Update of laser-induced thermotherapy for liver tumors

Surgical resection generally offers the only chance of long-term survival for patients with primary or secondary liver tumors. Difficulties relating to the stage of the tumor, the extent of underlying liver cirrhosis and the general condition of the patient make this technique unsuitable for the majority of patients. Many nonresectional methods of in-situ tumor ablation have been recently described. These include alcohol injection, cryotherapy, radiofrequency and intraoperative radiotherapy. Recently more interest has been directed to the use of laser as a source of ablative energy. Laser-induced interstitial thermotherapy is an experimental technique used to destroy tumors within the liver. Initially this was in the form of bare-tipped photocoagulation but the development of a diffuser tip has enabled the formation of larger diameter lesions using heat to produce an area of coagulative necrosis. Less heat is lost if hepatic vascular inflow is occluded during the procedure and consequently a larger area of tumor necrosis is produced. The prospect of a simpler, more efficient system of tumor ablation is attractive so we undertook a review of the current issues surrounding this emerging treatment.