Percutaneous Image-guided Radiofrequency Ablation Research Articles

Outcomes of Osteoid Osteoma Treated by Percutaneous CT-Guided Radiofrequency Ablation.

Introduction Osteoid osteomas are the most frequent true benign bone tumor in the adolescent age group and the third most prevalent benign bone tumor overall. This study was designed to assess the effectiveness of the procedure and correlate it with the analgesia offered because of the significant burden of this illness and new literature supporting the successful outcomes of image-guided percutaneous radiofrequency ablation (RFA) in osteoid osteoma. Methodology This hospital-based interventional trial was carried out in a tertiary care referral center. Forty-two patients with osteoid osteoma, ranging in age from 9 to 30, were included in the study. The patients received RFA guided by computed tomography (CT), and they were postoperatively monitored at one, two, and four weeks and three, six months, and 12 months. A numerical pain scale (NPS) was used to evaluate the patient's pain both before and after the procedure. The preoperative and postoperative results were contrasted. Results A total of 42 participants were enrolled in the study. Eight (19.05%) women and 34 (80.95%) men made up the group. Complete pain alleviation (NPS=0) was attained in 42.8% and 96.4% of the study groupinthe first and second weeks post-procedure. Almost all patients began protected weight-bearing at one week, according to their level of pain tolerance. Osteoid osteoma of the talus was a remnant lesion in one patient that required further treatment after two weeks. During the duration of the follow-up, no problems were recorded. Conclusion Percutaneous CT-guided RFA of osteoid osteoma is a safe, minimally invasive procedure and greatly reduces the duration of hospitalization. It has excellent functional outcomes and no known complications.

Role of percutaneous CT-guided radiofrequency ablation in treatment of intra-articular, in close contact with cartilage and extra-articular osteoid osteomas: comparative analysis and new classification system.

We investigated procedural safety, technical and clinical outcomes of the percutaneous image-guided radiofrequency ablation (PRFA) of intra-articular (IA), intra-articular close to cartilage (IACC), and extra-articular (EA) osteoid osteomas (OO). We proposed a new radiologic classification for osteoid osteoma depending on the degree and location of sclerosis which may correlate with technical failure and/or difficulties. According to the inclusion criteria, we enrolled consecutive patients who were referred to the investigation center from June 2018 to January 2022. After clinical and CT imaging features were suggestive for the diagnosis of OO, all the patients were treated by percutaneous CT-guided RFA with a standardized technique. Biopsy of the lesion was not performed in all patients. A retrospective analysis was conducted to assess the procedure's technical, primary clinical, and secondary clinical successes, recurrence rate, and complications. We classified all the OOs according to a new proposed classification of the site and the amount of sclerosis. A total number of 55 patients were enrolled in our study according to the inclusion criteria. The mean age of the enrolled patients was 24.07 ± 14.71years (ranges from 7 to 57years). The M/F ratio was roughly 2:1. The mean follow-up was 20.18 ± 12.60months (ranges from 2 to 44months). EA group included 36 patients, IA included 5 and IACC included 14 patients. Technical success was achieved in all cases of IA and IACC groups. Technical success in the EA group was 97.22% (1 technical failure). Primary clinical success was 100%, 92.85%, and 91.66% for IA, IACC, and EA groups, respectively. Accordingly, the recurrence rate was 5.88% in EA, and 7.14% in IACC, while no recurrence occurred in the IA group. No complications occurred. The secondary success rate of the 3 cases of recurrence was 100%. PRFA proved to be a safe procedure with a high rate of success for OO treatment even in intra-articular lesions in close contact with cartilage. This study showed that the results in terms of technical and clinical success are comparable for IA OO, IACC OO, and EA OO, even if the recurrence rate was higher in EA OO. Our proposed new classification of the degree and location of sclerosis may correlate to technical failure, but further studies with a larger number of patients are needed for validation.

