Article Outline

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This 200-page, hard-bound monograph is the latest contribution to Cambridge's Contemporary Issues in Cancer Imaging series. Each disease-specific volume brings together a multidisciplinary group of experts with the goals of educating diagnostic radiologists about current practice in tumor diagnosis, staging, and therapeutics, while updating treating physicians about the applications and limitations of recent advances in imaging science and technology.

Interventional oncology, the discipline of minimally invasive, image-guided targeted treatment of solid malignancies, has emerged as the “fourth house” of cancer care alongside medical, surgical, and radiation oncology. Nowhere is this more evident than in treatment of hepatic malignancies, which is the focus of this volume. Multidisciplinary liver tumor management teams must now integrate image-guided therapies such as ablation and embolotherapy with operative and systemic therapies to customize optimal care for each patient at various stages in the course of their disease.

The introductory chapter provides a broad overview of epidemiology, diagnosis, screening, staging, and a summary of each of the treatment options for hepatocellular carcinoma and colorectal liver metastases. This is supplemented by separate chapters on pathology and operative therapy, although the surgery chapter is displaced to the middle of the book. The third chapter covers diagnostic imaging of liver tumors, including contrast-enhanced ultrasound, computed tomography, and magnetic resonance imaging, with an emphasis on technical factors critical to accurate detection and characterization of liver nodules. The latter portion of this chapter covers imaging after thermal ablation and the challenges in characterizing residual or recurrent disease. Absent is coverage of tumor response assessment after image-guided therapies (including following the more commonly employed embolotherapies, which appear quite differently from ablated lesions), which defy the National Cancer Institute Response Evaluation Criteria in Solid Tumors or World Health Organization criteria.

A single chapter covers chemoembolization of primary and metastatic colorectal and neuroendocrine liver tumors. Y-90 radioembolization is not covered, although it has been in clinical use for several years; additionally, the topic of emerging technologies such as drug-eluting beads is not covered. The remaining 6 chapters cover the science, technology, techniques, and outcomes of various ablative modalities including radiofrequency, cryotherapy, high-intensity focused ultrasound, and percutaneous ethanol injection. Microwave and laser technologies and combinations of ablation with other therapies are not addressed. All authors are internationally recognized experts with unexcelled depth of experience.

Radiographic images and other figures are of high quality, and the color insert is very helpful for illuminating the histopathology and functional imaging illustrations. There is a detailed index.

Bottom Line: Cancer therapists and radiologists will find this monograph useful for an overview of ablative strategies. Because a majority of patients with hepatic malignancies present with tumor burdens in excess of what can be managed by ablative techniques alone, readers will want to utilize larger interventional oncology texts for a comprehensive understanding of the integration of all image-guided, systemic, and operative therapies.