Hospital of Hope Alhambra Facility Is Among Pioneers in Liver Cancer Cryosurgery

Hospital of hope: Alhambra facility is among

Pioneers in liver cancer cryosurgery

Los Angeles Times

Author:

STEVEN K. WAGNER

Section:

San Gabriel Valley

Text Word Count:

1964

Hsien T. Meng was out of options. Told a year ago that he had terminal liver cancer, he had little choice but to take matters into his own hands.

Meng, 75, a resident of Taiwan, had read that doctors at tiny Alhambra Hospital were successfully using an innovative technique to freeze and destroy malignant tumors. Hoping they might be able to help him, he contacted the hospital.

But Meng was told that the doctors were performing the procedure only on prostate cancer patients. They told him that using the procedure, called cryosurgery, to treat liver cancer was riskier than using it on prostate cancer patients.

Nonetheless, Meng flew from his home in Taiwan to plead his case. Touched by his persistence and his willingness to be their first liver patient, doctors agreed to help him.

"I told him we had no intention of doing cryosurgery on the liver at that time," said Dr. Wilson S. Wong, the radiologist who eventually performed the procedure July 22. "But he flew out anyway, so we decided to try it."

Today, Meng shows no signs of cancer, Wong says.

Meanwhile, Alhambra Hospital's Cryosurgical Center of Southern California is forging ahead. Less than a year after adapting its prostate cancer procedure to liver cancer patients, the hospital has emerged as a national leader of the cryosurgical treatment of hepatomas, or primary liver cancer-one of the deadliest of all malignancies and a disease that disproportionately afflicts Chinese.

"Our success has surpassed my best expectations," Wong said. "We had thought the liver would be secondary to prostate, but our work with liver cancer has really taken off."

Cryotherapy-the use of extreme cold-is not new as a cancer treatment. It dates to the 1850s, when iced saline solutions were applied to advanced carcinomas of the breast and cervix.

Cryosurgery-the use of probes to freeze tissue-entered the medical picture in 1961 with the development of crude technology that froze tissue using liquid nitrogen. However, the lack of effective medical imaging devices and the inability of doctors to prevent the destruction of adjacent healthy cells made cryosurgery on internal organs unrealistic.

That changed in 1985 when Dr. Gary Onik, then a radiologist at New England Deaconess Hospital in Boston, combined ultrasound imaging with advanced cryosurgical techniques to perform the first liver cryosurgery.

In concept, modern cryosurgery is simple. Guided by high-resolution ultrasound, physicians insert probes containing liquid nitrogen through small incisions in the liver or prostate gland. The probes are positioned to make contact with the tumor tissue, freezing it at temperatures colder than minus 328 degrees Fahrenheit and eventually killing it.

As with any surgery, cryosurgery can have drawbacks. Dr. Ronald Busuttil, director of the Dumont-UCLA Transplant Center, said the procedure is still considered experimental.

"It has no real long-term track record," he said of liver cryosurgery, which presents a risk of possible complications that include bleeding, infection, stroke, liver failure and even death. "Not all the data is in yet. It has to be treated like any other new (procedure)."

Nonetheless, Busuttil expressed cautious optimism about liver cryosurgery.

"I think it has some appeal because it doesn't involve a resection," he said, referring to conventional surgery to remove tumors. "For metastatic cancer, the results seem to be somewhat encouraging."

Only patients whose cancer originated in the liver or metastasized to the liver from the colon are candidates for liver cryosurgery. To minimize the risks, doctors often freeze only a portion of large tumors, returning later to refreeze the remaining malignancy or to infuse it with alcohol.

While attending a national medical conference in December, 1992, Wong was introduced to the cryosurgical probe system. The hospital purchased the system in March, establishing itself as the 14th cryosurgical center in the world and one of the few centers based at a small hospital.

Why did Alhambra Hospital, a 144-bed facility in the heart of the San Gabriel Valley, decide to enter such a specialized arena as liver cryosurgery?

Though Wong and his team first used the system on prostate cancer patients, the move to include liver cancer was a natural one. After all, primary liver cancer-cancer that originates in the liver rather than spreading to that organ-afflicts far more Chinese than almost any other nationality, primarily because of the high incidence of hepatitis among the population.

In Taiwan, 173 out of 100,000 people developed hepatomas in 1992, according to Wong. In China, the figure was 40 out of 100,000. In the United States, by contrast, the number was less than 1 in 100,000.

Alhambra's population includes a high concentration of Chinese and other residents of Asian ancestry. The city is 26% Chinese, according to the 1990 U.S. Census.

According to Onik, who is now a professor of neurosurgery at the Medical College of Pennsylvania, Alhambra Hospital is the only facility in the United States that specializes in cryosurgery to treat primary liver cancer.

"Part of the uniqueness of our situation is our Chinese affiliation and the fact that (primary liver cancer) is so rampant in the Chinese community," Wong said, adding that roughly one-third of the hospital's patients and one-fourth of its doctors are Chinese. "The hospital is geared toward meeting the community's unique ethnic needs-the tie-in is remarkable. Chinese patients feel more comfortable coming here."

So far, Wong and his cryosurgical team have performed more than 50 prostate and six liver procedures. All the patients appear to be recovering from their cancers, he said.

"I think we've been successful in killing the majority of the cancers," Wong said of the liver patients, four of whom were Chinese suffering from primary liver cancer. "I think they'll do much better than they otherwise would have. In terms of long-term prognosis, we don't know. Our program is too new."

Dar-Kwei Teng, 72, a Chinese immigrant who lives in Oakland, underwent cryosurgery at Alhambra Hospital on Nov. 1. During the procedure, performed less than six months after Teng underwent conventional liver resection, Wong destroyed two small liver tumors.

"Cryosurgery was much easier," Teng said. "There was much less bleeding, and the recovery wasn't as difficult."

More important, cryosurgery destroyed one tumor that doctors said was inoperable.

"It saved my life," Teng said.

[Illustration]

PHOTO: Dr. Wilson Wong, Alhambra radiologist, with hospital's innovative machine used to freeze cancer cells. / STEVEN K. WAGNER / For The Times; PHOTO: Wong with probe used in cryosurgery procedure to kill cancer.