Dr. Fong is the Medical Director of the USC Liver Transplant Program and Associate Professor of Medicine at the USC Keck School of Medicine. He obtained his medical degree from the University of Southern California and completed his residency in Internal Medicine at Los Angeles County-USC Medical Center. He is board certified in Internal Medicine and the subspecialty of Gastroenterology.
Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
What is proton beam therapy and for what is it
used?
Proton beam therapy is a form of radiation that can be used for the treatment
of various solid tumors, including liver cancer (Hepatocellular Carcinoma, HCC).
This technique is able to deliver high doses of radiation to a defined local area. The ideal
HCC patient for this treatment has only a small (<5 cm) solitary lesion
(tumor).
How is proton beam therapy done?
To have this procedure done, the patient actually is fitted with a body cast
so that he or she can be placed in the identical position for each session.
Therapy is conducted daily for 15 days.
How effective is this therapy in treating liver cancer?
There are not much data yet regarding the efficacy of this treatment in liver
cancer. Preliminary data from the U.S. suggest similar effectiveness as seen
with TACE (chemoembolization) or ablation (radiofrequency or alcohol) for the
treatment of HCC. It is not known, however, whether this type of radiation
treatment prolongs the life of the patient.
REFERENCES: Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW.
Guidelines for resection of colorectal cancer liver metastases.
Gut. 2006 Aug;55 Suppl 3:iii1-8.
Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D.
Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies.
J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.
Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases.
Management of hepatocellular carcinoma.
Hepatology. 2005 Nov;42(5):1208-36.
Medically Reviewed by Paul Oneill, MD,
Board Certified Oncology
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
When do surgeons do radiofrequency ablation (RFA)?
In the U.S., radiofrequency ablation (RFA) therapy has become the ablation (tissue destruction) therapy
of choice among surgeons for treating liver cancer (HCC). The surgeon can
perform this procedure laparoscopically (through small holes in the abdomen) or
during open exploration of the abdomen. In some instances, the procedure can be
done without opening the abdomen by just using ultrasound for visual
guidance.
How is RFA done and how does it
work?
In RFA, heat is generated locally by a high frequency, alternating current
that flows from the electrodes. A probe is inserted into the center of the tumor
and the non-insulated electrodes, which are shaped like prongs, are projected
into the tumor. The local heat that is generated melts the tissue (coagulative
necrosis) that is adjacent to the probe. The probe is left in place for about 10
to 15 minutes. The whole procedur...
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