[Palliative therapy for malignant hepatic tumors with hyperthermia]

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide with an annual occurrence of one million new cases. The incidence of liver metastasis is much higher than the incidence of HCC. Overall nearly 50% of the patients with colorectal adenocarcinoma will develop liver metastasis. Surgical resection remains the "gold standard" for resectable hepatic neoplasms, but only a minority of patients present with lesions which are potentially curable. In these nonresectable hepatic tumors palliative treatment using focal necrosis by hyperthermia (radiofrequency, microwave coagulation therapy, interstitial laser photocoagulation, thermo-ablation with hot water steam) appear as a valuable alternative. Best results are reported in the case of associations of thermo-necrosis with general or intraarterial chemotherapy. These methods of treatment can be performed by percutaneous, laparoscopic or open approach. Precise guidance of the focal necrosis can be realized using CT scan, IRM and intraoperative ultrasound exam and the results are evaluated by the same techniques. The key element in the management of the malignant tumors of the liver is the cooperation between surgeon, intensive care physician, oncologist and specialist in interventional radiology, to appreciate the indication of therapy. Further controlled trials are required to define the precise indications and long term results of these methods of treatment.