Clinical application of minimally invasive treatment for hepatocellular carcinoma

  Liver cancer is one of the common malignant tumors in China, and according to statistics, it is the second most common cancer “killer” in China, with about 260,000 patients dying of liver cancer worldwide every year, of which 42.5% are in China. Most of them occur on the basis of chronic hepatitis B and are commonly found in middle-aged men. Because of its high malignancy and fast progress, patients usually have no discomfort in the early stage, but once symptoms appear, they are often in the middle and late stage and often lose the opportunity of surgery.  Therefore, the treatment of liver cancer is difficult and ineffective, and the survival time is only 6 months after the onset of the disease, which is called “the king of cancer”. With the progress of basic medical and clinical medical research, various new non-surgical therapies, especially minimally invasive interventional therapies, have emerged in the treatment of hepatocellular carcinoma, including: 1) transcatheter hepatic artery chemoembolization (TACE); 2) physical ablation such as argon helium knife, microwave and radiofrequency; 3) permanent implantation of 125I radioactive particles; 4) traditional Chinese medicine, immunotherapy, liver protection and antiviral adjuvant therapy. Adjuvant treatment such as Chinese medicine, immunization, liver protection and anti-virus. For patients with liver cancer who come to our department, a comprehensive assessment of each patient’s physical condition and functional status of major internal organs, especially liver function, is made according to their condition, after which standardized, comprehensive and individualized treatment is applied to each patient.  In recent years, the Department of Interventional Oncology has adopted one or several methods alone to treat primary massive hepatocellular carcinoma in sequence according to the specific conditions of patients, which has achieved good clinical results and some patients have been cured.  Transcatheter hepatic artery chemoembolization (TACE) is currently recognized as the treatment of choice for unresectable hepatocellular carcinoma, and after TACE, iodine oil can be retained in the hepatocellular carcinoma tissue for a long time, which can directly block the main blood supply to the tumor tissue and cause ischemic necrosis of the tumor tissue.  However, the necrosis of tumor tissues is positively correlated with iodine oil deposition, and cancer cells in iodine oil-deficient areas and sparse areas cannot be completely necrosed, which is the basis for tumor recurrence and proliferation. In addition, patients with hepatocellular carcinoma generally have poor liver function, and repeated treatment with simple TACE is likely to cause damage to normal liver tissues, aggravate patients’ liver dysfunction and affect their survival quality. Therefore, the efficacy of simple TACE for large hepatocellular carcinoma is not ideal.  Ar-He knife as a kind of cryoablation therapy for tumor with exact efficacy. The rapid expansion of high-pressure argon gas at the tip of the knife causes rapid cooling of the diseased tissues, down to minus 140℃~170℃, and when high-pressure helium gas is output, it thaws the ice ball and rapidly increases the temperature to minus 20℃~40℃ within minutes, which causes the tumor tissues to be devastated in the cycle of one cold and one heat, and the dead tumor cells form tumor antigens to enhance human immune function.  After the microwave energy emitted by the focusing radiator is absorbed by the tissue and transformed into heat energy, the tissue temperature increases. Tumor tissues have poor blood circulation and high water content, which are easy to absorb microwave energy and heat up quickly and not easy to dissipate in time, so that the temperature in tumor tissues rises beyond healthy tissues by 5~11℃ and maintains for a long time.  Therefore, using pulse modulated microwave therapy instrument and highly concentrated microwave energy to selective effect on tumor, can achieve the purpose of killing tumor cells without damaging normal tissue.  Radiofrequency ablation uses high frequency radiofrequency current (100-500kHz, 460kHz is most commonly used) to conduct to the tumor tissue through the insulated electrode head, which generates local heat and conducts to the surrounding tissues, resulting in coagulation and necrosis of tumor tissue and surrounding normal liver tissue.  After TACE treatment, physical ablation treatment such as Ar-He knife, microwave and radiofrequency can reduce the “hot pool effect” inside the tumor and further improve the effect of intraoperative freezing or thermal ablation.  However, because of the large tumor lesions, irregular margins and small satellite lesions around the main tumor, tumor residuals may be caused. For the “dead corner” left after sequential treatment with TACE and Ar-He knife cryoablation, 125I radioactive particles can be permanently implanted, which can kill the residual cancer cells; because a large number of liver cancer cells are killed after sequential treatment, the residual non-proliferating cells enter the proliferating phase and the tumor cell cycle is synchronized. The γ-rays released by 125I radioactive particles can kill the cycle-sensitive cells.  The sequential treatment of multiple methods makes the treatment of tumor more complete and improves the efficacy, and even achieves radical cure.