ABSTRACT
Ronald S. Chamberlain and Ronald Kaleya Introduction The liver is a frequent site of both primary and metastatic tumors. Surgical resec
tion, and in rare instances liver transplantation, remain the only treatments associ ated with prolonged survival and in some cases cure. Unfortunately, less than 25% of patients with either hepatocellular cancer (HCC) or metastatic colorectal cancer present with liver-only disease and are candidates for surgical resection. The inabil ity o f surgery to impact on the survival o f most patients with malignant tumors of the liver has been the impetus behind the development of multiple alternative treat ment modalities. Tumor histology, stage and site o f the primary tumor, extent of hepatic parenchymal involvement, presence o f extrahepatic disease, and the clinical condition of the patient influence the appropriateness of the various alternative treat ments. Available alternatives include hepatic artery chemotherapy (Chapter 17) he patic arterial embolization or chemoembolization (Chapter 4), percutaneous ethanol ablation (Chapter 4), cryotherapy (percutaneous, laparoscopic, or open techniques), and thermal ablation that includes radiofrequency, microwave, and laser ablation. Nearly all of these modalities can be performed percutaneously or by using mini mally invasive techniques. This Chapter will focus on the indications, techniques, and complications associated with cryotherapy and radiofrequency thermal abla tion. Suffice it to say the clinical efficacy of both techniques remains unproven, and the subject o f considerable on-going study. Based upon this data, several prospective and retrospective analyses have demonstrated that liver failure is the primary cause of death in up to 90% of these patients. Non-resectional hepatic ablative strategies have been developed in an attempt to alter either the course of the disease and/or cause of death in patients with unresectable liver tumors.
