Treatment outcomes of percutaneous radiofrequency ablation versus adrenalectomy for adrenal metastases: a retrospective comparative study

Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future

“…Thermal ablation of the adrenal gland may overcome some surgery associated challenges. This percutaneous and minimally invasive technique offers the potential for fast and effective therapy to disrupt adrenal tumours while reducing patient discomfort, cost and hospitalised days [ 48 ▪▪ ]. Its indications are additionally broadened to those unwilling or unfit for adrenalectomy due to co-morbidity [ 49 ].…”

“…Its indications are additionally broadened to those unwilling or unfit for adrenalectomy due to co-morbidity [ 49 ]. It is in this regard that thermal therapy has been trialed amongst small cohorts as a (i) minimally invasive alternative to definitive management of benign adrenal adenomas [ 39 , 50 – 56 ], (ii) adrenal metastases in patients unsuitable for surgery and [ 3 , 10 , 48 ▪▪ , 57 – 59 ] (iii) for local management of metastatic adrenal cancers [ 60 ▪▪ , 61 ▪▪ , 62 , 63 ▪▪ ].…”

“…These studies have documented short and intermediate term outcomes for unilateral aldosterone producing adenomas (APA) [ 8 , 39 , 50 , 53 , 55 , 56 ], cortisol secreting adenoma [ 51 – 53 ], Adrenocorticotropic Hormone-dependent Cushing's disease [ 53 , 56 ], adrenal metastases and pheochromocytoma [ 60 ▪▪ , 61 ▪▪ , 62 , 63 ▪▪ ]. The approach to ablation has not been consistent across all studies and definitions of clinical response to therapy vary in accordance with underlying pathology [ 30 – 47 , 48 ▪▪ ]. For malignancy and metastasis to the adrenal, success is determined by change in tumour characteristics on imaging, specifically (i) tumour-size reduction, (ii) absence of local tumour progression or (iii) progression/recurrence-free survival [ 11 , 48 ▪▪ , 51 , 57 , 58 , 63 ▪▪ , 64 ].…”

“…For metastases to the adrenal gland, both MWA and RFA have demonstrated high efficacy of tumour ablation, demonstrating postprocedural presence of residual tumour in fewer than 25%, with similarly low recurrence rates (<25%). Overall survival rates have not been evaluated due to the lack of a comparator and the heterogeneity of the underlying primary malignancy in these studies [ 3 , 48 ▪▪ , 57 , 58 , 64 , 68 ].…”

“…These findings have been borne out in human studies where HTC is demonstrated in as high as 57% of individuals undergoing ablation [ 57 ]. HTC is frequently accompanied by ventricular arrhythmia in the setting of catecholamine excess [ 48 ▪▪ ]. In studies using preprocedural alpha adrenergic blockade, rates of HTC are reduced significantly for ablation of adrenocortical lesions (Table 2 ) [ 63 ▪▪ ].…”