Minimally Invasive Treatment of Liver Tumours

A liver tumour is a growth in the liver. Primary liver tumours start in the liver itself, most often as hepatocellular carcinoma (HCC). Secondary liver tumours, or liver metastases, have spread from cancers elsewhere, most often the colon or rectum.

Primary liver cancer is the sixth most common cancer worldwide, with about 866,000 new cases and 759,000 deaths in 2022 (World Cancer Research Fund, GLOBOCAN 2022).

Yes. In Western countries, liver metastases are far more common than primary liver cancer. In a population-based Stockholm study, 26.5% of patients with colorectal cancer were diagnosed with liver metastases within five years.

HCC usually develops in a liver damaged by chronic disease: cirrhosis, hepatitis B or C, heavy alcohol use or fatty liver disease. Regular monitoring of people at risk helps find tumours early, when they are easiest to treat.

Surgery is ruled out when there are too many tumours, when they lie close to major vessels, when too little healthy liver would remain, or when the patient’s general health does not allow a major operation. In one series of colorectal liver metastases, only 22% were resectable at the outset.

Recurrence is common. After removal of colorectal liver metastases, 50–75% of patients relapse within two years. After resection of HCC, about 80% had a recurrence within five years in a classic series.

The drug travels through the whole body, so only a small fraction reaches the tumour while side effects affect blood counts, nerves, gut and skin. With the current standard first-line therapy for advanced HCC, 43% of patients had severe (grade 3–4) treatment-related side effects.

Chemoperfusion delivers chemotherapy through a catheter placed in the hepatic artery and, where possible, in the small arteries feeding the tumour. Because liver tumours draw most of their blood from the hepatic artery, the drug reaches the tumour at high concentration while healthy liver and the rest of the body receive much less.

Both deliver chemotherapy through the liver artery. In chemoembolization, the drug is combined with particles or an oily agent that also slow or block the blood flow to the tumour. Chemoperfusion relies mainly on the drug itself. Which is better depends on the tumour type and the condition of the liver.

Yes, in suitable patients with HCC that cannot be removed surgically. In a randomised trial published in The Lancet in 2002, chemoembolization reduced the risk of death by about half compared with symptomatic treatment alone, and the trial was stopped early because of this benefit.

A thin probe is inserted through the skin into the tumour under image guidance. Microwave or radiofrequency energy then heats the tumour until the tumour tissue dies. No incision is needed.

Both are established. In a randomised phase 2 trial in HCC and colorectal metastases of 1.5–4 cm, local tumour progression after two years did not differ significantly (21% with microwave, 12% with radiofrequency). The choice depends on tumour size, position and nearby vessels.

For small tumours, it can be an alternative. In the COLLISION trial of colorectal liver metastases up to 3 cm, thermal ablation gave overall survival comparable to surgery, with far fewer side effects (19% versus 46%) and no treatment-related deaths, against three after surgery.

Each method covers the other’s weak point. Ablation destroys the tumour core but is less reliable at the edges of larger tumours, where blood flow carries heat away. Chemoperfusion reaches the margin and small satellite lesions the probe cannot see. Together they leave the tumour far fewer ways to escape.

Yes, for HCC. In a randomised trial of 189 patients with tumours up to 7 cm, adding chemoembolization to radiofrequency ablation raised four-year survival from 45.0% to 61.8%. For metastases from other cancers, the evidence is less extensive.

Hepatocellular carcinoma and liver metastases, for example from colorectal cancer, neuroendocrine tumours or other cancers. Suitability depends on the number, size and position of the tumours, liver function and whether the cancer has spread outside the liver.

The procedures are performed under anaesthesia or sedation, so you do not feel the treatment itself. Afterwards, some patients have pain in the upper abdomen for a few days, which is treated with painkillers.

After chemoembolization, pain, fever and nausea in the first days are common and are known as post-embolization syndrome; preventive medication reduces them considerably. After navigated ablation, complications occurred in 5% of procedures in a large series, and serious ones in 2%.

Usually only a short time. After navigated ablation, the median hospital stay was one day in the Bern series. The exact length of your stay depends on the combined treatment and is discussed with you beforehand.

Yes. If new tumours appear later, chemoperfusion and ablation can be repeated, which is rarely possible after major liver surgery.

Yes. The treatment can be used alongside systemic therapy, before or after surgery, or when surgery is not possible. The plan is coordinated with your oncologist.

It combines an angiography system and a full CT scanner in one room. Contrast can be injected directly into the liver artery and the liver scanned at the same moment, which shows the tumour’s feeding vessels, reveals small lesions and confirms that the treated area is fully covered, without moving the patient.

CAS-One, from CAScination, is a navigation system for ablation. It plans the path of each probe on CT images, tracks the probe optically during insertion and verifies its position before energy is delivered. In a series of 301 liver tumours, the probe tip landed a median of 2.9 mm from its planned position.

Because a tumour that is not fully covered can grow back. In the Bern series, a probe position error over 5 mm and tumour size over 3 cm were the strongest predictors of early recurrence at the ablation site.

A CT scan in the same room, at the end of the procedure, confirms that the tumour and a safety margin are covered. Afterwards, imaging at regular intervals checks the result and looks for new tumours.

Your most recent CT or MRI images (as files, not just reports), the radiology and pathology reports, recent blood tests including liver values, and a summary of previous treatments.

Call +49 (0)177 23 82 863 or write to international@vitusprivatklinik.com. We review your findings and discuss in an online consultation whether the double-pronged treatment is suitable for you.