The incidence of primary and metastatic liver tumors is rising and the therapeutic armamentarium for these tumors is expanding at a rapid pace. Surgery remains the primary treatment modality for these tumors. With improvements in our perioperative management and operative techniques a larger proportion of patients are able to undergo potentially curative liver surgery. In addition, indications and criteria for liver transplantation for both primary and metastatic liver tumors are constantly expanding. Unfortunately, many patients are not amendable to surgical resection or liver transplantation and therefore alternative liver-directed therapies are routinely being implemented as part of complex multidisciplinary treatment models. However, these models are continually evolving as these regional therapeutic options continue to expand. New embolization agents and techniques, as well as, improvements in radiation delivery, are all evolving in the background of improvement in systemic and targeted therapy options for these tumors. This book provides a comprehensive, state-of-the art review of the current state of liver-directed therapy for malignant liver tumors. The book will serve as a valuable resource for not only surgeons and clinicians but for researchers with an interest in malignant liver tumors. The book focuses on the therapeutic approach to primary and metastatic tumors providing an up-to-date review on surgical liver anatomy and new imaging techniques as well as patient selection and technical consideration for resection and transplantation. In addition, the book provides new insight into novel and evolving therapies in the areas of transarterial therapy such as: (i) bland embolization, (ii) chemoembolization, and (iii) radioembolization; as well as new radiation techniques including SBRT and proton therapy. Furthermore, the expanding role of hepatic artery infusion therapy in primary malignant tumors is highlighted. Finally, integration of all these regional therapy options with upcoming and evolving systemic and targeted therapy regimens are integrated and discussed. This book will serve as a very useful resource for clinicians and researchers managing and treating patients with these challenging malignancies. It provides a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts. All chapters are written by experts in their fields and include the most up to date scientific and clinical information.

The incidence of primary and metastatic liver tumors is rising and the therapeutic armamentarium for these tumors is expanding at a rapid pace. Surgery remains the primary treatment modality for these tumors. With improvements in our perioperative management and operative techniques a larger proportion of patients are able to undergo potentially curative liver surgery. In addition, indications and criteria for liver transplantation for both primary and metastatic liver tumors are constantly expanding. Unfortunately, many patients are not amendable to surgical resection or liver transplantation and therefore alternative liver-directed therapies are routinely being implemented as part of complex multidisciplinary treatment models. However, these models are continually evolving as these regional therapeutic options continue to expand. New embolization agents and techniques, as well as, improvements in radiation delivery, are all evolving in the background of improvement in systemic and targeted therapy options for these tumors. This book provides a comprehensive, state-of-the art review of the current state of liver-directed therapy for malignant liver tumors. The book will serve as a valuable resource for not only surgeons and clinicians but for researchers with an interest in malignant liver tumors. The book focuses on the therapeutic approach to primary and metastatic tumors providing an up-to-date review on surgical liver anatomy and new imaging techniques as well as patient selection and technical consideration for resection and transplantation. In addition, the book provides new insight into novel and evolving therapies in the areas of transarterial therapy such as: (i) bland embolization, (ii) chemoembolization, and (iii) radioembolization; as well as new radiation techniques including SBRT and proton therapy. Furthermore, the expanding role of hepatic artery infusion therapy in primary malignant tumors is highlighted. Finally, integration of all these regional therapy options with upcoming and evolving systemic and targeted therapy regimens are integrated and discussed. This book will serve as a very useful resource for clinicians and researchers managing and treating patients with these challenging malignancies. It provides a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts. All chapters are written by experts in their fields and include the most up to date scientific and clinical information.

