Radiofrequency ablation as a treatment for hilar cholangiocarcinoma

Abstract

AIM:To explore the role of radio-frequency ablation (RFA) as a treatment for hilar cholangiocarcinoma. M E T H O D S :E l e v e n p a t i e n t s w i t h o b s t r u c t i v e cholestasis underwent Computed Tomography (CT) examination, occupying lesions were observed in the hepatic hilar region in each patient. All lesions were confirmed as cholangioadenocarcinoma by biopsy and were classified as type Ⅲ or Ⅳ by percutaneous transhepatic cholangiography. Patients were treated with multiple electrodes RFA combined with other adjuvant therapy. The survival rate, change of CT attenuation coefficient of the tumor and tumor size were studied in these patients after RFA. RESULTS: In a follow-up CT scan one month after RFA, a size reduction of about 30% was observed in six masses, and two masses were reduced by about 20% in size, three of the eleven masses remained unchanged. In a follow-up CT scan 6 mo after RFA, all the masses were reduced in size (overall 35%), in which the most significant size reduction was 60%. The survival follow-up among these eleven cases was 18 mo in average. Ongoing follow-up showed that the longest survival case was 30 mo and the shortest case was 10 mo. CONCLUSION: RFA is a microinvasive and effective treatment for hilar cholangiocarcinoma.

Irreversible Electroporation Ablation: Is All the Damage Nonthermal?

“…This is especially true for IRE application at higher voltages and pulse numbers, where some have reported tissue changes resembling the "white zone" (28) thermal coagulation seen with radiofrequency and other forms of thermal ablation (29). Given the fact that the M inimally invasive percutaneous (1-3) thermal tumor ablation is now an established treatment option for focal solid tumors in the liver (4-6), kidney (7), bone (8), and lung (9), with ever-expanding indications for focal tumors in additional locations (10)(11)(12). Yet improvements are necessary as treatment efficacy decreases for larger tumors (3-5 cm) (13).…”

Radiofrequency ablation in metastatic melanoma

“…Unintended thermal injuries to the bile ducts, gall bladder, adrenal gland, diaphragmatic crus, and liver have all been described in the literature. The proximity of surrounding vital structures and the potential for immediate and late injury should be considered in every case .…”

Thermal Ablation

“…We have shown in our previously published studies a wide range of thermal sensitivity among tissues subject to RF ablation [11], and that the classic equations used for hyperthermia applications, like CEM 43 may not be as useful for much higher temperature ranges observed during thermal ablations [12]. Particularly, in that recent study performed with a single cooled tip RF electrode, the thermal dosimetry (as measured by [AUC]) was not constant, but both current-dependent and distance-dependent.…”

“…In many cases, these techniques allow one to avoid major surgery, that otherwise would have been required for removal of malignancy or enable treatment for non-surgical candidates [2,3]. Owing to advancements in both imaging modalities used for visualization and percutaneous devices used for delivery of energy into tumor tissue, these techniques have established themselves as viable treatment options for eradication of solid tumors in locations such as the liver [4,5,6], kidney [7], bone [8], lung [9], with ever expanding utility to additional locations including head and neck [10], adrenals, prostate and others [11,12]. …”