UCLA Liver Tumor Ablation Program

The UCLA Liver Tumor Ablation Program is one of the first and largest in the United States. Multiple strategies and innovative maneuvers have been developed at our institution to enhance the safety and efficacy of a new class of minimal invasive procedures. Our experience and recently published data (Lu et al: Radiology 2005 & Kim et al, UCLA ARRS Meeting 2005) have shown treatment success ranging from 83% complete local cure rate for small (<= 3cm) hepatocellular carcinomas by percutaneus radiofrequency ablation (RFA), to 32%, 4-year survival in patients with large volume non-resectable colon metastases by intra-operative RFA.

The Liver Tumor Ablation Program at UCLA is active in research that help advance the field of minimal invasive treatments of liver malignancy. New techniques are being developed to enhance ablation methods to reduce and/or lower the already infrequent side effects of such procedures.

Radiofrequency Ablation is the most mature & commonly utilized ablation technology today. fig 1: Under CT guidance, a multiple array needle probe is inserted into the center of the liver tumor. After the individual electrodes are deployed from the hollow core of the needle, an alternating current is applied through the needle and electrodes. The tumor cells are killed as the current passes into the tissue at the electrode tips. fig 2: CT images of a liver tumor caused by colon cancer that spreads to the liver, the RFA lesion 1 hour after the treatment and the scar 6 months after the RFA treatment

Tumor Ablation Methods

Many ablation methods can be effective in treating patients, including ethanol injection, cryo-ablation, microwave ablation and radiofrequency ablation. These ablation strategies will allow better customization, and enable more patients and tumors to be eligible for local ablative therapy.

In radiofrequency ablation, a needle probe under ultrasound, CT, or even MRI guidance is inserted into the center of the liver tumor (figure 1). An alternating current (oscillating in the radiofrequency spectrum, hence the name) is applied through the needle. As the current passes into the tissue at the needle tip, ionic agitation creates frictional heating in the tissue and tumor cells are killed. To make sure that all tumor cells are destroyed, the ablation is extended beyond the tumor margin by about 0.5 to 1.0 cm. The post-ablation lesion, therefore, is larger than the original tumor size (figure 2). The ablation lesion eventually shrinks into a much smaller scar, if there is no recurrence. These minimally invasive procedures allow patients to go home the same day or after an overnight hospital stay. There are only minimal side effects and major complication rate is minimal at 1-3%.

Large tumors and multiple tumors may be approached by placing these probes intra-operatively or even laparoscopically, by possibly combining surgical resection and/or hepatic arterial chemo-infusion pump placement. Although surgery is still required, intra-operative or laparoscopic RFA is much less invasive than open surgical resection.

Consultation/Evaluation for Liver Tumor Ablation Referring Physicians please contact the following numbers 310-825-8526 Radiology, Tumor Ablation Program 310-825-1412 Liver Cancer Center 310-825-2644 Surgical Oncology 310-825-6301 Emergency Operator request to talk to Liver Tumor Ablation team members listed below

Liver Tumor Ablation Team Members Department of Radiology David S.K. Lu, MDCM Director, Liver Tumor Ablation Program Professor & Chief, Cross Sectional Interventional Radiology Steven Raman, MD Associate Professor, Cross Sectional Interventional Radiology Department of Surgery Ronald W. Busuttil, MD, PhD Director, Dumont-UCLA Liver Cancer Center & Transplant Center Professor & Chief, Department of Surgery James Economou, MD, PhD Professor & Chief, Division of Surgical Oncology Jonathan Hiatt, MD Professor & Chief, Division of General Surgery Department of Medicine Myron Tong, MD Professor & Director, Clinical Hepatology & Liver Cancer Center Carolyn Britten, MD Assistant Professor, Division of Medical Oncology Richard Finn, MD Assistant Professor, Division of Medical Oncology

Indications

Hepatocellular carcinoma and liver-dominant metastases from a variety of malignancies may be eligible, such as colon carcinoma, sarcomas, neuroendocrine tumors, and breast carcinoma. Functional neuroendocrine metastases may also be eligible for less severe of symptoms. Tumors that are 5cm or smaller have a better success with percutaneous RFA. Larger tumors on the other hand may be best treated by intra-operative RFA or combination therapies.

Referral Process

Depending on the case, a patient will be evaluated by the members of the Dumont-
UCLA Liver Cancer Center, a multidisciplinary team of surgeons, oncologists, hepatologists, and interventional radiologists specializing in liver malignancy. Evaluation includes a comprehensive history, physical exam, and laboratory profile as well as detailed imaging evaluation of the liver tumor and metastatic work-up. The patient who is NOT a surgical resection candidate may be eligible for image guided ablative therapy.

Post Therapy Follow Up

Patient follow-up is performed in conjunction with the primary and referring physicians after discharge. In addition to routine follow-up of any tumor markers, our specific protocol for imaging consists of a dual-phase contrast-enhanced CT scan (or MRI) immediately after ablation to establish baseline, every 3 months thereafter. PET-CT is used in PET positive tumors such as colon cancer. Strict follow-up is critical as residual or recurrent tumor should be detected when they are still small, when another simple percutaneous RFA could be performed without much additional risk to the patient.
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