Percutaneous image-guided radiofrequency ablation for adrenal tumours: a systematic review

To undertaken a systematic review of the technical success and technique efficacy rates of percutaneous image-guided radiofrequency ablation (RFA) for adrenal tumours. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from inception to the third week of January 2020. Only studies reporting effectiveness rates of percutaneous RFA for adrenal tumours were included. Data regarding sample size, tumours, effectiveness rates, outcomes, and complications were extracted in duplicate and recorded. A total of 15 studies evaluating 292 individuals with 305 tumours were included. Patient selection criteria included age ≥18 years, contraindication to surgical intervention, and no uncorrected coagulopathy. Cumulative technical success, primary technique efficacy, and secondary technique efficacy rates were 99%, 95.1% and 100%, respectively, indicating optimal immediate control of adrenal tumours. Technical success and technique efficacy rates of primary adrenal tumours were higher than adrenal metastases; however, formal statistical analyses were precluded due to lack of comparative studies. Local tumour progression rates for adrenal metastases were 20.3% at 3 months, 26.3% at 6 months, and 29.3% at 12 months. Overall survival rates for adrenal metastases were 81.8% at 6 months, 59.6% at 12 months, and 62.9% at 18 months. The intraprocedural complication rate was 30.2%, with the most frequency reported complication being procedural hypertensive crisis. The findings of this study suggest percutaneous image-guided RFA is a safe and efficacious procedure. Further studies are warranted to define patient selection criteria and long-term outcomes.

Complications Following Percutaneous Image-guided Radiofrequency Ablation of Bone Tumors: A 10-year Dual-Center Experience.

Background Percutaneous radiofrequency ablation (RFA) is effective in the management of bone tumors. However, knowledge of the complication rate and risk factors for complications of RFA is lacking. Purpose To report the complication rate and risk factors of bone tumor RFA. Materials and Methods This retrospective study reviewed complications in consecutive patients who underwent RFA of primary or metastatic bone tumors from January 2008 to April 2018. Complications were categorized into major (grade 3 or 4, severe or life-threatening) or minor (grade 1 or 2, mild or moderate) according to Common Terminology Criteria for Adverse Events. Univariable and multivariable regression analyses were performed to identify variables associated with complications of RFA. Results A total of 169 patients (median age, 63 years; interquartile range, 55-73 years; 85 men) with 217 tumors were evaluated. The total complication rate was 30.0% (65 of 217; 95% confidence interval [CI]: 23.8%, 36.0%). The major complication rate was 2.3% (five of 217; 95% CI: 0.8%, 5.3%), with secondary fracture being the most frequent event (1.8% [four of 217]). The minor complication rate was 27.7% (60 of 217; 95% CI: 21.7%, 33.6%), with immediate postoperative pain being the most frequent event (18.0% [39 of 217]). Risk factors for all complications included tumor size greater than 3 cm (adjusted odds ratio [AOR], 2.4 [95% CI: 1.2, 4.5]; P = .03) and previous radiation therapy (AOR, 3.8 [95% CI: 2.0, 7.4]; P = .02). The only risk factor for minor complications was previous radiation therapy (AOR, 2.2 [95% CI: 1.0, 4.7]; P = .04). Conclusion Bone tumor radiofrequency ablation is safe, with a low rate of major complications mainly consistent with secondary fractures. Risk factors for complications are tumor size greater than 3 cm and previous radiation therapy. © RSNA, 2020 Online supplemental material is available for this article.

Percutaneous image-guided thermal ablation of bone metastases: a retrospective propensity study comparing the safety profile of radio-frequency ablation and cryo-ablation

Objectives To retrospectively compare the safety profile of percutaneous image-guided radiofrequency ablation (RFA) and cryoablation (CA) of bone metastases (BM) with and without a propensity score analysis. Methods Between January 2008 and April 2018, 274 consecutive patients (mean age 61.6 ± 12.1 years) with BM were treated at our Institution with RFA (53 patients; 66 BM) or CA (221 patients; 301 BM) and included in this study. Complications were assessed according to the type of ablation modality before and after applying a 1:1 propensity score method taking into account patient’s demographics, BM features, procedural details and follow-up findings. Results In the whole 9 BM (2.5%) reported major complications without significant difference between RFA (1/66; 1.5%) and CA (8/301; 2.7%; p = 1); 40 BM (10.9%) showed minor complications, which were more common with RFA (22/66; 33.3%) than with CA (18/301; 6.0%, p<.001) mainly due to post-procedural pain occurring more frequently with RFA than CA (20/66; 30.3% vs. 7/301; 2.3%, p<.001). Following 1:1 matching, similar results were obtained, since there were similar rates of major complications with RFA and CA (1/66 [1.5%] and 0/66 [0.0%], respectively; p = 1); and higher rates of minor complications with RFA compared to CA [33.3% (22/66) vs. 2/66 (3%); p<.001] due to preponderant postprocedural pain (90.9% [20/22] minor complications with RFA). Conclusions Similar low rates of major complications are expected with RFA and CA of BM. In the post-operative period, RFA appears more painful than CA, thus warranting for adoption of dedicated analgesic protocols for patients undergoing RFA.

