Indications for HIFU in primary liver cancer - hepatocellular carcinoma (HCC):
- Histologically verified HCC
- Assessment of inoperability after consultations with two independent liver surgeons
- The tumor is visualized by ultrasound – it is focal form with clear boundaries
- Possibility of radical therapy in the first stages of the disease. When the disease is advanced - local palliative treatment with HIFU can be applied
- Combination of TAE + HIFU in cases with hypervascular infiltrative process
- Application of HIFU in cases of multifocal hepatocellular cancer - with up to 4 nodular foci
- The distance between the skin surface and the farthest margin of the tumor is not more than 12 cm
- The acoustic path of the FUS is safe and without obstructions
- Good general condition of the patient - > 70% by Karnofsky’ scale
Contraindications for HIFU in hepatocellular carcinoma:
- Diffuse hepatocarcinoma
- The tumor infiltrates more than 50% of the liver
- Seriously decompensated liver function
- A patient with cachexia and presence of distant metastases Infected liver foci
- Class "C" by the scale of Child
- Thrombosis / tumor emboli / of the vena cava inferior
- Prothrombin time <50%
INDICATIONS FOR HIFU IN SECONDARY LIVER TU / METASTASES / :
- Histologically verified malignancy
- A contrast enhanced CT study or visualized with abdominal ultrasound liver foci
- Liver lesions are inoperable with the conventional surgery ( infiltration into large vessels , multi- centric metastases etc.).
- Assessment of inoperability after consultations with two independent liver surgeons
- A signed written refusal of the patient for a conventional surgical operation
- At least two courses of chemotherapy are applied according to the specifics of the underlying disease
- Expected survival for more than 3 months
- HIFU ablation is an alternative method for the palliative treatment of liver metastases which may be applied under the following conditions : the number of metastases in the liver is not more than 3-4 , they are not larger in size than 5 cm , the total amount does not exceed 10 cm
CONTRAINDICATIONS FOR HIFU ABLATION OF LIVER METASTASES :
- the metastatic process is spread in more than 50% of the liver
- More than 4 metastatic foci; larger than 5 cm or the total amount of their size is exceeding 10 cm
- Obstructive jaundice
- Platelets <50,000 / UL
- prothrombin time below 50%
- Leukocytes / WBC /> 3.5
- Contraindications for general anesthesia