Image-guided percutaneous laser ablation for primary and secondary liver tumours

The most common type of primary liver cancer is hepatocellular carcinoma (HCC). Secondary cancer in the liver can arise from any primary site, but it most commonly spreads from cancers of the breast, bowel, lung, pancreas, stomach, ovary, and neuroendocrine tumours.

Treatment for primary liver cancer depends on several factors, including the exact location and stage of the cancer, the person's liver function and any patient-related comorbidities. The treatment options include:

• surgical excision

• chemotherapy (conventional or hepatic artery infusion)

• transarterial chemoembolisation (TACE)

• selective internal radiation therapy

• percutaneous ethanol injection

• local ablation techniques such as cryotherapy, radiofrequency, and microwave ablation.

Treatment for secondary liver cancer depends on the site of the primary cancer, which parts of the liver are affected and whether the cancer has metastasised further. The most common treatment is chemotherapy, but other treatments include surgery, hormonal therapies, targeted therapies, ablation and embolisation treatments.

Image-guided percutaneous laser ablation is usually done under sedation. Depending on the size of the tumour, 1 or more (usually up to 4) optical fibres are percutaneously inserted into the liver using a small introducer needle. The fibre distance and energy delivery per fibre are adjusted to shape the area to be ablated. The fibres deliver laser energy for several minutes to heat the tissue until it is destroyed with a sufficient safety margin. Image guidance is used to check the positioning of the fibres, monitor the treatment, and verify the effective ablation area. The aim is to destroy the tumour.