Liver-directed therapy

Liver-directed therapy refers to a set of treatments specifically targeting cancer within the liver. The liver is an organ in the abdomen. About the size of a football, it performs numerous essential functions, including cleaning harmful substances in the blood, producing bile to help digestion, and storing nutrients. Liver-directed therapies deliver medications or treatments directly to liver tumors, bypassing the bloodstream to target the cancer more directly. This localized approach ensures the treatment focuses on the liver without affecting the entire body.

At Penn Medicine, we prioritize your well-being when it comes to liver treatments. Our fellowship-trained surgeons, medical oncologists, radiation oncologists, and other specialists work together to create the best plan for you. With extensive expertise, we tackle even the most complex cases, providing a comprehensive array of advanced therapies, including innovative approaches not widely accessible in the southeastern Pennsylvania and New Jersey regions. 

There are several types of liver-directed therapies.

• Transarterial chemoembolization (TACE) delivers chemotherapy directly to the liver tumor through the hepatic artery, blocking blood flow to the tumor while at the same time administering chemotherapy. 
• Transarterial radioembolization (TARE) delivers radioactive beads to the tumor through the hepatic artery, providing localized radiation treatment. 
• Radiofrequency ablation (RFA) uses heat generated by radio waves to destroy cancer cells.  
• Microwave ablation (MWA) uses microwave energy to generate heat and destroy the tumor cells. 
• Cryoablation uses extreme cold to freeze and destroy cancer cells. 
• Percutaneous ethanol injection (PEI) involves injecting ethanol directly into the tumor to target cancer cells. 
• Hepatic artery infusion (HAI) pump delivers chemotherapy directly to the liver, allowing higher concentrations of the drug to target tumors in the liver more effectively while minimizing side effects.

Your doctor may recommend liver-directed therapy if you have one of the following conditions:

• Primary liver cancer, such as hepatocellular carcinoma.
• Metastatic cancer that has spread to the liver from another part of the body, such as colon cancer or rectal cancer. 
• Cancer that started in the neuroendocrine cells, such as neuroendocrine tumors (NETs)

Before your procedure, your doctor will explain the type of liver-directed therapy you’ll receive and allow time for you to ask questions. Your care team will ask about your medications and health history and provide instructions on preparing for the surgery.

Depending on the procedure, you may receive local anesthesia to numb the area or general anesthesia to put you to sleep. For some types of liver-directed therapy treatments, your provider will use imaging technology, such as a computed tomography (CT) scan, x-ray, or ultrasound to help pinpoint the tumor’s location.

Each procedure is done differently:

• TACE: A catheter is inserted through a small incision in your groin and guided to the liver artery. A mixture of chemotherapy drugs is injected directly into the tumor, then tiny particles are injected to block the blood supply to the tumor, trapping chemotherapy within the tumor and blocking oxygen and nutrients from feeding it. 
• TARE: Through a small incision in your groin, a catheter is inserted and guided to the liver artery. Radioactive beads are then injected through the catheter into the tumor’s small blood vessels, providing high doses of localized radiation. 
• RFA: A needle-like probe is inserted through your skin and into the tumor. A high-frequency current is then delivered through the probe’s tip, heating the tumor, and destroying the cancer cells. 
• MWA: A needle-like probe is inserted through your skin and into the tumor. Energy from electromagnetic waves heats the tumor and destroys cancer cells. 
• Cryoablation: A thin, hollow probe is inserted through your skin and into the tumor. Cold gases are circulated through the probe, freezing the tumor, and destroying the cancer cells. 
• PEI: A thin needle is inserted through your skin and into the tumor. A small amount of concentrated ethanol is injected directly into the tumor, destroying cancer cells. 
• HAI pump: A hockey puck-shaped device is implanted under the skin in your abdomen and connected to the hepatic artery. A thin tube is threaded from the pump into the hepatic artery allowing for direct delivery of chemotherapy drugs into the bloodstream feeding the liver.

The length of the procedure varies depending on which method is done and how many tumors you have.

Recovery is different for each procedure. Your provider will let you know what to expect based on your specific situation. If you have concerns or questions once you go home, don’t hesitate to contact your Penn Medicine provider for guidance and support.

When you partner with our experts, you can expect:

• Experience: Our specialists perform hundreds of liver-directed therapy procedures each year in the greater Philadelphia, Lancaster, and Princeton regions. We know how to perform these procedures safely and effectively. 
• Collaboration: Sometimes the liver needs surgery and sometimes it needs liver-directed therapy. Our weekly tumor board brings together a range of experts who discuss which treatments will work best for each patient. 
• Support: Our nurse navigators are dedicated to assisting you. They address your concerns, provide valuable information, and help coordinate your appointments. 
• Expertise: Our liver specialists sit on committees that form national treatment guidelines. We’re also overseeing a global clinical trial to find the best options for treating neuroendocrine tumor metastases in the liver.