Many people cannot have surgery for primary liver tumors because the cancer is too advanced. Others may not eligible because they have an underlying liver disease such as cirrhosis. In some cases, tumors may be so small that nonsurgical treatments may be equally effective.
Even after successful surgery or other localized treatments for primary liver cancer, the disease can spread, or metastasize, to another part of the body. So far, additional treatment in these situations is given on a limited basis — although your doctor may recommend it in certain special circumstances or as part of a clinical trial.
Our investigators are constantly evaluating new targeted or smart drug medications (a single drug or a combination of drugs) to improve the standard of care for people in these situations. Investigational therapies are sometimes offered to people through our clinical trials.
Novel targeted agents do not cause the common side effects that so many people experience with chemotherapy, such as fatigue, nausea, and diarrhea. Other side effects may arise, but our medical oncologists are experienced in helping patients manage them.
For hepatocellular carcinoma, our doctors may prescribe sorafenib (a commonly used targeted drug) or may recommend a clinical trial exploring new treatment options for this illness — in some cases available even if you have advanced cirrhosis or liver failure. Memorial Sloan Kettering has one of the largest clinical trial programs for liver cancer in the country.
At Memorial Sloan Kettering we sometimes give chemotherapy before surgery to help shrink liver tumors (called conversion therapy) or to help reduce the chance of recurrence (called neoadjuvant therapy).
For cholangiocarcinoma we usually prescribe a combination of the chemotherapy agent gemcitabine and cisplatin. Our team has experience in using additional targeted agents, which you may be offered as part of a clinical trial.
Chemotherapy with Hepatic Arterial Infusion
Chemotherapy with hepatic arterial infusion (HAI) is a relatively new technique that delivers a high dose of chemotherapy drugs to the hepatic artery — the main source of blood and nutrients for liver tumors — through a small pump implanted under the skin in the lower abdomen. Additional chemotherapy medicine is injected into the pump, as needed, on an outpatient basis.
Like systemic chemotherapy, HAI therapy may be used to shrink tumors before surgery, or given after surgery to prevent their recurrence. For example, HAI chemotherapy, in combination with systemic chemotherapy or alone, has been shown to dramatically increase survival for patients with colon cancer that has metastasized to the liver.(1),(2),(3),(4)More-recent evidence suggests that HAI chemotherapy alone can extend survival in people with primary liver cancer, as well.(5) In addition, because HAI chemotherapy is delivered to just a part of the body (regionally), it causes fewer toxic side effects than systemic chemotherapy.(6) Memorial Sloan Kettering conducts clinical trials on this technique.
Radiation oncologist Josh Yamada talks about a technique called IGRT that delivers high doses of radiation precisely along the contours of a tumor.
Radiation therapy is a less commonly used treatment option for patients whose liver tumors cannot be surgically removed. Radiation may be administered alone or in combination with chemotherapy or other treatments. Image-guided radiation therapy and respiratory gating are two approaches that have the potential to reduce damage to normal tissue during treatment for liver cancer.
Image-Guided Radiation Therapy (IGRT)
GRT targets tumors with greater precision than conventional radiation therapy. Using highly sophisticated computer software and 3-D images from CT scans, the radiation oncologist can develop an individualized treatment plan that delivers high doses of radiation to cancerous tissue while sparing surrounding organs and reducing the risk of injury to healthy tissue.
Because tumors and organs in the abdomen shift during breathing, precise delivery of radiation therapy to cancerous tissue can be difficult. Respiratory gating is the delivery of radiation only at certain points during a patient's breathing cycle, when the “mobile” tumors and/or regions of the abdomen are in a specific position. This approach decreases the radiation dose to the surrounding healthy tissue.