumor cells. Several tumors can be treated at one time.

A CT scan or MRI will be performed one month following the ablation to determine the effectiveness of the treatment. The treatment can be repeated.

Following the procedure, you should call your doctor if you develop:

• Fever greater than 102.0
• Severe pain or nausea
• Bleeding or signs of infection at the puncture site

For more information about this procedure or general information about our interventional radiology practice, please contact one of our clinical coordinators at 513-527-9999.