Liver-Directed Therapies

Treatment options for patients with cancer in the liver

Doctors at Fox Chase Cancer Center evaluate every patient for the treatment plan that will allow the best chance for cure. This is true for patients with cancer either originating from or spreading to the liver. Specialists with many types of expertise and experience work together to accomplish this goal through a comprehensive program that includes liver surgeons, medical oncologists, gastroenterologists, interventional radiologists and radiation oncologists. The goal is always to increase survival rates for patients.

Liver Resection Surgery

Patients who are eligible for surgical removal (resection) of their liver tumors have access to the nation's leading surgeons at Fox Chase who have vast experience with this procedure. This technique is used whenever possible, as it offers patients the greatest chance of cure.

For patients whose liver tumors cannot be safely removed by surgery, other treatments are used to attack the cancer in the liver. These options include: radiofrequency ablation, microwave ablation, cryotherapy, chemoembolization, radioembolization, bland embolization and external radiation therapy.

Radiofrequency Ablation of Liver Tumors

Radiofrequency ablation is used to treat patients with liver tumors that are unresectable (unable to be surgically removed). In the procedure, doctors insert a thin electrode (or needle) into the center of the tumor, using a CAT scan or ultrasound to accurately guide the needle. The electrode is connected to a generator and the current destroys the tumor using heat. If the procedure does not completely sterilize the cancer, repeat treatments can be given until the tumor is eliminated.

Radioembolization (SIR-Spheres and TheraSpheres)

SIR-Spheres and TheraSpheres are tiny radioactive microspheres that are implanted in the liver tumor. They are carefully infused into the arteries of the liver to deliver radioactive substances to tumors within the liver. The microspheres are then trapped in the small blood vessels of the tumor and deliver radiation slowly over a period of approximately 14 days. This process destroys the tumor, while preserving healthy nearby tissue. Radioactive microspheres can target tumors of the liver, regardless of their number and location.

Chemoembolization (TACE)

Chemoembolization is a procedure in which doctors inject a chemotherapeutic substance into the tumor to stop blood flow. Blood flow to tumors provides oxygen needed for the cells to survive. When the blood flow is stopped with chemoembolization, tumor cells cannot survive, and tumors stabilize or shrink. This procedure is frequently beneficial to some patients with liver tumors.

Bland embolization

Similarly, bland embolization is a procedure in which doctors inject a bland substance into the tumors to stop blood flow. This procedure can kill and/or stabilize the tumor by ischemia (blood flow reduction). It is often used to reduce large tumor bulk or tumors that are not amenable to other ablative therapies, with the ultimate goals of tumor control and pain relief.

External beam radiation therapy

See National Cancer Institute information on Liver Cancer

External beam radiation therapy delivers radiation from outside of the body using x-rays. This treatment is frequently done using complex techniques such 3D-conformal radiation or intensity modulated radiation therapy (IMRT). These are sophisticated techniques that maximize the dose to the tumor while minimizing the radiation delivered to adjacent normal tissues. For patients whose tumors are appropriate, liver tumors can be treated with stereotactic body radiation therapy (SBRT), which consists of 3-5 treatments of high dose radiation delivered with great precision.

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