Radiofrequency Ablation of Intrahepatic Cholangiocarcinoma: Preliminary Experience

Abstract

The purpose of this study was to evaluate the safety and efficacy of percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) in patients with intrahepatic cholangiocarcinoma (ICCA) in a small, nonrandomized series. From February 2004 to July 2008, six patients (four men and two women; mean age 69.8 years [range 48 to 83]) with ICCA underwent percutaneous US-guided RFA. Preintervetional transarterial embolization was performed in two cases to decrease heat dispersion during RFA in order to increase the area of ablation. The efficacy of RFA was evaluated using contrast-enhanced dynamic computed tomography (CT) 1 month after treatment and then every 3 months thereafter. Nine RFA sessions were performed for six solid hepatic tumors in six patients. The duration of follow-up ranged from 13 to 21 months (mean 17.5). Posttreatment CT showed total necrosis in four of six tumors after one or two RFA sessions. Residual tumor was observed in two patients with larger tumors (5 and 5.8 cm in diameter). All patients tolerated the procedure, and there with no major complications. Only 1 patient developed post-RFA syndrome (pain, fever, malaise, and leukocytosis), which resolved with oral administration of acetaminophen. Percutaneous RFA is a safe and effective treatment for patients with hepatic tumors: It is ideally suited for those who are not eligible for surgery. Long-term follow-up data regarding local and systemic recurrence and survival are still needed.

Percutaneous ultrasound-guided thermal ablation for intrahepatic cholangiocarcinoma

“…Owing to restricted resources of liver donors and poor prognosis after liver transplantation, transplantation for ICC remains a controversial area. Furthermore, there are not standard chemotherapeutic protocols for ICC [24].…”

“…A 78-year-old man with a solitary ICC was successfully treated by RFA and remained free of disease after a follow-up of 24 months. Since then, thermal ablation has been increasingly applied in treating ICC, including both RFA and MWA [7,24,[28][29][30]. The complete ablation rates for ICC,5 cm were 88-97% [7,29].…”

Ablative therapies for intrahepatic cholangiocarcinoma

“…However, Giorgio et al reported that it is difficult to achieve complete ablation during the 1st session when the tumor size exceeds 4 cm, while complete ablation was always achieved for smaller nodules equal to or less than 3.4 cm (16). In multivariate analyses in previous studies, tumor size was identified as the main factor predicting the initial effectiveness of RFA, as well as the survival outcomes after RFA (13,19).…”

“…However, the local tumor progression rate after RFA was relatively high, ranging from 8% to 50% (12)(13)(14)(15)17,19,20), and the pooled rate in a meta-analysis was reported to be 21% (95% CI, 13-30%) (11). The rate of major complication observed after RFA was 8% in the evaluable population, as shown in Table 1.…”

“…Therefore, in most previous studies, the efficacies of ablation therapies were mainly investigated among patients with unresectable ICC or recurrent ICC after surgery (12)(13)(14)(15)(16)(17)(18)(19)(20)(21) only used in limited cases. RFA is usually performed under ultrasound guidance, and sufficient ablative margins of at least 0.5 to 1.0 cm surrounding tumors are required to secure the complete ablation of tumor nodules.…”