Feasibility, safety, and long-term efficacy of stereotactic radiofrequency ablation for tumors adjacent to the diaphragm in the hepatic dome: a case-control study

Abstract

Objectives Achievement of adequate treatment margins may be challenging when the target is either difficult to visualize, awkward to access, or situated adjacent to vulnerable structures. Treatment of tumors located close to the diaphragm in the hepatic dome is challenging for percutaneous radiofrequency (RF) ablation for these reasons. The purpose was to assess the feasibility, safety, and clinical outcome of multi-probe stereotactic RF ablation (SRFA) of liver tumors in the subdiaphragmatic area. Methods Between 2006 and 2018, 177 patients (82 HCCs, 6 ICCs, and 89 metastatic tumors) underwent SRFA of 238 tumors abutting the diaphragm in the hepatic dome. For comparison, 177 patients were randomly selected from our database by the R package "MatchIt" for propensity score matching to compare treatment safety and efficacy in this retrospective, single-center study. Results Median treated tumor size was 2.2 cm (range 0.5 to 10 cm). SRFA was primarily successful for 232/238 (97.5%) tumors. Five tumors were successfully retreated, resulting in a secondary technical efficacy rate of 99.6%. Local tumor recurrence developed in 21 of 238 tumors (8.8%). The major ablation complication rate was 10.7% (22 of 204). Twelve (55%) of 22 major complications could be successfully treated by the interventional radiologist in the same anesthesia session. There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls. Conclusions SRFA is a safe and feasible option in the management of difficult-to-treat tumors abutting the diaphragm in the hepatic dome, with similar safety profile compared with matched controls. Key Points • RFA was primarily successful for 232/238 (97.5%) subdiaphragmatic dome tumors. Local tumor recurrence developed in 21 of 238 tumors (8.8%). • The major complication rate directly related to ablation of the hepatic dome tumors was 10.7% (22 of 204). 12/22 (55%) of major complications could be successfully treated in the same anesthesia session. • There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls.

Stereotactic Image-Guided Microwave Ablation for Malignant Liver Tumors—A Multivariable Accuracy and Efficacy Analysis

“…First clinical reports on stereotactic percutaneous ablation of liver tumors are available (22)(23)(24)(25), as well as several comparative studies highlighting the accuracy and efficiency of using navigation technology vs. conventional image guidance for tumor targeting (26,27). While little is known about factors influencing targeting accuracy and therapeutic efficacy when using such navigation systems for stereotactic tumor targeting, they likely facilitate accessibility and treatment of traditionally difficult to target liver tumors (28). Our group has previously reported the benefits of using stereotactic imageguided microwave ablation (SMWA) in the treatment of HCC (29).…”

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumours - A Systematic Review and Meta-Analysis

“…All of the 34 included works were single-centre studies, of which 26 were retrospective studies (29,30,(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)31,(49)(50)(51)(52)(53)(54)(32)(33)(34)(35)(36)(37)(38), 3 prospective case series(55-57), 3 prospective cohort studies(58-60) and 2 randomised controlled trials (61,62). Two studies reported results using a laparoscopic treatment access (44,55), the other 32 reporting on thermal ablations using a percutaneous approach.…”

“…Four propensity score matched analyses compared stereotactic thermal ablation for different subtypes of patients or lesions. Stereotactic RFA yielded similar safety and treatment e cacy outcomes when comparing CT 'invisible' tumours ablated with MR image fusion to CT visible tumours (30), octogenarians to a younger study population (36), lesions in a subphrenic location to non-dome locations (39) and HCC in a subcardiac position to a non-subcardiac location (40).…”

Primary efficacy of percutaneous microwave ablation of malignant liver tumors: comparison of stereotactic and conventional manual guidance

“…To achieve the most accurate probe position, navigation systems can be a helpful tool 7 – 13 . An accurate placement of the probe is a precondition for a high primary efficacy.…”