SC86 - Percutaneous image-guided radiofrequency ablation for cT1a-b renal masses: A comparison between patients younger vs. older than 65 years

SC86 - Percutaneous image-guided radiofrequency ablation for cT1a-b renal masses: A comparison between patients younger vs. older than 65 years

Combined Transarterial Chemoembolization and Percutaneous Radiofrequency Ablation: More Promising Evidence of Effectiveness in Treating Solitary, Medium-Sized Hepatocellular Carcinoma.

Locoregional therapy (LRT) has become a cornerstone in the management of patients with surgically unresectable hepatocellular carcinoma (HCC). Transarterial chemoembolization and percutaneous radiofrequency (RF) ablation—both prototypical LRTs with long track records of use—prolong overall survival (OS) in HCC patients ( 1 Lo C.M. Ngan H. Tso W.K. et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002; 35: 1164-1171 Crossref PubMed Scopus (2200) Google Scholar , 2 Llovet J.M. Real M.I. Montana X. et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359: 1734-1739 Abstract Full Text Full Text PDF PubMed Scopus (2871) Google Scholar , 3 Lencioni R. Cioni D. Crocetti L. et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology. 2005; 234: 961-967 Crossref PubMed Scopus (708) Google Scholar ) but have shortcomings when used independently ( 4 Carmi L. Georgiades C. Combination percutaneous and intraarterial therapy for the treatment of hepatocellular carcinoma: a review. Semin Intervent Radiol. 2010; 27: 296-301 Google Scholar ). Although transarterial chemoembolization is the current standard of care for patients with Barcelona Clinic Liver Cancer stage B (intermediate-stage) HCC, it is considered a palliative treatment rather than a curative treatment. To this end, rates of complete (ie, 100%) pathologic necrosis are modest—ranging as low as 20%–35% ( 5 Riaz A. Lewandowski R.J. Kulik L. Ryu R.K. Mulcahy M.F. Baker T. et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with chemoembolization. Cardiovasc Intervent Radiol. 2010; 33: 1143-1152 Crossref PubMed Scopus (78) Google Scholar , 6 Shim J.H. Han S. Shin Y.M. et al. Optimal measurement modality and method for evaluation of responses to transarterial chemoembolization of hepatocellular carcinoma based on enhancement criteria. J Vasc Interv Radiol. 2013; 24: 316-325 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar )—and result in unacceptably high tumor progression rates, with median time-to-progression of 3.1–13.5 months ( 7 Lencioni R. de Baere T. Soulen M.C. Rilling W.S. Geschwind J.F. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data. Hepatology. 2016; 64: 106-116 Crossref PubMed Scopus (391) Google Scholar ), ensuring that most HCC patients succumb to cancer despite repeated transarterial chemoembolization aimed at disease control. Conversely, RF ablation is considered a definitive therapy for Barcelona Clinic Liver Cancer stage A (early-stage) HCC tumors ≤3 cm, although as tumor size exceeds 3 cm, there is a significant reduction in the rate of complete coagulative necrosis due to heat dissipation with increasing distance from the RF ablation electrode, which results in higher local tumor progression rates, as confirmed in a study of nearly 1500 early-stage HCC tumors treated with RF ablation ( 8 Kim Y.S. Lim H.K. Rhim H. et al. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol. 2013; 58: 89-97 Abstract Full Text Full Text PDF PubMed Scopus (267) Google Scholar ). In addition, RF ablation is susceptible to heat sink effects, or convective heat loss due to blood flow in adjacent vessels, which may limit therapeutic efficacy ( 9 McGhana J.P. Dodd 3rd, G.D. Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol. 2001; 176: 3-16 Crossref PubMed Scopus (572) Google Scholar , 10 Lu D.S. Yu N.C. Raman S.S. et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology. 2005; 234: 954-960 Crossref PubMed Scopus (320) Google Scholar ). Moreover, HCCs larger than 2 cm are more frequently associated with satellite tumors and microscopic vascular invasion, which may precipitate treatment failure or disease recurrence despite satisfactory target tumor ablation ( 11 European Association for Study of Liver, European Organisation for Research and Treatment of CancerEASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Eur J Cancer. 2012; 48: 599-641 Abstract Full Text Full Text PDF PubMed Scopus (374) Google Scholar ). Given the individual limitations of transarterial chemoembolization and RF ablation, there is a pressing need to validate more effective treatment permutations to enhance the efficacy of LRT. Chemoembolization Combined with Radiofrequency Ablation for Medium-Sized Hepatocellular Carcinoma: A Propensity-Score AnalysisJournal of Vascular and Interventional RadiologyVol. 30Issue 10PreviewTo compare survival outcomes of patients with single medium-sized hepatocellular carcinomas (HCCs) who underwent treatment with transarterial chemoembolization, radiofrequency (RF) ablation, or a combination of the 2 therapies. Full-Text PDF

