**Old versus New – Tumor Ablation versus Tumor Nanoablation with Particular Emphasis on Liver Tumors**

Zeno Sparchez, Tudor Mocan and Pompilia Radu

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/61008

#### **Abstract**

18 Recent Advances in Liver Diseases and Surgery

222 Recent Advances in Liver Diseases and Surgery

2005;**29**:524–527. .

**31**:375–379. .

[119] Sakamoto Y, Yamamoto J, Yoshimoto M, Kasumi F, Kosuge T, Kokudo N, et al. Hepatic resection for metastatic breast cancer: prognostic analysis of 34 patients. World J Surg.

[120] Selzner M, Morse MA, Vredenburgh JJ, Meyers WC, Clavien PA. Liver metastases from breast cancer: long-term survival after curative resection. Surgery. 2000;**127**:383–389.

[121] Vlastos G, Smith DL, Singletary SE, Mirza NQ, Tuttle TM, Popat RJ, et al. Long-term survival after an aggressive surgical approach in patients with breast cancer hepatic

[122] Elias D, Maisonnette F, Druet-Cabanac M, Ouellet JF, Guinebretiere JM, Spielmann M, et al. An attempt to clarify indications for hepatectomy for liver metastases from breast

[123] Lubrano J, Roman H, Tarrab S, Resch B, Marpeau L, Scotté M. Liver resection for breast cancer metastasis: does it improve survival? Surg Today. 2008;**38**:293–299. .

[124] Pocard M, Pouillart P, Asselain B, Salmon R. Hepatic resection in metastatic breast cancer: results and prognostic factors. Eur J Surg Oncol. 2000;**26**:155–159. .

[125] Kollmar O, Moussavian MR, Richter S, Bolli M, Schilling MK. Surgery of liver metastasis in gynecological cancer – indication and results. Onkologie. 2008;

[126] Abbott D, Brouquet A, Meric-Bernstam F, Valero V, Green M, Kuerer H, et al. Resection of liver metastases from breast cancer: timing of surgery and estrogen receptor status

metastases. Ann Surg Oncol. 2004;**11**:869–874. .

define outcome (P135). Ann Surg Oncol. 2011;**18**:S80. .

cancer. Am J Surg. 2003;**185**:158–164.

Loco-regional treatments play a key role in the management of hepatocellular carcino‐ ma (HCC). Image-guided tumor ablation is recommended in patients with early-stage HCC when surgical options are precluded. Radiofrequency ablation is currently es‐ tablished as the standard method for local tumor treatment. Despite major advances in tumor ablation techniques the disease recurs in a high proportion of cases. A major limitation in its overall effectiveness is due to the difficulties of heating large tumors. Small regions of viable tumor may still remain even after apparently good tumor ablation by perfusion-mediated tissue cooling, preventing the whole tumor reaching a sufficient temperature for coagulation and necrosis. Moreover simple heating techni‐ ques have trouble discriminating between tumors and surrounding healthy tissues leading to many side effects. In order to overcome these major limitations numerous groups are investigating the use of energy-absorbing agents localized within tumor tissues to facilitate localized heating. A personal answer based on the review of the literature will be offered to the following questions: NIR photothermal therapy, RFA with nanoparticles, or magnetic fluid hyperthermia for the long term management of HCC? How should we deliver nanoparticles: systemically or directly intratumoral? Ablation versus mild hyperthermia: Pros and Cons in the majority of cases, hyper‐ thermia is applied in one of two ways: a) high temperature for short time periods commonly referred to as ablation, or b) lower temperatures for long time periods, of‐ ten called mild hyperthermia. The former is used to kill cells directly with heat and consequently can be used to thermally ablate tumor. The second method is just above physiological temperature, and these temperatures are more often used to trigger re‐ lease from thermosensitive drug carriers. Both approaches can be combined with heat-sensitive drug targeting. There are many ways to induce nanoparticle mediated thermal therapy in solid tumors including absorption of infrared light, radiofrequency ablation and magnetically induced heating. These approaches have demonstrated high efficacy in preclinical models of HCC and are already tested in human clinical trials.

**Keywords:** Nanoparticles, liver tumors, percutaneous ablation

© 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
