Treatment eases liver cancer

Patients with incurable liver cancer may be able to prolong their lives with a surgical radiation procedure recently started in Hawaii, which has the nation’s highest incidence of liver cancer.

The minimally invasive surgery, once available only at large mainland academic medical centers, was begun several months ago at the Queen’s Medical Center.

It involves tiny incisions in the hip for a catheter — smaller than a spaghetti noodle — to inject radioactive particles into an artery that feeds the liver tumor. The particles enter the tumor and treat it with radiation from the inside out, Queen’s said last week.

The particles are about the size of talcum powder and contain yttrium-90, a radioactive substance.

Patients are typically discharged the same day and most feel no pain after treatment, said Dr. Michael Itagaki, a tumor specialist and one of two Queen’s interventional radiologists who perform the surgery. The hospital has completed the procedure on six patients in the past six months.

Hawaii has the highest incidence of liver cancer in the country at 5.5 cases per 100,000 people each year, according to the Centers for Disease Control and Prevention. About 76 Hawaii residents are diagnosed with the disease each year. Statistics show that Asians and Pacific islanders are most at risk for liver cancer.

"Oftentimes patients with these kinds of cancer, they have no hope," Itagaki said. "They’ve exhausted their traditional medical therapies. Now we can give them hope because treatments can suppress the tumor and buy a lot of time. It doesn’t require really awful chemotherapy where they lose their hair and are vomiting, or surgery where there’s a recovery. From a compassionate standpoint, I think it’s fantastic."

Doctors can use the treatment for patients with cancer originating from the liver, as well as colon and pancreatic cancers that spread to the liver. The treatment can set tumor growth back six months to a year, Itagaki said.

"We may be able to shrink it down to where it was nine months ago and sort of reverse the clock so a patient’s life will be extended for that long," Itagaki said, adding that the procedure doesn’t work for everybody. "Some people will have progression of the disease; for approximately 25 percent, it won’t work. These are patients (that) if we don’t do anything, there’s a 100 percent guarantee they’re going to have progression of the tumor. We’re offering them a 75 percent chance a tumor will stop growing for at least a period of time and a 50 percent (chance) it will shrink."

The procedure not only may extend a patient’s life, but also improve its quality with few side effects, Itagaki said. The surgery is covered by both private and public insurance plans. Patients with tumors that have spread throughout the body or with destroyed livers are typically ineligible for treatment.

Richard Sato of Maui was treated in April. He said the procedure shrank a tumor roughly 10 centimeters in diameter — the size of a softball — in the middle of his liver, buying him more quality time with his family. The 73-year-old Pukalani resident said he is too old for a liver transplant and that the tumor is not in a place where it can be removed, so the procedure was among his few options.

"Right now I’m feeling really healthy," he said. "I have no side effects, nothing from the cancer. I’m feeling normal right now."

An estimated 28,720 people in the United States will be diagnosed with liver cancer and 20,550 will die this year, according to the National Cancer Institute. In addition, 143,460 people will be diagnosed with the more common colorectal cancer and 51,690 of them will die in 2012, the institute said. Colorectal cancer spreads to the liver in about 40 percent of cases, which may then be treated with this surgery.

An estimated 890 people will be diagnosed with colorectal cancer and 289 will die in Hawaii every year.

Recent statistics weren’t available for the third type of rare cancer that can spread to the liver, neuroendocrine cancer, a collection of tumors that arise in a variety of organs such as the lung and pancreas.

Researchers are studying a variety of other cancers, including breast cancer and melanoma, to determine whether this treatment will be beneficial.