Abstract
Radiofrequency thermal ablation (RFA) has shown promise as a technique for treating solid tumors. This method has been suggested as an alternative to surgery in patients with adrenocortical carcinoma (ACC). We reviewed the literature, and report the case of a patient with stage 4 ACC who received intraoperative and percutaneous RFA of two liver metastasis according to a standard ablation protocol. Post-interventional imaging in our patient demonstrated that after both interventions, a stellar-like structure of vital tumor tissue had remained within the coagulation necrosis. This was the starting point of a fast and progressive tumor recurrence. We suspect heat-sink effects of blood vessels in the highly vascularized metastasis to cause the tumor recurrence. In literature, there are only a few reports of RFA in ACC patients. In addition, there is no large randomized trial investigating the efficacy of RFA against surgery in those patients. Presently, RFA in ACC should be restricted to patients in whom surgery is contraindicated. It is necessary that strongly vascularized ACC metastases deserve a modified ablation protocol due to perfusion related cooling effects and to increase the efficacy of RFA.
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