Image-guided Percutaneous Radiofrequency Ablation for Osteoid Osteoma: Experience from a Developing Nation.

ObjectiveThe purpose of this study is to report our experience in using image-guided percutaneous radiofrequency ablation (RFA) for the treatment of osteoid osteoma (OO) and the subsequent duration of pain relief over a period of about six years (May 2013-March 2019; 70 months) at a tertiary-care hospital in a developing nation.MethodsA retrospective study was performed at the radiology department of Aga Khan University, Karachi, Pakistan. All patients who had undergone image-guided percutaneous RFA for OO between May 2013-March 2019 were included. All cases had been performed with CT-guidance under general anesthesia, with an additional local anesthesia injection also administered to the patients. A soloist needle had been used for RFA. The primary success rates, complications, symptom-free intervals, and follow-ups were evaluated.ResultsIn total, 15 patients (11 males, 4 females) of a mean age of 13.93 years (range: 5-25 years; median age: 14.5 years) with OO underwent image-guided percutaneous RFA during a period of 70 months. Eleven lesions were located in the femur, three in the tibia, and one in the humerus. The mean nidus size was 8.1 x 5.73 mm [range: (4.9-11.5) x (3.8-9.1) mm]. All patients were successfully treated and experienced resolution of pain in 2.36 months (range: 1-4 months). During the follow-up period (range: 3-40 months; mean: 13.85 months; median: nine months), none of the patients experienced any relapse or persistent symptoms. No major complications were reported.ConclusionImage-guided percutaneous RFA is a minimally invasive and safe treatment option with high efficiency and a high rate of technical success for the treatment of OO. The risk of recurrence is remote with all patients achieving independent recovery.

Minimally invasive CT-guided excision of osteoid osteoma and other small benign bone tumours: a single centre case series in South Africa