The incidence of primary and metastatic liver tumors is rising and the therapeutic armamentarium for these tumors is expanding at a rapid pace. Surgery remains the primary treatment modality for these tumors. With improvements in our perioperative management and operative techniques a larger proportion of patients are able to undergo potentially curative liver surgery. In addition, indications and criteria for liver transplantation for both primary and metastatic liver tumors are constantly expanding. Unfortunately, many patients are not amendable to surgical resection or liver transplantation and therefore alternative liver-directed therapies are routinely being implemented as part of complex multidisciplinary treatment models. However, these models are continually evolving as these regional therapeutic options continue to expand. New embolization agents and techniques, as well as, improvements in radiation delivery, are all evolving in the background of improvement in systemic and targeted therapy options for these tumors. This book provides a comprehensive, state-of-the art review of the current state of liver-directed therapy for malignant liver tumors. The book will serve as a valuable resource for not only surgeons and clinicians but for researchers with an interest in malignant liver tumors. The book focuses on the therapeutic approach to primary and metastatic tumors providing an up-to-date review on surgical liver anatomy and new imaging techniques as well as patient selection and technical consideration for resection and transplantation. In addition, the book provides new insight into novel and evolving therapies in the areas of transarterial therapy such as: (i) bland embolization, (ii) chemoembolization, and (iii) radioembolization; as well as new radiation techniques including SBRT and proton therapy. Furthermore, the expanding role of hepatic artery infusion therapy in primary malignant tumors is highlighted. Finally, integration of all these regional therapy options with upcoming and evolving systemic and targeted therapy regimens are integrated and discussed. This book will serve as a very useful resource for clinicians and researchers managing and treating patients with these challenging malignancies. It provides a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts. All chapters are written by experts in their fields and include the most up to date scientific and clinical information.

Liver-Directed Therapy for Primary and Metastatic Liver Tumors is a comprehensive examination of tumors of the liver. It provides a unique multi-modality approach to management of all types of primary and secondary liver tumors. The biology of liver cancers, state of the art radiologic imaging and novel, non-surgical interventional strategies are given. There is an in depth analysis of surgical options including transplantation, resection, interstitial ablation techniques and liver-directed chemotherapy for hepatocellular carcinoma, bile duct cancers, and colorectal and neuroendocrine liver metastases. Because of the unique and comprehensive examination of liver tumors, this work is an excellent resource for surgical, transplant and medical oncologists, surgeons, gastroenterologists, and radiologists.

One reason for failure to cure solid tumors by surgery appears to be the impossibility of controlling metastases that are present but latent at the time of operation. This failure is a common clinical experience with aggressive neoplasms. but it is not always appreciated in tumors with longer survival times. e. g .• breast and colon cancer. In addition. recent evidence indicates that after resection of a primary tumor micrometas tases from it might be enhanced by suppression of immune and reticu loendothelial functions of the host. Other factors, such as increase of coagulability and stress in the perioperative period, can also promote tumor growth. The development of new metastases might be facilitated by cells forced into the circulation during operative manipulations. Such events could be important for the outcome of treatment and it is suggested that preventive measures should be directed to this systemic component of solid tumors. Radical surgery can reduce the number of tumor cells to a subclinical 3 6 stage (10 to 10 cells) in which chemotherapy might be more effective than in advanced stages. Chemotherapy, on the other hand, might aggravate the surgical morbidity by influencing the wound healing pro cess, by decreasing the immune response, and/or by toxicity to the bone marrow and to the gastrointestinal tract, for example.

Primary and metastasizing malignant carcinoma of the liv er represent a challenge to both the diagnostician and the therapist. For this reason, it appears a worthwhile task to review the current status of knowledge about the treatment of primary and metastasizing tumors of the liver. The ques tion is whether modem diagnostic methods and new thera peutic concepts can help to improve the prospects of treat ment. Of particular interest is the role played by therapeu tic procedures directly involving the liver. Thus, it is equally important to discuss the pathophysiological and pharmacological bases for a modem therapy concept as it is to consider diagnostic issues and possible definitions of stages of progression. Therapeutic concepts comprise sys temic therapy and organ-related therapeutic methods, in cluding surgical resection, changes in the blood supply, re gional selective chemotherapy, and other localized or regional, highly specialized forms of therapy. This survey of the various possibilities in the field is meant too to stimulate further scientific research, given that methods of treatment are as yet by no means stan dardized, but are still in the stage of clinical research, where experimental models can find an application. The only well-established operative procedure is surgery on the isolated liver tumor. In this area, specialized techniques and various intraoperative procedures are discussed. There is a wealth of information available on all the top ics covered.