Percutaneous radiofrequency ablation of adrenal metastases from hepatocellular carcinoma: a single-center experience

Abstract

Background The prognosis of adrenal metastases (AM) from hepatocellular carcinoma (HCC) with surgical contraindication was poor. This study evaluated the feasibility, safety and treatment efficacy of percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for the local treatment of AM originated from HCC. Methods A retrospective study was carried out on 22 patients (21 male and 1 female, mean age, 53.0 ± 13.0 years) who had single AM (mean diameter, 4.0 ± 1.8 cm, range, 1.7–8.0 cm) originated from HCC and received US-guided percutaneous RFA at our institution. The diagnosis was established on typical radiologic findings. The primary technical success was defined as the tumour being completely ablated in the first RFA session. The secondary technical success was defined as tumour residual left from the first ablation was completely ablated by a second ablation session. Local tumour progression (LTP) and overall survival (OS) were estimated by using Kaplan-Meier analysis. Results A total of 25 ablation sessions were performed. The primary technical success and the secondary technical success were 77.3% (17 of 22) and 86.4% (19 of 22), respectively, with the major complication rate at 4.5% (1 of 22). The median follow-up period after RFA was 10 months (3–55 months). During the follow-up period, five patients were detected LTP. The LTP at 3, 6, and 12 months were 15.8, 26.3, and 26.3%, respectively. Nine patients died of distant extra-adrenal metastases and another five of liver failure due to HCC. The OS at 6, 12, 24 months after RFA for AM were at 79.7, 52.6, and 32.9%, respectively. Conclusion Percutaneous US-guided RFA in the treatment of AM originated from HCC is feasible, safe and effective.

Survival After Adrenalectomy for Metastatic Hepatocellular Carcinoma: A 25‐year Institutional Experience

“…Currently, there are no definitive guidelines of how to treat adrenal metastases originating from HCC [11]. Potential treatment options are surgery, local ablative treatment (transcatheter arterial chemoembolization (TACE), percutaneous radiofrequency ablation, percutaneous ethanol injection therapy (PEIT) or radiotherapy) and systemic treatment (sorafenib), which should be chosen according to the overall condition of the individual patient concerned [11,13,19,20,[22][23][24]. Adrenalectomy was shown to be associated with significantly longer survival, compared to other treatment options [11].…”

Percutaneous Adrenal Radiofrequency Ablation: A Short Review for Endocrinologists

“…Major complications requiring hospital stay or intervention are not common, ranging from 0% to 8.3% (median, 1.5%) [11][12][13][14][15][16][17][18]. Hypertensive crisis is the most common complication during the procedure and rapid increases in BP may complicate cerebrovascular and cardiovascular diseases ( Fig.…”

“…RFA outcomes for treating adrenal metastasis are not as good as those for benign adrenal tumors ( Table 2 ) [ 12 , 13 , 18 , 21 ]. The local control rate ranges from 77% to 80% (median, 78%).…”

“…The local control rate ranges from 77% to 80% (median, 78%). These treatment outcomes may depend on metastatic tumor size, which is larger, ranging from 3.3 to 4.0 cm ( Table 2 ) [ 12 , 13 , 18 , 21 , 22 ]. Because cryoablation or microwave ablation can create a larger ablation area, these modalities should be considered for treating adrenal masses 3 cm or larger.…”

“…Percutaneous thermal ablation is a minimally invasive treatment for liver [1,2], kidney [3,4], lung [5,6], bone [7,8], and thyroid [9,10] tumors in patients who are unable to undergo surgery. This treatment also has been used to treat adrenal tumors in patients who are poor surgical candidates [11][12][13][14][15][16][17][18][19][20][21][22][23]. Thermal ablation techniques for adrenal ablation include radiofrequency ablation (RFA), cryoablation [24,25], and microwave ablation [26,27].…”