Once you're diagnosed with liver cancer, surgery is the only opportunity to cure the disease completely. If the surgeon can remove all of the cancerous tissue visualized during surgery, your outlook for survival is better, as well. However, complete removal of liver cancers is not always possible, and many people diagnosed with the disease aren't candidates for surgery for various reasons.¹

Sometimes, the tumors have grown too large, or have invaded major blood vessels or other vital organs. Sometimes, many small tumors are spread throughout the liver, making surgery too risky or impractical. Also, surgeons must be mindful of compromised liver function and the risk that cancer treatments may cause additional liver damage and toxicity in these patients, which could be fatal.²

A Minimally Invasive Alternative
But there is an option for people who can't have surgery for their cancer, and a team of doctors at Johns Hopkins University say they are confident of its benefits.^3,4 It's known as chemoembolization, and it was the focus of two studies released at the annual meeting of the American Society of Interventional Radiology in New Orleans this month.

"Chemoembolization should be the standard first-line treatment for inoperable liver tumors," stated Jeff Geschwind, MD, lead investigator of one of the studies, and director of Interventional Radiology at Johns Hopkins University School of Medicine. "Patients have minimal procedural toxicity, and chemoembolization is already proven to substantially increase survival."

Chemoembolization is a technique that uses chemotherapy drugs like doxorubicin and cisplatin. An interventional radiologist inserts a catheter through a small cut in the skin at the groin, and using x-ray imaging, guides it through an artery that feeds the tumors.

Once the catheter is at the tumor site, a combination of chemotherapy drugs and tiny particles like grains of sand are injected directly into the tumor. While the chemotherapy directly treats the tumor, the tiny particles included in the procedure block blood flow leading to the tumor, which normally supplies its needed nutrients. The particles also help contain the chemotherapy to the tumor site.⁵

Evaluating Toxicity
In one of the studies released at the medical conference this month,2 Geschwind and his cohorts evaluated the risks of toxicity from the chemotherapy drugs used in the technique. They analyzed records from nearly 150 patients who underwent the procedure over a 5-year period. Each patient had been diagnosed with primary hepatocellular carcinoma and other cancers of the liver.

The investigators determined that chemoembolization causes relatively minimal toxicity and little change in liver enzymes and blood counts.

Safety Assessment
In the second study,3 Geschwind and his colleagues examined the safety of chemoembolization combined with the survival odds of a group of 31 patients diagnosed with portal vein thrombosis (PVT) who underwent the procedure over a 4-year period.

Given the fact that chemoembolization is considered risky in patients diagnosed with portal vein thrombosis, the physicians wanted to confirm this. "The fear is that further compromise of the blood supply to the liver may push the patient into premature hepatic failure," they wrote. PVT is a clot that blocks bloodflow in the portal vein, the main blood vessel that supplies the liver. In addition to liver cancer, PVT can also be caused by cirrhosis or inflammation of the bile ducts.⁶ 

At the end of the study, the investigators determined that no patients faced immediate complications during the procedure, and recovery was similar to that of patients without PVT. "A small minority [of patients] required a second day of hospitalization for symptomatic control," they wrote.

Improved Chances of Survival
While one patient died within a month after the procedure from gastrointestinal hemorrhage, the rest of the patients faced survival odds of between 5 months and 1 year. Those with poorer chances of survival had higher rates of ascites, encephalopathy, and portal varices, as well as lower albumin levels, they reported.

While those odds of survival seem pessimistic, Geschwind and his team noted that a patient's chances of survival with PVT and no treatment for liver cancer is only about three-and-a-half months. For those who receive systemic chemotherapy, the chances of survival are only about 5 months, at best, they wrote.

There are other benefits of this procedure, Geschwind pointed out. "Chemoembolization offers patients a nonsurgical option that preserves healthy tissue, is well tolerated, and has a short recovery time," he explained. "It can be repeated as needed to control tumor growth or progression, thereby extending life expectancy in the majority of cases."

 1. American Cancer Society. How is Liver Cancer Treated? Available at: http://www.cancer.org/docroot/CRI/content/
CRI_2_2_4X_How_Is_Liver_Cancer_Treated_25.asp?rnav=cri. Accessed April 6, 2005.
2. American Society of Interventional Radiology. Press Release.
3. Kessler JM, Hariri A, Hong K, Georgiades CS, Geschwind J. Toxicity of transcatheter arterial chemoembolization for unresectable liver tumors (Abstract 149).  American Society of Interventional Radiology. 30th Annual Meeting. 2005 Mar 31-Apr 5. New Orleans, LA.
4. Georgiades CS et al. TACE in patients with unresectable hepatocellular carcinoma and portal vein thrombosis: toxicity and survival data. American Society of Interventional Radiology. 30th Annual Meeting. 2005 Mar 31-Apr 5. New Orleans, LA.
5. Society of Interventional Radiology. Treatments. Chemoembolization. Available at: http://www.sirweb.org/patPub/cancerTreatments.shtml. Accessed April 6, 2005.
6. The Merck Manual. Portal Vein Thrombosis.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.