Interventional radiological techniques are becoming increasingly important in the treatment of both primary and secondary malignant liver tumours. Surgery for liver tumours can be effective but carries considerable risks and new techniques have recently been developed. This volume provides an account of interventional radiological methods by some of the greatest experts in the field. It includes chapters on cryotherapy, chemoembolization and radiofrequency ablation and an extensive chapter on imaging techniques. The scientific background of these techniques, the pathology of the diseases involved and an analysis of more traditional surgical methods are also described. This text brings together the latest advances in this fast-developing field.
Author(s): Andy Adam, Peter R. Mueller
Edition: 1
Year: 2009
Language: English
Pages: 232
Tags: Медицинские дисциплины;Онкология;
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Series foreword......Page 13
Preface to Interventional Radiological Treatment of Liver Tumors......Page 15
Epidemiology and etiology......Page 17
Diagnosis......Page 18
Screening......Page 19
Liver resection......Page 20
Transplantation......Page 21
Transarterial chemoembolization......Page 22
Chemotherapy......Page 24
Angiogenesis and hepatocellular carcinoma......Page 25
Radiation therapy......Page 28
Radiofrequency ablation for liver metastases......Page 29
Systemic therapy for colorectal cancer......Page 30
Downstaging of liver metastases......Page 32
Conclusions......Page 33
References......Page 34
Pathology of hepatocellular carcinoma......Page 41
Dysplastic nodules......Page 42
Morphologic characteristics of small HCC of early stage......Page 43
Evolution of HCC from early to advanced stage......Page 46
Gross appearance......Page 47
Histological findings......Page 48
Variants of HCC......Page 50
Arterial tumor vessels (unpaired arteries)......Page 51
Incidence......Page 53
Gross appearance of metastatic tumors......Page 54
References......Page 56
Introduction......Page 60
Role of dynamic imaging......Page 61
Pre-RFA evaluation of hepatic lesions......Page 63
Screening for extrahepatic extension......Page 77
Imaging protocol for post-ablation follow-up......Page 79
Expected imaging (complete ablation)......Page 81
Indeterminate imaging (needs follow-up)......Page 85
Residual and recurrent imaging......Page 88
Role of PET and PET/CT after RFA......Page 90
Complications......Page 92
Conclusions......Page 93
References......Page 94
Introduction......Page 98
Embolization procedure......Page 99
Choice of embolic particles......Page 100
Choice of emulsion: transarterial oily chemoembolization......Page 101
Role of chemoembolization in unresectable hepatocellular carcinoma......Page 102
Role of chemoembolization as a neoadjuvant therapy in HCC......Page 104
Role of chemoembolization in neuroendocrine tumor metastases......Page 106
Toxicity of chemoembolization......Page 107
Major complications......Page 108
Selecting patients for optimum tolerability......Page 110
Summary......Page 111
References......Page 112
Principles of HIFU......Page 116
Treatment devices and procedures......Page 121
Liver cancer......Page 123
HIFU in the treatment of liver tumors......Page 125
References......Page 128
Introduction......Page 132
Percutaneous ethanol injection......Page 133
Equipment......Page 134
Procedure......Page 136
Indications and contraindications......Page 140
Evaluation of therapeutic effectiveness......Page 141
Results......Page 144
References......Page 147
Recent reports demonstrating increasing safety of hepatectomy for cancer......Page 151
The role of surgery in the treatment of hepatocellular carcinoma......Page 153
The role of surgery in the treatment of hepatic metastases......Page 156
Surgical treatment of hepatic metastases from colorectal cancer......Page 157
Surgical treatment of hepatic metastases from neuroendocrine tumors......Page 160
Surgical treatment of hepatic metastases from non-colorectal and non-neuroendocrine tumors......Page 163
References......Page 165
Eligibility criteria......Page 172
Technique......Page 174
Imaging......Page 177
Treatment of hepatocellular carcinoma......Page 181
Treatment of colorectal hepatic metastases......Page 184
Summary......Page 186
References......Page 187
Goals of minimally invasive tumor ablation......Page 191
Radiofrequency induction of coagulation necrosis......Page 192
Principles of the bioheat equation......Page 193
Multitine arrays......Page 194
Perfused electrodes......Page 195
Modulating tissue characteristics......Page 196
Modulating tissue blood flow......Page 197
Synergistic therapies......Page 198
Thermal ablation with radiation therapy......Page 199
References......Page 200
Introduction......Page 205
Hepatocellular carcinoma......Page 206
Metastatic disease......Page 207
Probe placement......Page 209
Monitoring of the ablation zone......Page 212
Periprocedural sedation and pain control......Page 215
Hemorrhage......Page 216
Abscess......Page 217
Post-ablation syndrome......Page 218
Follow-up......Page 219
Conclusion......Page 221
References......Page 222
Introduction......Page 227
Training for the radiologist in ablation......Page 228
Setting up a clinic......Page 229
Professional team......Page 230
Marketing and building referrals......Page 231
Communication......Page 232
Patient management......Page 233
Post-procedural follow-up......Page 234
References......Page 235
Index......Page 237
