Indications and Precautions of Interventional Therapy for Liver Tumors

Primary and secondary tumors of the liver are a major cause of death among cancer patients. Whether it is primary liver cancer or secondary hepatic metastasis, patients should prioritize treatment of the hepatic lesion. Because the liver is the second most important organ of the human body, once a primary or secondary tumor appears in the liver and the patient is not treated properly, his life is seriously threatened; the survival time is usually within six months.

There are many treatment options for primary or secondary liver tumors. For patients who have an opportunity for surgery and for whom surgery is of high value, surgical resection is the preferred treatment. However, many patients have already lost the chance for surgery. For such patients, the optimal treatment for the local hepatic lesion is interventional therapy for liver tumors.

Liver tumor interventional therapy is a technique in which intervention is performed on the arteries supplying the tumor, carried out by the hepatobiliary surgery department. Its main purpose is to deliver highly effective local chemotherapy to the liver tumor or to block the tumor's blood supply so as to cause ischemic and hypoxic necrosis of the tumor. It can effectively prolong the patient's survival and improve quality of life.

Liver tumor interventional therapy differs from liver surgery; it is minimally invasive and relatively inexpensive, and is covered by medical insurance. The procedure generally costs around 30,000 yuan, of which medical insurance reimburses about 70%. Usually a patient needs only to stay in hospital for a few days after the procedure. Based on the author's many years of observation, the side effects of interventional therapy are mild, and mature solutions exist for most of them; thus interventional therapy is the most economical option for palliative treatment of liver tumors. The author once saw a fortunate patient diagnosed decades ago with a huge liver cancer who had lost the chance for surgery; using only absolute alcohol as the embolic agent, he underwent liver tumor interventional therapy, after which the tumor disappeared completely and he survived into his seventies without recurrence.

In liver tumor interventional therapy, the operator percutaneously inserts a catheter from the femoral artery all the way to the hepatic artery, and delivers chemotherapeutic drugs, embolic agents, or gelatin sponge into the hepatic artery to achieve local chemotherapy or embolization. At present, liver tumor interventional therapy mainly includes three forms: 1. Transarterial infusion chemotherapy (TAI); 2. Transarterial embolization (TAE); 3. Transarterial chemoembolization (TACE).

Transarterial infusion chemotherapy percutaneously inserts a catheter into the artery supplying the liver tumor and infuses chemotherapeutic drugs either as a single dose or via an indwelling catheter; continuous infusion through an indwelling catheter is also called HAIC therapy. Compared with systemic chemotherapy, this local chemotherapy has the advantages of high local drug concentration and less systemic harm, achieving the goals of improved efficacy and better quality of life.

Transarterial embolization percutaneously inserts a catheter into the artery supplying the liver tumor and then delivers embolic materials such as microspheres, absolute alcohol, polyvinyl alcohol microspheres, or gelatin sponge particles through the catheter to embolize the feeding artery, thereby blocking the tumor's blood supply and inhibiting tumor growth.

Transarterial chemoembolization percutaneously inserts a catheter into the artery supplying the liver tumor and then delivers iodized-oil emulsion loaded with chemotherapy drugs, microspheres, polyvinyl alcohol microspheres, or gelatin sponge particles, achieving both local chemotherapy and embolization. This is currently the main interventional method used in most hospitals and is the preferred option recommended by the author.

After liver cancer has lost the chance for surgery, or after other cancers develop hepatic metastasis, the author likewise recommends prioritizing liver tumor interventional therapy. However, the patient's overall condition must first be assessed to see whether interventional therapy is suitable. The patient can undergo a series of examinations at the local hospital's hepatobiliary surgery department, where the surgeon evaluates whether there are indications for interventional therapy and then decides whether to proceed.

Some patients often ask me whether TCM treatment of liver cancer and hepatic metastases is more reliable than interventional therapy; my answer is no. The liver is the body's detoxification organ, and oral medications themselves place a considerable burden on the liver. Herbal decoctions, in particular, after long-term use rarely fail to injure the liver. Over the years the author has seen many patients with primary or secondary liver tumors whose disease progressed rapidly after taking herbal decoctions, missing the optimal window for interventional therapy. In fact, most patients whom the author advised to combine interventional therapy with Chinese medicine have survived longer.

Do not start Chinese medicine immediately after interventional therapy. Only after 45 days should a TCM physician who specializes in oncology and is familiar with both Chinese and Western medicine evaluate whether to begin TCM treatment. Some TCM enthusiasts who do not understand interventional therapy quickly give patients herbs that activate blood and resolve stasis after the procedure; this is exactly opposite to the therapeutic logic of interventional therapy and often causes the procedure to have been done in vain.

After interventional therapy has taken effect and some time has passed, if the patient's problem persists and cannot be solved by interventional therapy alone, integrated Chinese-Western treatment may then be carried out under the guidance of an experienced TCM physician.