Liver Directed Therapies Quick View
Liver directed therapies have evolved over the past few years and are able to offer patients with metastatic or primary liver tumors multiple treatment options to provide disease control. Coupled with other treatments, liver directed therapies are helping to prolong life and crease quality of life for patients.
A variety of ablative therapies are available, these include: Cryotherapy, NanoKnife, and RadioFreqquency Ablation. All of these procedures can be performed percutaneously (through the skin) by interventional radiologists (IR) or as an open surgical procedure by a surgeon who specializes in oncology. Ablation therapy consists of heating or cooling the liver tissue, or uses intense electric pulses, to achieve cancer cell death. A special probe is used to access the tumor and each specific method of treatment is delivered by the probe. Ablation is safe and is well tolerated. It is an effective treatment for patients with inoperable metastatic tumors but is limited by the size and number of tumors present. Medicare does provide coverage for these ablation procedures.
Cryotherapy, also called cryosurgery, cryoablation, or targeted cryoablation therapy, uses the application of extreme cold to destroy the
NanoKnife works by applying electrical energy directly into tumors and opening cell walls of the tumor. The cancer cells die; and the
healthy tissue remains unharmed.
Radio Frequency Ablation
Radiofrequency ablation, also known as RFA, is a technique of heating up liver cancers with probes inserted into the tumors.
Hepatic Arterial Infusion (HAI) involves a drug delivery system that is implanted under the skin. A catheter from the pump is connected to the gastroduodenal artery, which joins the hepatic arteries, allowing the pump to infuse only the liver with chemotherapy. Medicare provides coverage for the cost of the procedure and the implantable pump.
Radioembolization or SIRT: Yttrium 90 Microspheres
SIRT is what YES is all about!!! Selective internal radiation therapy (SIRT) or Yttrium 90 Microspheres is a relatively new treatment suitable for use even in patients with extensive liver involvement. Radioactive spheres (SIR-Spheres or Therasphere) are injected into an artery in the liver. The spheres are very tiny radioactive seeds. After they are iinjected through the liver artery, they travel into smaller arteries that feed the tumor. Once "the little magic beads" are in the tumor, they give off radiation for about three days. The radioactivity causes damage to cancer cells with little damage to the healthy liver tissue. Radioembolization is a highly efffective and well-tolerated regional treatment for liver tumors. This treatment is covered by Medicare.
Chemoembolization is also known as TACE. In this technique an interventional radiologist injects a chemotherapeutic agent directly into the arteries supplying the tumors within the liver. Embolization therapies have been used for the last two decades by interventional radiologists to treat liver tumors. Medicare has no established policy for coverage but has traditionally paid for this treatment.