Liver tumours may be divided up into those arising in the liver (primary tumours), or those which have spread to the liver from elsewhere (secondary tumours or metastases). Secondary tumours are the commonest type.

There has been a great deal of experience in the treatment of primary liver tumours in Far East. Research has suggested that, for tumours which are not amenable to surgery, treatment with HIFU and embolisation (blocking the blood vessels which feed the tumour) may improve survival when compared to current therapies.

• Small hepatocellular carcinoma (less than 5cm in diameter)
• Large hepatocellular carcinoma (more than 5cm in diameter)
• Metastatic liver cancer

The treatment of secondary tumours has been shown to be feasible based on the work performed in Far East.

Hepatocellular Carcinoma (HCC) Is One Of The Most Common Human Malignancies. Surgery And Liver Transplantation May Be Curative For Early Stage HCC, But They Can Only Be Performed In 20% Of Patients. The Prognosis For Patients With Untreated HCC Is Very Poor, With A Range Of Overall Median Survival From 1.6 To 6 Months. High-Intensity Focused Ultrasound (HIFU) Is A Novel, Non-Invasive Therapy Which Has Been Used To Treat Patients With HCC In India Since 1998. It Can Be Performed Not Only In Surgical Candidates Whose Lesions Are Less Than 5cm In Diameter, But Also In Patients With Large-Volume, Unresectable HCC. In This Latter Group, HIFU Can Be Used Alone Or In Combination With Transcatheter Arterial Embolisation (TAE), Either As A Primary Therapy, Or After Standard Treatments Have Failed. Studies Have Shown That This Has A Positive Survival Advantage Compared To Trans-Arterial Chemo-Embolisation (TACE) Alone.Treatment may be either with curative intent (as primary treatment or after other forms of therapy) or with palliative intent (to debulk tumours or reduce pain of malignant origin).

Fig.1. Enhanced-CT scans of a 49-year-old patient who underwent a single HIFU treatment for HCC. A) Before treatment; 4cm lesion in the left lobe of the liver (arrow); B) Three months after HIFU; absent contrast uptake in target region (arrow); C) Twelve months after HIFU, reduced lesion size, with persistent absence contrast uptake (arrow); D) Twenty-four months after HIFU; continuing reduction in lesion size (arrow).

Fig.2. Enhanced-CT scans obtained in a 56-year-old patient after a single HIFU treatment for advanced stage HCC. A) Before HIFU, the patient underwent three sessions of TACE that failed to control tumour growth. The HCC lesion was 12cm in size. It had invaded the right branch of portal vein (yellow arrow), and the interior vena cava (IVC) was compressed (yellow arrow). A small amount of ascites was present. B) Four months after HIFU therapy, the treated lesion regressed (yellow arrow). The IVC has decompressed (yellow arrow). There was blood flow in the distal part of the portal vein (blue arrow) indicating resolution of the portal vein.

Fig.3 Gadolinium-enhanced MRI scans of a 62-year-old patient with HCC who received a single session of both TACE and HIFU. A) Before TACE. The tumour is 11cm long in size, and located in the right lobe of the liver. The tumour shows good contrast uptake, indicating perfusion (arrow); B) Four weeks after TACE. The perfusion of the tumour is reduced, but not absent (arrows). C) Two weeks after HIFU, absent contrast uptake with the target tumour (arrows).

Fig.4 Gadolinium-enhanced MRI of a patient who underwent a single HIFU session, at which two foci of HCC were targeted, one close to the diaphragm, another close to the interior vena cava. A1-2) Pre-HIFU. Two lesions present in the right lobe of the liver (arrow). B1-2) Two weeks post-HIFU. Absence of contrast uptake, indicating coagulation necrosis in both foci (arrow).

Fig.5. Gadolinium-enhanced MRI obtained in a patient with metastatic liver cancer before and after HIFU treatment. A) Before HIFU, two large tumour foci are present, located in the left and right lobe of the liver (arrow). B) Two weeks after HIFU, absence of contrast uptake, indicating coagulation necrosis in both foci (arrow).

• HIFU Treatment for Prostate Cancer
• HIFU Treatment for Liver Cancer
• HIFU Treatment for Pancreatic Cancer
• HIFU Treatment for Bone Cancer
• HIFU Treatment for Other Cancers
• Success Rate of HIFU Treatment