Surgeons Use New Technique to “Melt” Liver Tumors

Surgeons at Thomas Jefferson University Hospital are using a new technique to “melt” away cancerous liver tumors. The technique, called radiofrequency interstitial tumor ablation (RITA) promises faster, more specific treatment with fewer side effects and shorter hospital stays than are associated with standard therapies. The new technique delivers electrical energy through a special catheter to the tumor. The heated cancer cells then die within a day and a half.

Surgeons prefer removing liver tumors surgically, but approximately 80% of these tumors are surgically unresectable at diagnosis. Other options include chemotherapy, which has limited effectiveness, and cryosurgery, which entails freezing tumors. Although cryosurgery is generally an effective treatment, it requires patients to remain hospitalized for several days.

Less Invasive Than Cryoablation

“RITA gives us a huge advantage over cryoablation,” said Ernest Rosato, MD, assistant professor of surgery at Jefferson Medical College. “While patient results have been good using cryosurgery, it requires a hospital stay of 4 or 5 days and has some side effects.” Cryosurgery also involves more invasive surgery than does RITA, and the probes used are awkward.

With RITA, Dr. Rosato says, “We can do what we do with cryosurgery but with fewer side effects. Patients can even have this treatment while they are receiving chemotherapy. It’s a minimally invasive way of dealing with tumors.” In the RITA system, a catheter is attached to four prongs that encompass and deliver electrical energy to the tumor. Surgery is performed laparoscopically, through tiny incisions and with the use of small lighted cameras at the end of long tubes. As tissue emperatures rise above 113° F, cell protein is permanently damaged, killing the cell.

“Many patients that come to us are almost hopeless candidates,” said Dr. Rosato. “They have failed chemotherapy and are looking to have their tumors treated. We would like to see them earlier, after chemotherapy, rather than waiting until they get into late stages of disease,” he said.

Applicable to Wide Range of Tumors

Dr. Rosato calls RITA “revolutionary in terms of minimizing patient risk, loss of ability to work, and expense.” Doctors using RITA need to know the exact location, size, shape, and orientation of a cancerous tumor.

Therapy can be applied to a range of different sized tumors. “In a larger tumor, doctors can start in one area and try to wipe the tumor out. We might take four or five passes with RITA, see what tumor remains to be treated, and retreat. What’s striking is that every patient we’ve treated wakes up and asks if they can go home. It is extraordinary how well patients are tolerating this treatment,” he said.

Some patients can be treated with RITA under conscious sedation, but most are seen as outpatients. “We’re treating some patients that we couldn’t have treated in the past, such as those with esophageal cancer that has spread to the liver,” said Dr. Rosato. “We can treat primary liver cancers, and metastatic colorectal tumors to the liver, as well as some metastatic melanomas. It seems like a reasonable approach for tumors that don’t warrant the stress of a full-blown operation,” he said.

Long-Term Impact Unknown

For any cancer treatment, the bottom line regarding effectiveness is not only whether patients live longer, but also whether they enjoy better, healthier lives. At present, no one knows the long-term impact of the RITA treatment on patients’ health. “We don’t know what the ultimate results will be,” said Dr. Rosato. “It will take us several more years to document the efficacy of this program.”