Liver is a vital human organ which performs many synthetic and metabolic functions. Primary tumor of the liver, namely hepatocellular carcinoma (HCC), typically arises in the setting of underlying hepatitis and cirrhosis. Although some HCC can be resected, overwhelming majority of patients with HCC are not surgical or liver transplant candidates and thus require palliative treatment.
Typical medical cancer management, i.e. intravenous chemotherapy and external beam radiation, are limited in HCC therapy as they have not shown significant survival benefit. Regional therapies such as transarterial chemoembolization (TACE) and selective internal radiation treatment (SIRT) are minimally invasive therapies which can prolong survival.
TACE
Using catheters under fluoroscopic (x-ray) guidance, interventional radiologist can target the delivery of medications and embolic material directly to the tumor.
Typically the common femoral artery is accessed with a needle and subsequently a catheter is advanced into the arteries which supply the tumor and chemotherapeutic medications and embolic materials are directly delivered. Thus, the systemic side effects of the medications are reduced and the cancer is treated with greater amount of anti-cancer medication.
Two to four sessions are typically required to obtain optimal results. Although not curative, studies have shown survival benefits. In some cases, tumors can be shrunken and allow surgical resection for cure. Patients are admitted overnight for observation and typically discharged the next day. Patients are followed clinically as well as with imaging tests, e.g. CT scans.
SIRT
Selective internal radiation therapy is a more novel technique in which the liver tumors (primary or metastatic) are treated with radiation from the inside the body rather than from traditional external source. Microscopic particles bound to yttrium90 are delivered directly and exclusively to the artery supplying the cancer. Yttrium90 then kills the tumor as it decays. SIRT is performed by an interventional radiologist with catheters under fluoroscopic guidance. SIRT is an outpatient procedure performed in the hospital setting.
Picture shows the catheter passage way to the artery supply the liver tumors seen in green
