Results after nonsurgical local treatment of primary liver malignancies

Although it is generally agreed that surgical resection is the only curative treatment for liver malignancy, this is not possible in all cases. In situ methods for destruction of liver tumors are now available. We describe recently developed methods, with an up-date based on the literature and our own experience. Under ultrasound guidance chemical agents such as ethanol, hot saline, and acetic acid may be injected into the tumor, or thermally mediated techniques involving cryotherapy, microwaves, radiofrequency, or interstitial laser photocoagulation may be applied. Also, various ways of delivering radiotherapy to primary liver cancer have been developed. Although there are few randomized studies to compare these local, nonsurgical techniques, they have been shown to improve survival and in some cases to render tumors resectable. The long-term results will show the real benefits of these newer treatments, particularly in high-risk patients.