With the continuous development of liver cancer treatment technology, non-surgical treatment methods are gradually abundant and mature, among which stands the “needle of the sea” in liver cancer treatment. Who is it? What are its indications and efficacy? The following article will reveal the answer. Primary liver cancer (PLC)
PLC (liver cancer for short) is one of the most common malignant tumors in clinical practice, ranking 5th in malignant tumors, with the number of deaths close to 600,000/year, ranking 3rd in tumor-related deaths. The annual number of new cases worldwide is about 500,000 to 1 million, of which about 55% occur in China, and the mortality rate is second only to lung cancer. Therefore, liver cancer is a serious threat to the life and health safety of the nation. With the continuous development of medical science in the past two decades, the diagnosis and treatment of liver cancer have made great progress. At present, the treatment of liver cancer is basically divided into surgical treatment and non-surgical treatment. Surgical treatment can be further divided into local liver resection and liver transplantation. However, due to the insidious onset of liver cancer, most patients are already in the middle or late stage when they are diagnosed. Therefore, most of the patients have already lost the best time for surgery when they are diagnosed, and the treatment methods rely on a wide range of non-surgical treatments. Non-surgical treatment mainly includes interventional therapy, local ablation therapy, molecular targeted therapy, and Chinese medicine treatment. In recent years, the most rapidly developing and reliable non-surgical treatment method is local ablation therapy. Local ablation therapy is a type of treatment that directly kills liver cancer cells locally under the guidance of imaging technology (including ultrasound and CT), by using energy to ablate tumor or injecting drugs to kill cancer cells, which is a minimally invasive treatment method. Currently, radiofrequency and microwave ablation as well as anhydrous alcohol injection are the most common treatments. Some international clinical studies have confirmed that radiofrequency ablation can achieve the same efficacy as microwave ablation and anhydrous alcohol injection with less treatment times. So what is radiofrequency ablation treatment for liver cancer? If the stability of the Dragon Palace in the East Sea in the Journey to the West relies on the “golden hoop stick”, then the core technology of radiofrequency ablation is the “radiofrequency ablation needle”, which is inserted in the tumor of liver cancer. The RF ablation needle inserted in the tumor will generate RF energy when it is connected to the power supply, and the tumor tissue will generate internal heat by obstructing the conduction of RF energy, which is similar to the mechanism of heat energy generated by electric current through resistance in our life. At present, the front end of the RF ablation needle generating RF energy can be adjusted to a diameter similar to the tumor size (slightly larger than the corresponding tumor diameter), so the scope of ablation is adjustable and controllable, relatively safe operation. Meanwhile, researchers have reported that the high temperature around the RF electrode can be generated from 50 to 110℃, while human tissues can experience complete cellular inactivation in just a few seconds under the environment of more than 55℃. Therefore, the killing of tumor cells by radiofrequency ablation is different from radiotherapy and chemotherapy and is instantly destructive. At the same time, the vascular tissue surrounding the tumor coagulates to form an inflammatory response zone, which serves to make it impossible to continue to supply blood to the tumor and prevent metastasis. Currently radiofrequency ablation needles can be used under local or general anesthesia with a transdermal approach, as well as during laparoscopic or open surgery. The imaging guidance means we routinely use is currently mainly ultrasound. Ultrasound-guided percutaneous ablation has the advantages of minimally invasive, safe, easy, real-time monitoring and low cost. So what kind of patients are suitable for radiofrequency ablation? 1.hepatocellular carcinoma without extrahepatic metastasis, single hepatocellular carcinoma lesion diameter ≤5cm; 2.small hepatocellular carcinoma (diameter ≤3cm) with 3 or less lesions; 3.patients with greater surgical risk, such as those with liver insufficiency, severe cirrhosis and severe portal hypertension with significant improvement after hepatoprotective treatment; 4.tumor recurrence after surgery but not suitable for further surgery; 5.for larger tumors or multiple tumors combined 5.For larger tumors or multiple tumors combined with surgical resection treatment, it is also possible to carry out elective fractionated treatment; 6.Preoperative treatment during liver transplantation for liver cancer. At the same time, patients with pacemakers, severe aneurysms, metal objects in the area of radiofrequency ablation, and patients with intrahepatic portal and intra-abdominal vascular stents need to be carefully selected. What is the clinical efficacy of radiofrequency ablation? A large number of animal experiments and clinical practice at home and abroad have confirmed that radiofrequency ablation can effectively inactivate liver cancer cells. In clinical observation, the treatment of liver tumors with radiofrequency ablation has also achieved very good results. It is reported that the survival rates of 1, 2, 3 and 5 years after radiofrequency treatment are 94%, 86%, 68% and 40% respectively, while as early as 1996, foreign scholars reported that the treatment effect for liver cancer with diameter ≤3cm is comparable to liver resection, while the complications, mortality, hospitalization time and cost are greatly reduced. What are the precautions after radiofrequency ablation? Radiofrequency ablation treatment for liver tumor is relatively safe, with low impact on the whole body and mild traumatic reaction. The complications after treatment are what we need to understand and pay attention to: including self-limiting symptoms such as transient hypothermia and local pain after the procedure, as well as mild abnormalities of liver function indexes (such as ALT) within 48 hours after treatment, most of which return to pre-treatment or normal levels in 1 to 2 weeks, while bleeding at the site of liver puncture or subhepatic hematoma, liver abscess at the treatment site, acute cholecystitis may occur if the treatment site is close to the gallbladder, and perihepatic hematoma. Gallbladder inflammation, and injury to perihepatic organs such as colonic perforation, all of which are associated with preoperative patient assessment and surgeon proficiency. Tumor metastases along the perforating needle tract are less common. Post-treatment rest is predominantly sedentary, with a 1-2 day hospital stay for observation to prevent various complications and for prompt treatment if complications are identified. Overall, radiofrequency ablation of liver is a minimally invasive, safe, simple and repeatable treatment. It is believed that more and more liver cancer patients will benefit from this “magic needle” as radiofrequency technology continues to be improved and perfected.