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Heapatic tumours treatment by hepatic artery embolization and radiofrequency ablation

What is a hepatic artery embolization? 

It is a treatment to decrease the blood supply to a liver tumor.  In some cases, it is used to treat the tumor with chemotherapy.  The goal of this treatment is to shrink the tumor and lessen the symptoms that you may be having.  A tube (catheter) is placed into a large blood vessel in the groin.  It is then threaded up into the hepatic artery in the liver.  A special mixture is put into the artery that supplies blood to the tumor.  This mixture blocks the blood supply to the tumor and causes it to shrink.  The blocking of the blood supply is called embolization.


There are two types of embolizations: bland and chemo.  The mixture for a bland embolization is made up of spongy particles and contrast (dye) material.  The mixture for the chemo embolization is made up of spongy particles, contrast material, and chemotherapy.  Your doctor will discuss with you which type is best for your kind of liver tumor.


Getting Ready
You will need to have blood drawn to make sure your liver and kidneys are working well.  You may need to have more CT scans to check on the tumor and the liver.  You may have these tests before you come to the hospital or when you are admitted.

Bland Embolization

You will come to the hospital the morning of the procedure.
You must not eat or drink anything after midnight.
You can expect to spend 1 night in the hospital.
Chemo Embolization

You will come to the hospital the morning the procedure.
Your evening meal will be clear liquids.  You may not have anything to eat or drink after midnight.
You will drink a liquid laxative to clean out your colon (large bowel) until your bowel movements become clear.
You can expect to spend 2 nights in the hospital.



When you are settled in your room, the oncology nurse practitioner (NP) will review your health history, do a brief physical exam, and talk with you about what to expect.  The IVR doctor and NP will visit you to review what to expect and answer your questions.  Before you are taken to Interventional Radiology, two IVs (intravenous lines) will be put into your arms.  Through the IV, you will be given fluids and antibiotics.  You will have a tube (catheter) placed in your bladder to drain urine.

During the Procedure
You will be brought to a special room.  You will lie on a narrow bed.  At this time, you will be given medicine to help prevent nausea and pain and to help you relax.  Your upper leg and groin area will be washed with iodine soap.  Next, you will get a numbing medicine at the site on the groin where the tube is to be placed.  The doctor will place the tube into the large blood vessel in the groin and thread it up into the artery.  When the tube is in the right place, the doctor will slowly inject, through the tube, the bland or chemo mixture until the blood flow to the tumor is almost stopped.  Then, the tube will be removed.  The doctor will put pressure on your groin for 15 minutes to prevent bleeding.  The whole procedure may take up to 2 hours.  You will be taken back to your room.  A CT scan may be done at this time or before you go home.  The scan will show how much of the mixture was placed into the tumor. 

Back in Your Room
You will need to lie flat for a few hours.  This will help prevent bleeding from the site where the tube was placed.  You will be given only clear liquids to drink.  This will help you avoid nausea and bloating.  If you can drink the clear liquids without any problems, you will be allowed to eat some food.
After the embolization, some people have fever, chills, pain, nausea, vomiting, and fatigue.  This is called
post-embolization syndrome and may last 1 to 4 days.  If you have any of these symptoms, you will be given medicine to help.  In most cases, you will be able to go home within 2 3 days.  At home, you will take antibiotics for about one week and pain medicine, as you need it.

At Home

Drink 8 (8-oz) glasses of fluid daily.
If you have a fever over 101 F for 2 readings taken 4 hours apart, call your doctor.
Call the oncology staff if you are having pain or nausea that has not improved by taking the medicine, or if these symptoms quickly get worse.

In about 4 6 weeks after the procedure, you will return to see your oncologist.  Blood will be taken, and a CT scan will be done.  This will help to show how well the embolization worked for you.  Your doctors will review the CT scan and talk to you about whether or not you need to have another embolization done.

RFA 'radiofrequency ablation"

 Percutaneous radio frequency ablation (RFA) is an exciting approach to destroying inoperable primary or metastasis tumors in the liver. In the treatment of hepatocellular carcinoma (HCC), less than 40% of patients are candidates for surgery, and the rate of recurrence after curative surgery is high. Percutaneous techniques like RFA are, therefore, very important. RFA is widely used for metastatic and small primary tumors RFA serves as a bridge for transplant candidates, especially in relation to small primary lesions. Percutaneous RFA is a minimally invasive, repeatable procedure with few complications. It is performed under radiological guidance. Randomized controlled trials have shown that RFA is superior to ethanol injection in the treatment of small HCC.    RFA results in a higher rate of complete necrosis and requires fewer treatment sessions than percutaneous ethanol injection (PEI). Long-term survival rates are also better with RFA. A randomized clinical trial has shown that RFA results in significantly better 1-year complete response than does PEI. RFA in combination with transcatheter arterial chemoembolization (TACE) is also an effective treatment for inoperable hepatic tumors.
Recent studies that have compared percutaneous RFA and percutaneous microwave coagulation therapy (PMCT) have shown better results with RFA in treatment of small tumors. RFA results in better survival rates, fewer complications, and significantly lower local recurrence rate.
In RFA, a needle is inserted into the liver, usually under the guidance of ultrasonography or CT. Once placed within the tumor, a generator is used to deliver a rapidly alternating current (radiofrequency energy). This needle may be bipolar or unipolar; the latter requires grounding pads placed on the patient's thighs. Heat is generated at the site of the lesion through frictional heat produced by rapid agitation of adjacent cells and produces destruction (liquefactive necrosis) of the tumor.
This technology is used widely in Europe and the United States. As noted by Shiina et al, 1500 institutes in Japan have introduced RFA in the treatment of liver tumors.
Percutaneous radiofrequency ablation (RFA) can be performed with local anesthesia and mild sedation. Deep sedation or general anesthesia can also be used. Modality of anesthesia depends upon the patient choice and operator preferences. For more information, see Local Anesthetic Agents, Infiltrative Administration and Procedural Sedation.
In a day case setting, the local anesthetic is injected into the site where the skin incision is planned, and the patient is sedated by an intravenous injection. The patient is often able to go home the same day. If general anesthesia is not used, discomfort or pain may be felt while the area is being ablated. Day case treatments for RFA are becoming more common.


The imaging equipment needed for radiofrequency ablation (RFA) depends on the modality used. It can include the equipment necessary for ultrasonography, CT, or MRI.
RFA equipment itself has 3 main components.
Needle electrodes
An electrical generator
Grounding pads
The needle electrodes are available in 2 forms.

Electrodes for radiofrequency ablation.

Simple straight needles, as in the image below Electrodes for radiofrequency ablation.

Umbrella-type electrodes for radiofrequency ablati

Straight needles that contain multiple curved, retractable electrodes that are kept inside the needle until its tip is positioned within a tumor (When the needle is properly positioned, a plunger on the hub of the needle is advanced so that the electrodes extend from the needle tip. When fully extended, these electrodes resemble an open umbrella, as shown in the image below.) Umbrella-type electrodes for radiofrequency ablation.

The radiofrequency generator is connected by insulated wires to the needle electrodes and to grounding pads that are placed on the patient's thighs. The generator produces alternating electrical current in the range of radiofrequency waves.




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