Background: The management of osteoid osteoma (OO) and other small primary benign lesions of bone has evolved over the past 50 years from open surgery with wide resection margins to less invasive surgical techniques such as image-guided intralesional excision and percutaneous radiofrequency ablation. We aim to evaluate the outcomes of patients treated with computerised tomography (CT-guided) intralesional excision and bone grafting of small benign lesions of bone. Method: A retrospective folder review of patients treated in a large academic hospital in Cape Town, South Africa, between March 2012 and May 2016 was performed. Patient demographics, details of presentation, clinical information and outcome following treatment were analysed descriptively. Pre-operative diagnosis based on radiological examination was compared with histological diagnosis. Result: Eleven patients (five male) with a median age of 16 years (range 5–33) were included. Pain was the most common presenting feature. A histological diagnosis of OO was confirmed in five of nine patients with a suspected diagnosis of OO pre-operatively. Of the four patients whose diagnosis changed after the procedure, the diagnoses included a benign spindle cell lesion, a benign fibrous histiocytoma, subacute osteitis and an osteochondral defect with geode cyst formation. Of the two patients where OO was not suspected pre-operatively, chondroblastoma was confirmed in one while a benign spindle cell lesion was reported in the other.Overall histological yield was thus 100%. There were no complications or repeat procedures at a median follow-up of 42 months (range 30–52 months). Conclusion: CT-guided intralesional curettage is a safe and minimally invasive technique. This is especially useful in less accessible regions of the skeleton as it provides a means of accurately locating the lesion with minimal risk of complications and morbidity to the patient. We consider this to be the optimal method of treatment in our setting as it provides high success rates, few complications and a histological diagnosis without the need for any additional and expensive equipment. Level of evidence: Level 4

Spinal Osteoid Osteoma: Percutaneous Radiofrequency Ablation Using a Navigational Bipolar Electrode System.

The purpose of this article is to describe the use of a navigational bipolar radiofrequency ablation system for the treatment of spinal osteoid osteomas. Safe and effective imaging-guided percutaneous radiofrequency ablation of spinal osteomas can be performed using a multidirectional bipolar electrode system.

Image-Guided Percutaneous Radiofrequency Ablation of Central Renal Cell Carcinoma: Assessment of Clinical Efficacy and Safety in 31 Tumors

PurposeTo assess clinical efficacy and safety of image-guided percutaneous radiofrequency (RF) ablation of central renal cell carcinoma with adjunctive pyeloperfusion. Materials and MethodsPatients with central renal tumors who underwent percutaneous RF ablation between 2005 and 2010 were retrospectively evaluated. Thirty patients with 31 central renal tumors underwent 39 RF ablation sessions. Mean tumor diameter was 3.7 cm (range, 2–7 cm). Median distance between tumor and renal pelvis was 5 mm (range, 0–15 mm). Pyeloperfusion was performed in 27 patients (27/30; 90%). Contrast–enhanced CT or MR imaging was performed to evaluate treatment response. ResultsTechnical success of RF ablation was achieved in 38/39 (97.4%) ablation sessions. Primary efficacy was 83.9% (26/31) on first follow-up imaging. One (3.2%) case of local tumor progression was detected 6 months after initial ablation. Secondary efficacy was 96.8% (30/31) after repeat RF ablation for residual tumor or local tumor progression. Median follow-up was 88 months (mean 82.6 mo ± 30.7; range, 9–121 mo). Major complications occurred in 5/39 (12.8%) RF ablation sessions. Complications were significantly higher for tumors located within 5 mm of the renal pelvis or 0 mm of a major calyx (28.6% vs 4.0%; P < .05). Overall survival was 96.0% (95% CI, 88.4%–100.0%), and progression-free survival at 5 years was 80.9% (95% CI, 65.8%–95.9%). ConclusionImage-guided percutaneous RF ablation combined with pyeloperfusion has satisfactory clinical efficacy in treating central renal tumors. Although clinically effective, RF ablation of central tumors may also be associated with significant major complications.

Pain in mesothelioma: feasibility study of percutaneous image-guided radiofrequency ablation of chest wall lesions

Malignant pleural mesothelioma (MPM) is a rare tumor that originates in the lung pleura; it commonly results from previous asbestos exposure that occurred between 20 and 50 years prior to disease onset, and its incidence is increasing worldwide. Symptoms commonly related to MPM include chest pain. The causes of the pain are multifactorial: it may be due to tumor infiltration of the ribs of the nerve roots, intercostal nerves, chest wall, or, in some cases, from tumor invasion of the neurovascular bundle. Treatment of chest pain makes use of medical therapy, surgical and radiotherapy approaches.

Image-guided minimally invasive percutaneous treatment of spinal metastasis.

