Interventional Oncologic Approaches to Liver Metastases

The rationale, application, and clinical results are reviewed of interventional oncologic techniques developed to treat secondary liver malignancies.

Course ID: Q00380 Category:
Modalities: ,

4.0

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Registered Radiologist Assistant: 4.00
Procedures: 4.00
Abdominal Section: 4.00

Radiation Therapy: 2.75
Patient Care: 1.50
Patient and Medical Record Management: 1.50
Procedures: 1.25
Treatment Sites and Tumors: 1.25

Vascular-Interventional Radiography: 4.00
Procedures: 4.00
Vascular Interventional Procedures: 3.00
Nonvascular Procedures: 1.00

Outline

  1. Introduction
  2. Overview of PVE
    1. Technique
    2. Indications and Results
  3. Overview of HAIC
    1. Technique
    2. Indications and Results
  4. Percutaneous Ablation Techniques
    1. Rationale
    2. RF Ablation
    3. Microwave Ablation
    4. Indications and Results of Thermal Ablation in Metastatic Liver Disease
  5. Transarterial Embolization Techniques in Hepatic Metastases
    1. Indications
    2. Technical Considerations in Chemoembolization
    3. Clinical Results of Chemoembolization
  6. Radioembolization of Liver Metastases
    1. Rationale for 90Y Radioembolization
    2. Technical Considerations in Radioembolization
    3. Clinical Results of Radioembolization in Liver Metastases
    4. Toxicity and Complications in Transarterial Embolization Techniques
    5. Techniques Under Development
  7. Conclusion

Objectives

Upon completion of this course, students will:

  1. understand the number of patients that will die due to metastatic liver disease from colorectal liver metastases
  2. communicate what treatment provides the best long term survival rate in patients with colorectal metastatic disease
  3. explain the percentage of patients who are candidates for surgery to treat colorectal metastatic cancer
  4. indicate what percentage of metastatic lesions in colorectal cancer patients will be completely sterilized by chemotherapy
  5. identify a limit to liver resection
  6. recognize the most feared post-operative complication after hepatectomy
  7. understand what vessels are targeted during portal vein embolization
  8. visualize portogram images at all stages of portal vein embolization procedures
  9. explain which approach to the portal venous system may damage future remnant liver
  10. understand the most frequently reported embolic materials used for portal vein embolization
  11. communicate what area of the liver is most commonly targeted for PVE
  12. indicate the percentage of future remnant liver volume patients must have to be considered for portal vein embolization
  13. discuss what liver condition will produce better portal vein embolization outcomes
  14. understand how liver metastases receive blood supply
  15. indicate the percentage of FUDR extraction in the liver that occurs during hepatic artery infusion chemotherapy
  16. explain why permanent access to a hepatic artery is necessary for hepatic artery infusion chemotherapy
  17. identify the routes for catheter placement into the hepatic artery
  18. understand when hepatic artery infusion chemotherapy is utilized
  19. communicate the most common side effects of FUDR used in hepatic artery infusion chemotherapy
  20. indicate the benefits to hepatic artery infusion chemotherapy
  21. be aware of multiple percutaneous ablation techniques
  22. communicate the intent of ablation therapy
  23. understand the three phenomena that define the results of hyperthermal ablation
  24. identify the limitations to surgical resection of liver metastases
  25. indicate what therapy utilizes direct injection of pure alcohol into cancer cells
  26. discuss methods used to perform microwave ablation therapy
  27. understand the technical advantage of microwave therapy over radiofrequency therapy
  28. be aware of the advantages of thermal ablation over resection
  29. explain what size metastatic liver tumors respond best to thermal ablation therapy
  30. discuss the advantages of intraoperative radiofrequency ablation
  31. recognize the survival rate for patients receiving thermal ablation of liver metastases caused from neuroendocrine tumors
  32. state the two types of transarterial embolization
  33. explain the Eastern Cooperative Oncology Group scoring system
  34. describe the ECOG status of 2 required for transarterial treatment
  35. list the indications for radioembolization in colorectal metastases to the liver
  36. understand pre-treatments required for chemoembolization patients
  37. describe the type of diagnostic angiography necessary for chemoembolization patients
  38. list the most commonly used chemotherapeutic agents
  39. describe the types of metastases for which chemoembolization has been utilized
  40. indicate what percent of the population receiving chemoembolization will experience major complications
  41. understand why care must be taken when advancing catheters during chemoembolization procedures
  42. understand the rare, non-vascular complications associated with chemoembolization
  43. identify the two materials used in radioactive microspheres
  44. select which commercially available 90Y particles are comprised of glass or resin
  45. communicate the three qualifications for radioembolization
  46. discuss the importance of pre-radioembolization angiography
  47. summarize studies on radioembolization of liver metastases from NET, breast cancer, and uveal melanoma
  48. communicate the difference in toxicity levels between radioembolization and chemoembolization
  49. state the more serious complications involved with radioembolization
  50. recognize the new techniques under development for cancer treatment