Transarterial Chemoembolization Prepares Liver Metastases for Laser Treatment

Laurie Barclay, MD

October 28, 2003

Oct. 28, 2003 --- Repeated transarterial chemoembolization (TACE) reduces the size of unresectable liver metastases sufficiently to make them treatable by laser-induced thermotherapy (LITT), according to the results of a study published in the November issue of Radiology.

"This was initiated because we could not perform the laser therapy on tumors that were too large," lead author Thomas J. Vogl, MD, from University Hospital in Frankfurt, Germany, says in a news release. "We see a lot of patients with liver tumors larger than 5 centimeters and in the past we had to refuse them. We needed a way to reduce the tumor to a size where we could perform the laser treatment."

After using TACE to occlude blood vessels, reduce tumor blood supply and help shrink the tumor with chemotherapy, an interventional radiologist performs LITT by inserting laser fibers into the tumor and heating it to 100 degrees.

Between March 1999 and December 2001, 162 patients with unresectable liver metastases each had two to seven TACE treatments. Before treatment, the largest tumor diameter was 80 mm on magnetic resonance imaging (MRI).

The criterion for use of MRI-guided LITT was a decrease in tumor diameter to less than 50 mm, which was met in 82 patients (50.6%). Mean reduction in tumor size in these patients was 35% ± 14%. Of 47 patients who had no reduction in tumor size with LITT, 33 patients had disease progression at follow-up, leading to further TACE treatments or change to systemic chemotherapy.

Median survival was 26.2 months for patients who responded to combined treatment with TACE-LITT compared with 12.8 months for patients treated with only TACE.

"This treatment is local, [which] allows us to be very aggressive in attacking the tumor, while maintaining a good quality of life for the patient," Dr. Vogl says.

In addition to recruiting more patients to determine the best indications for combination therapy and optimal intervals between several courses of TACE and LITT, he recommends development of new cytostatic drugs with higher local efficacy if delivered intravascularly.

Although his group has used this combination treatment only for liver tumors, he believes it also has applications for lung, bone and lymph node tumors. "These procedures are FDA accepted, and they're starting to be used all over Europe," he adds.

Radiology. 2003;229;457-464

Reviewed by Gary D. Vogin, MD