In order to provide effective options for minimally invasive treatment of spinal metastases, the present study retrospectively evaluated the efficacy and safety of image-guided minimally invasive percutaneous treatment of spinal metastases. Image-guided percutaneous vertebral body enhancement, radiofrequency ablation (RFA) and tumor debulking combined with other methods to strengthen the vertebrae were applied dependent on the indications. Percutaneous vertebroplasty (PVP) was used when vertebral body destruction was simple. In addition, RFA was used in cases where pure spinal epidural soft tissue mass or accessories (spinous process, vertebral plate and vertebral pedicle) were destroyed, but vertebral integrity and stability existed. Tumor debulking (also known as limited RFA) combined with vertebral augmentation were used in cases presenting destruction of the epidural soft tissue mass and accessories, and pathological vertebral fractures. A comprehensive assessment was performed through a standardized questionnaire and indicators including biomechanical stability of the spine, quality of life, neurological status and tumor progression status were assessed during the 6 weeks-6 months follow-up following surgery. After the most suitable treatment was used, the biomechanical stability of the spine was increased, the pain caused by spinal metastases within 6 weeks was significantly reduced, while the daily activities and quality of life were improved. The mean progression-free survival of tumors was 330±54 days, and no associated complications occurred. Therefore, the use of a combination of image-guided PVP, RFA and other methods is safe and effective for the treatment of spinal metastases.

Erratum: Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management.

Background Radiofrequency ablation (RFA) is an established treatment for small renal tumors. The objective of this review is to systematically assess the type, frequency, risk factors and management of treatment failure after image-guided percutaneous RFA of renal tumors. Method 10 studies (967 patients, 1033 tumors) with a mean/median follow-up of ≥ 30 months were systematically identified and analyzed. Results and Conclusion Image-guided percutaneous RFA of localized renal tumors is very effective. The most common type of treatment failure is residual unablated tumor (5.9 %), followed by local tumor progression (4.7 %). De novo tumors in the kidneys occur in 1.3 % of cases and extra-renal metastases in 2.0 %. Local tumor progression, de novo tumors in the kidneys and extra-renal metastases occur predominantly later than 12 months after initial RFA. Tumor size > 3 cm and central tumor location are the major risk factors for treatment failure. In the case of treatment failure, repeated RFA shows high success rates (86.3 % for residual unablated tumors and 87.5 % for local tumor progression). Key Points: Citation Format

Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - ASystematic Review with Description of Type, Frequency,Risk Factors and Management.

Background Radiofrequency ablation (RFA) is an established treatment for small renal tumors. The objective of this review is to systematically assess the type, frequency, risk factors and management of treatment failure after image-guided percutaneous RFA of renal tumors. Method 10 studies (967 patients, 1033 tumors) with a mean/median follow-up of ≥ 30 months were systematically identified and analyzed. Results and Conclusion Image-guided percutaneous RFA of localized renal tumors is very effective. The most common type of treatment failure is residual unablated tumor (5.9 %), followed by local tumor progression (4.7 %). De novo tumors in the kidneys occur in 1.3 % of cases and extra-renal metastases in 2.0 %. Local tumor progression, de novo tumors in the kidneys and extra-renal metastases occur predominantly later than 12 months after initial RFA. Tumor size > 3 cm and central tumor location are the major risk factors for treatment failure. In the case of treatment failure, repeated RFA shows high success rates (86.3 % for residual unablated tumors and 87.5 % for local tumor progression). Key Points: · Treatment failure can be subdivided into residual unablated tumor and local tumor progression.. · Residual unablated tumor occurs in 5.9 % of cases.. · Local tumor progression occurs in 4.7 % of cases.. · Tumor size and location are the major risk factors for treatment failure.. · Repeated RFA is effective and commonly used for management.. Citation Format · Vollherbst D, Bertheau R, Kauczor H et al. Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management. Fortschr Röntgenstr 2017; 189: 219 - 227.

Percutaneous Image-guided Radiofrequency Ablation of Tumors in Inoperable Patients - Immediate Complications and Overall Safety.

