Radiofrequency Ablation in 447 Complex Unresectable Liver Tumors: Lessons Learned

Bleicher, Richard J.; Allegra, David; Nora, Dean T.; Wood, Tabitha E.; Foshag, Leland J.; Bilchik, Anton J.

doi:10.1245/aso.2003.03.018

Cited by 261 publications

(151 citation statements)

References 12 publications

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“…Although the approach of RFA was not shown to influence survival, there was a trend towards a higher rate of recurrence with percutaneous RFA (PcRFA) (15.1%) compared to open (6.7%) and laparoscopy (9%) in a study by Bleicher et al of 153 patients treated for a total of 447 liver tumours [8]. In addition, several studies had consistently reported significantly higher complication rates with PcRFA relative to operative approaches [9,10]. Despite the perceived technical simplicity with PcRFA, the cooperation of patients' respiratory effort following sedation poses difficulty in accurate probe placement [11].…”

Section: Delivery Of Rfamentioning

confidence: 99%

“…As early as 1996, incorporation of neoadjuvant systemic chemotherapy into treating initially unresectable CLMs has expanded curability with sequential surgical resection [36]. Most centres have, therefore, adopted an aggressive multimodal approach in treating CLMs; offering surgical resection alone or in combination with thermal ablation provided complete tumor extirpation can be achieved with sufficient functional post-operative hepatic parenchyma [9][10][11]15,17,20,23,[25][26][27]31,[35][36][37][38][39][40][41][42][43][44]. How RFA fits into the expanded unresectable criteria today is unclear.…”

Section: Overall Survivalmentioning

confidence: 99%

“…Treatment failure as depicted by local recurrence following any form of ablative therapy remains a concern. A wide range of local recurrence rates at RFA-treated sites had been reported, from as low as 2% up to 60% [9,[11][12][13][14][15]17,19,[23][24][25][26][27][28][29]32,35,[37][38][39]42,43,45,46]. The majority of these were diagnosed within the first 12 months post-RFA, with virtually none observed after 18 months [24,26,43].…”

Section: Disease Recurrencementioning

confidence: 99%

“…Similarly, another study demonstrated a trend towards higher local recurrence rate of 22.2% in CLM patients with post-ablation margin of less than 0.4 cm [48]. Therefore, a circumferential rim of 0.5 to 1.0 cm of ablation is required for best tumour control [9,35].…”

Section: Tumour Marginmentioning

confidence: 99%

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Resection and Ablation for Colorectal Liver Metastases

Ng¹

2013

J Gastrointest Dig Syst

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The surgical approach combining resection and ablation allows for a greater number of patients with colorectal liver metastases who would otherwise be considered to have unresectable disease to be given an opportunity to undergo a curative attempt surgery. Ablation results in local destruction of tumour and is often employed in lesions that are in locations which are not easily resectable. This may involve the use of radiofrequency ablation that causes thermal destruction or cryotherapy that freezes tumours. This review examined the literature reporting resection and ablation of colorectal liver metastases.

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Section: Delivery Of Rfamentioning

confidence: 99%

Section: Overall Survivalmentioning

confidence: 99%

Section: Disease Recurrencementioning

confidence: 99%

Section: Tumour Marginmentioning

confidence: 99%

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Resection and Ablation for Colorectal Liver Metastases

Ng¹

2013

J Gastrointest Dig Syst

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“…Another tool in the arsenal of cancer therapy is radiofrequency (RF) ablation. RF ablation is a safe and effective technique to destroy focal cancer lesions in a variety of locations, including the liver, bone, and kidney (1)(2)(3). Clinical research is currently under way in cancers in the lung, breast, and adrenal gland as well (4)(5)(6).…”

mentioning

confidence: 99%

Radiofrequency Ablation in a Previously Irradiated Liver

Friedman

Altemus

Wood

2003

Journal of Vascular and Interventional Radiology

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A patient with renal cell carcinoma underwent external-beam radiation therapy (XRT) to treat a painful chest-wall metastasis. One month later, she underwent radiofrequency (RF) ablation of two metastatic deposits within the liver; one of the target lesions was in the recent irradiation zone and the other was outside of the radiation field. RF ablation within the irradiated liver produced a slightly larger ablation zone with prominent needle tract scarring, and required less energy input than treatment in the unirradiated liver. RF ablation and XRT may interact, possibly producing a synergistic effect. Further study of the potentially adjunctive relationship between these two modalities is warranted.Current treatment strategies for liver cancer frequently rely on a combination of modalities, including chemotherapy, radiation therapy, and surgery. This multifaceted approach may be more effective than any single therapy. Another tool in the arsenal of cancer therapy is radiofrequency (RF) ablation. RF ablation is a safe and effective technique to destroy focal cancer lesions in a variety of locations, including the liver, bone, and kidney (1-3). Clinical research is currently under way in cancers in the lung, breast, and adrenal gland as well (4-6). RF ablation also has the potential for synergism with traditional cancer treatments, as RF ablation and liposomal chemotherapy have been shown to considerably enhance ablation volumes (7). Although the additive effects of hyperthermia and radiation have been studied at low temperatures (40°C-44°C), there are few data about radiation and the high temperatures of RF ablation (60°C-100°C) (8). Herein we present a case in which the effects of externalbeam radiation treatment (XRT) in combination with RF ablation may account for treatment differences seen with RF ablation of liver metastases. The potential synergism between RF ablation and radiation therapy for local control warrants further investigation. CASE REPORTIn 1969, a 42-year-old woman presented with hematuria secondary to renal-cell carcinoma. She underwent right nephrectomy and XRT to the renal bed; there was no evidence of metastatic disease at that time. Twenty-seven years later, the woman, now 69 years of age, developed biopsy-proven metastases to the pelvis and liver. She was treated with abdominal resection of the pelvic mass followed by XRT, RF ablation of the liver lesion, and administration of interleukin-2, with good response. The following month, the patient developed a painful metastasis to the right chest wall, which was successfully treated with 2,100 cGy of radiation. On this hospital admission, the patient presented with two liver metastases and was referred for RF treatment. There was a 0.9-cm (transverse) by 0.8-cm (anteroposterior) lesion in the anterior section of the left lobe, and a 0.9-cm (transverse) by 0.8-cm (anteroposterior) in the posterior aspect of the right lobe. The region of the posterior

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Radiofrequency Ablation of Liver Tumors

Sutherland

Williams²,

Padbury³

et al. 2006

Arch Surg

246

128

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Objectives: To systematically review radiofrequency ablation (RFA) for treating liver tumors. Data Sources: Databases were searched in July 2003. Study Selection: Studies comparing RFA with other therapies for hepatocellular carcinoma (HCC) and colorectal liver metastases (CLM) plus selected case series for CLM. Data Extraction: One researcher used standardized data extraction tables developed before the study, and these were checked by a second researcher. Data Synthesis: For HCC, 13 comparative studies were included, 4 of which were randomized, controlled trials. For CLM, 13 studies were included, 2 of which were nonrandomized comparative studies and 11 that were case series. There did not seem to be any distinct differences in the complication rates between RFA and any of the other procedures for treatment of HCC. The local recurrence rate at 2 years showed a statistically significant benefit for

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Radiofrequency Ablation in 447 Complex Unresectable Liver Tumors: Lessons Learned

Cited by 261 publications

References 12 publications

Resection and Ablation for Colorectal Liver Metastases

Resection and Ablation for Colorectal Liver Metastases

Radiofrequency Ablation in a Previously Irradiated Liver

Radiofrequency Ablation of Liver Tumors

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