Liver Cancer procedures:

Hepatocellular carcinoma accounts for
most liver cancers.
In most cases, the cause of liver
cancer is usually scarring of the liver
(cirrhosis). Cirrhosis may be caused by:

Alcohol abuse (the most common
cause in the U.S.)
Certain autoimmune diseases of the
liver
Diseases that cause long-term
inflammation of the liver
Hepatitis B or C virus infection
Too much iron in the body
(hemochromatosis)
Patients with hepatitis B or C are at
risk for liver cancer, even if they do not
have cirrhosis.
An estimated 245,000 new cases of
liver cancer are diagnosed yearly in
the US, nearly 225,000 of which are
metastatic cancers.



LIVER REMOVED,
RECONSTRUCTED, REPLANTED
In January 2012 a team led by Alan
Hemming, MD, transplant surgeon at
UC San Diego Health System, has
successfully performed the west coast’
s first ex-vivo liver resection, a radical
procedure to completely remove and
reconstruct a diseased liver and re-
implant it without any tumors. The
procedure saved the life of a 27-year
old mother whose liver had been
invaded by a painful tumor that
crushed the organ and entangled its
blood supply.

“During a 9-hour surgery the team was
able to remove the basketball-sized
tumor,” said Hemming, professor and
surgical director of the Center for
Hepatobiliary Disease and Abdominal
Transplantation (CHAT) at UC San
Diego Health System. “This is a
surgery that carries a 15 to 20 percent
risk of mortality. In this case, the
patient would not have survived if she
did not have surgery. This was the
only way we could save her liver and
her life.”

During the procedure, the diseased
liver was detached from the body,
flushed with preservation solution and
cooled to a temperature of 4 degrees
Celsius. This allowed Hemming to
carefully remove the tumor from the
liver in a bloodless field while
preserving vital structures. Hemming
then removed the tumor which weighed
as much as the liver itself. Once the
tumor was removed, the vessels were
meticulously reconstructed. The liver
was then successfully reimplanted.




DELCATH USES CATHETER FOR
PRECISE DELIVERY OF CANCER
DRUGS
Delcath Systems  announced positive
clinical data for their proprietary liver
cancer treatment system, The Delcath
Percutaneous Hepatic Perfusion (PHP)
device.

The PHP system works by first isolating
the patient's liver from the rest of the
circulatory system. This is
accomplished using catheters and
balloons, which are inserted via small
incisions in the patient's neck and legs.
Highly-concentrated doses of
chemotherapy drugs are then
delivered directly to the diseased
organ. After treatment, the blood is
filtered and cleansed of potentially
toxic drugs and returned to circulation.

The system — which is unique as far
as we know — allows doctors to target
the liver with 10x higher doses of
chemotherapy than are normally
feasible. Since the drugs are targeted
directly at the tumors, then filtered out
of the bloodstream after treatment,
Delcath  thinks they can significantly
increase dosage without increasing
toxicity. It could prove to be an
important life-extending development
for patients who currently have few
treatment options.

Comparing treatment with the Delcath
PHP System with melphalan to Best
Alternative Care (BAC), based on
independent core lab review of patient
scans, the statistical analysis revealed
that the PHP patients had a statistically
significant longer median hPFS of 214
days compared to 70 days in the BAC
arm.
Trial no: NCT00324727 and
NCT00096083

RADIOACTIVE PARTICLES INFUSED
DIRECTLY INTO THE LIVER
Thetaspheres and microspheres are
radioactive particles which contain the
isotope yttrium 90 are infused directly
into the liver. First, one of the
interventional radiologists places a
tube into a large artery in the patient’s
right groin and passes the tube up into
the hepatic arteries (the main blood
vessels that directly feed the liver).
Dye is injected to be sure the tube is in
the right place, and then Microspheres
are injected. The microscopic beads
are carried to the smallest blood
vessels where, because of their size,
they become trapped. Over the few
weeks, the Yttrium delivers painless
radiation to the tumors from the inside.
Radioactive Microspheres are
generally well tolerated with only some
tiredness and low grade fever in most
patients. The amount of radiation that
comes out of the patient is small and
patients are not a danger to family
members.
A unique combination of liver targeted
radioactive microspheres (SIR-
Spheres) and a standard-of-care
systemic agent (Sorafenib/Nexavar by
Bayer) appears to confer a survival
benefit for patients with inoperable
primary hepatocellular cancer (HCC)
including those with disease that has
spread outside the liver, according to a
recent study.
MDS Nordion is the maker of the
isotopes.
Expanded access is currently available
for this treatment at trial no:
NCT01076517
Another trial:  NCT00493883


OTHER DEVELOPMENTS     
Cyberknife by Accuray Inc;

Microwave ablation by Acculis Limited;

Transarterial chemoembolization
(TACE) the chemotherapy is delivered
directly to the tumor - rather than to  
the entire body as is the case with
traditional chemotherapy;

HepaSphere beads loaded with
chemotherapeutic agents;