Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial

Abstract

The aim of this study was to evaluate feasibility, safety, and effectiveness of radio-frequency (RF) thermal ablation, performed by using a cooled-tip electrode needle, in the treatment of liver metastases. Twenty-nine patients (20 males and 9 females; age range 43-77 years) with one to four hepatic metastases 1.1-4.8 cm in diameter (mean 2.9 +/- 0.8 cm) from previously resected intra-abdominal primary malignancies were treated. All patients were excluded from surgery and had partial or no response to chemotherapy. Radio-frequency ablation was performed by using a 100-W generator and 17-gauge, dual-lumen, cooled-tip electrode needles with a 2- to 3-cm exposed tip. Exposure time was 12 min for each needle insertion. Findings at spiral CT were used to assess the therapeutic response. A total of 127 insertions were performed (mean 2.4 +/- 1.7 insertions/lesion) during 84 treatment sessions (mean 1.6 +/- 0.7 sessions/lesion) in absence of major complications. Complete tumor response (i. e., unenhancing area of thermal necrosis larger than the treated tumor) was seen in 41 (77 %) of 53 lesions, including 33 (87 %) of 38 lesions 3 cm or less in diameter. After a mean follow-up period of 6.5 +/- 2.1 months (range 3-9 months), recurrence of the treated lesion was seen in 5 (12 %) of the 41 cases. New metastatic lesions appeared in 7 patients. Two patients died after 6 and 8 months, respectively. Of the 27 patients still in follow-up, 14 are currently free of disease. Radio-frequency thermal ablation with a cooled-tip electrode needle is a safe and effective local treatment for hepatic metastases 3 cm or less in greatest dimension.

Radiofrequency Ablation of Malignant Liver Tumors

“…The use of radiofrequency (RF) energy to produce thermal tissue destruction has been the focus of increasing research and practice for the past several years [16][17][18][19]. During the application of RF energy, a high frequency alternating current moves from the tip of an electrode into the tissue surrounding that electrode.…”

Liver tumor ablation: Percutaneous and open approaches

“…[192,205,206] 1998 CS 9 patients Lap CSA is safe and feasible CRLM, colorectal liver metastasis; CSA, cryosurgical ablation; CS, case series; nRCT, non-randomized controlled trial. [214] 234 CS L 18.4% actual 5-year survival Sorensen et al [215] 102 CS P 44% OS at 5-year Aloia et al [190] 30 CS P, O 27% 5-year OS Jakobs et al [216] 68 CS P 68% OS at 3-year Pereira et al [195] 177 CS P 55% 5-year OS Berber et al [217] 135 CS L Median OS 28.9 months; CEA level, size and number of lesions are predictors of OS Abdalla et al [178] 57 CS O 37% 3-year OS Lencioni et al [193,194] 423 CS P 24% 5-year cumulative OS; 56% 5-year OS in patients with single lesion 2.5 cm size Gillams et al [196] 167 CS P 30% 5-year OS in patients with 5 metastases, 5 cm max size and no extra-hepatic disease Solbiati et al [218] 117 CS P 67/117 AWD after 28 months; 46% 3-year OS Gillams et al [219] 69 CS P 34% OS at 3-year Lencioni et al [207] 29 CS P 93% OS at 1-year Solbiati et al [208,220] …”

“…Table VI documents the outcomes of studies [184,192,[203][204][205][206] metastatic disease in patients not suitable for hepatic resection, and reported successful local tumor control [207][208][209][210]. Recently, data on long-term survival of nonsurgical patients with hepatic colorectal metastases treated with RFA have become available.…”

“…A recent retrospective study compared hepatic resection with RFA for solitary CRLM [212]. Table VII illustrates the outcomes of studies [178,190,[193][194][195][196]207,208,[213][214][215][216][217][218][219][220] evaluating RFA for CRLM.…”

Morphologic and Functional Changes in Nontumorous Liver Tissue After Radiofrequency Ablation in an In Vivo Model: Comparison of 18F-FDG PET/CT, MRI, Ultrasound, and CT

“…After a sterile field had been prepared, radiofrequency ablation was performed under CT guidance with the Cool-tip system (Radionics), comprising a dual-lumen, internally cooled electrode to prevent tissue charring (20). The electrode is cooled internally by continuous perfusion of the lumen with cooled saline.…”