Unresectable Adrenal Metastases: Clinical Outcomes of Radiofrequency Ablation

Hasegawa, Takaaki; Yamakado, Koichiro; Nakatsuka, Atsuhiro; Uraki, Junji; Yamanaka, Takashi; Fujimori, Masashi; Miki, Manabu; Sasaki, Takeshi; Sakuma, Hajime; Sugimura, Yoshiki

doi:10.1148/radiol.2015142029

Cited by 71 publications

(99 citation statements)

References 32 publications

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“…The first step is the confirmation or the exclusion of the diagnosis of AM: in the recent years the combination of high resolution CT and PET scans has proved to be very accurate in distinguishing benign from malignant adrenal masses (13,24); the use of FNAC is rarely needed in indeterminate cases (25). Notwithstanding the reliability of pre-operative imaging in excluding the benign nature of the mass, a basic functional evaluation is warranted, especially in order to exclude pheochromocytoma (8,26), perhaps essential also if the treatment choice is radiofrequency ablation of the mass (27,28).…”

Section: Discussionmentioning

confidence: 99%

The role of laparoscopic resection of metastases to adrenal glands

et al. 2017

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Background: The potential role of the laparoscopic approach for metastases to the adrenal gland is debated. We review here a series of patients consecutively submitted to laparoscopic adrenalectomy (LA) for suspected adrenal metastasis (AM).Methods: Retrospective study (consecutive series) of LA for AM. We measured parameters associated to primary tumor and metastasis. Statistical analysis: stepwise regression model.Results: Thirty-seven LA were performed on 36 patients. The mean age was 62.1 yrs. The side was right in 13 cases. Primary tumor was in the lung (n=22), breast (n=4), colon-rectum (n=4), kidney (n=3), thyroid, melanoma and ovary (n=1 each). Thirty-three out of 37 were confirmed to be AM (mean diameter 50 mm).Twenty-five were single metastasis. One LA was converted due to cava vein infiltration. Mean operative time was 142 min', median p.o. hospital stay was 3 days. After a mean follow-up of 33 months, 9 patients (25%) were alive free of disease, 6 (17%) were alive with disease. Mean post-adrenalectomy DFI was 19 months (range, 0-97 months), and it was the most predictive variable for survival (P<0.001). Conclusions:The dimensions and absence of invasion on imaging, the evolutive status of the disease and the performance status of the patient are key factors for LA, which is associated with adequate oncologic results, a quicker postoperative recovery, and potential survival benefits.

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Section: Discussionmentioning

confidence: 99%

The role of laparoscopic resection of metastases to adrenal glands

et al. 2017

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“…The objective response rate (technical effectiveness) and median survival duration were 100% and 24.9 months, respectively [17]. However, another recent study [19] involving four cases observed a median survival duration of only 9.3 months, which is significantly different from that in abovementioned study. This discrepancy can be attributed to the intrahepatic tumor status, which is an important factor influencing the overall outcomes of patients with EHM [21].…”

Section: Discussionmentioning

confidence: 62%

“…Sohn et al reported that the tumor response rate for sorafenib treatment in patients with HCC and EHM was 5% (complete response: 0%, partial response: 5%), with a median survival duration of 11.9 months for patients with adrenal metastases [30]. Previous studies have shown that local treatments for metastases achieve better control and outcomes, with survival durations of 12 to 21.4 months and 9.3 to 24.9 months after adrenalectomy and thermal ablation, respectively [9,10,17,19]. Our results support this theory by showing that local treatment may be effective in controlling limited metastases from HCC, and that patients with unresectable metastatic tumors are potential candidates for ablation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies also reported effective local control of EHM by ablation; however, these studies mainly focused on the lungs and lymph nodes, which are the most common sites of EHM [15,16]. To our knowledge, adrenal metastases have been documented only in case reports and a few studies with very small sample sizes ( 6) [17][18][19][20]. Therefore, the value of CT-guided thermal ablation for adrenal metastasis from HCC has not been evaluated in large-scale studies with long-term followup periods.…”

Section: Introductionmentioning

confidence: 99%

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Survival benefits of computed tomography-guided thermal ablation for adrenal metastases from hepatocellular carcinoma

Lyu

Kong

et al. 2019

International Journal of Hyperthermia

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Purpose: To evaluate the safety, efficacy, and survival outcomes of computed tomography (CT)-guided thermal ablation for adrenal metastases from hepatocellular carcinoma (HCC). Methods: This long-term retrospective study included 27 male patients (median age, 50 years; range, 34-77 years) with 29 adrenal metastatic tumors associated with HCC who underwent ablation between January 2004 and December 2015. The technical success rate, effectiveness rate, complications, and survival were recorded. Complications were assessed according to the Common Terminology Criteria for Adverse Events. Survival curves were estimated using the Kaplan-Meier method. A Cox regression model was used for the evaluation of factors predicting survival. Results: A total of 33 ablation sessions were performed for the 29 tumors. No ablation-related death was observed, and the incidence of complications was 87.9%. Grade 1-2 complications occurred in 23 of the 33 sessions (69.7%), and grade 3 hypertension was the only major complication, occurring in eight sessions (24.2%). The technical success and effectiveness rates were 93.1% (27 of 29 tumors) and 92.6% (25 of 27 patients), respectively. The median progression-free survival and overall survival (OS) durations for the 27 patients were 6.9 months and 16.8 months, respectively. The median OS duration was longer for patients with adrenal oligometastases (21.8 months) than for those with (12.8 months) multiple metastases (p ¼ .037). Adrenal oligometastases were the only significant predictor of OS (p ¼ .043). Conclusions: CT-guided ablation is a feasible and safe procedure for adrenal metastases from HCC, and it may be more beneficial for patients with adrenal oligometastases.

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“…RFA is not advisable for large lesions and those that are suspected to be malignant on imaging. Although RFA is potentially applicable to malignant adrenal conditions, its use in patients with potentially curative primary adrenocortical carcinoma should be strongly discouraged.…”

Section: Discussionmentioning

confidence: 99%