Introduction:Percutaneous destruction of cancer cells using a radiofrequency energy source has become an accepted part of the modern armamentarium for managing malignancies. Radiofrequency ablation (RFA) is a relatively novel procedure for treating recurrent and metastatic tumors. It is used for debulking tumors and as adjuvant therapy for palliative care apart from its role as a pain management tool. Its use in the third world countries is limited by various factors such as cost and expertise. In the remotest parts of India, where economic development has been slow, abject poverty with poor health care facilities advanced malignancies present a challenge to health care providers. We undertook this study to assess the safety of the percutaneous RFA tumor ablation as a therapeutic or palliative measure in patients where surgery was not possible. We observed that RFA may be an effective, alternative therapeutic modality for some inoperable tumors where other therapeutic modalities cannot be considered.Context:Palliative and therapeutic image-guided RFAs of tumors may be the only treatment option in patients who are inoperable for a variety of reasons. To assess the safety and complications of RFA in such a patient population is important before embarking upon any interventions given their physically, mentally, and socially compromised status in a country such as India.Aims:To assess the safety of percutaneous image-guided radiofrequency tumor ablation and to note the various immediate and early complications of the intervention.Settings and Design:This was a prospective, observational study conducted in Tata Main Hospital, Jamshedpur, Jharkhand, India.Subjects and Methods:After approval by the Hospital Approval Committee all patients who consented for percutaneous RFA of their tumor admitted in the hospital were included after taking fully informed consent from patient/close relative keeping the following criteria in view.Inclusion Criteria:Patients who were likely to derive a direct benefit in the survival or as a palliative measure for relief in their symptoms and patients who were inoperable because of any of the following reasons: (1) Exhausted conventional treatment options, (2) technical and anatomical contraindications to conventional treatment, (3) medical comorbidities precluding surgery, (4) patient refusal, (5) recurrent tumors, and (6) advanced tumor stage. Conventional Treatment has been defined as surgical resection, radiotherapy, and/or chemotherapy, although the patient eligibility for each treatment may vary.Exclusion Criteria:Patients with the following were excluded: (1) Severe coagulopathy, (2) heart, renal, or liver failure, (3) lesions within 1 cm of gall bladder, hilum, bowel wall, and major blood vessels, (4) patient with any metal implant, (5) patients in sepsis, and (6) tumor adjacent to structures at risk (main bile ducts, pericardium, stomach, or bowel).Results:The duration of procedure as well as ablation of tumor free margin was significantly related to the size of the tumor. As the size of tumor increased, duration of procedure increased significantly. A good tumor-free margin also needs to be ablated for optimum results as it prevents residual tumors and recurrences in the future. We observed that tumors sized <3.1 cm were optimal in this regard. Most common adverse event in postprocedure period was pain in and around ablation site. Post-RFA syndrome is also a common and benign self-limiting side effect. Patient counseling and proper selection of patients in the early stages of malignancy can enhance the efficacy of the procedure and patient satisfaction.Conclusions:Percutaneous image-guided RFA is an option in patients where most other tumor management modalities have been exhausted or rejected. RFA may not be free from side effects such as postablation syndrome, pain, and there may be other serious complications such as bleeding, but based on our observations, percutaneous image-guided RFA of tumors is a safe palliative and therapeutic treatment option.

Radiofrequency ablation under 3D intraoperative Iso-C C-arm navigation for the treatment of osteoid osteomas.

To evaluate the efficacy of intraoperative three-dimensional (3D) Iso-C C-arm-navigated percutaneous radiofrequency ablation (RFA) of osteoid osteomas. 35 patients (20 males and 15 females) with osteoid osteomas underwent treatment with intraoperative 3D Iso-C C-arm navigation-guided RFA. The tumour was first biopsied for pathological examination, the core needle was removed and the RFA needle was inserted into the nidus. Post-operative X-rays and CT scans were performed to evaluate the degree of ablation and to assess for recurrence at 3-month follow-up. Patients also completed a visual analogue scale (VAS) both pre-operatively and 3 days post-operatively to subjectively assess pain. Pathological diagnosis confirmed osteoid osteoma in 19 cases. The other 16 cases were not pathologically diagnosed owing to inadequate biopsy specimens. In all cases, localized pain was immediately relieved following RFA. Patients reported significantly decreased pain, with mean pre-operative VAS scores of 3.4 reducing to 0.80 at 3 days post-operatively and further to 0.06 at 3-month follow-up (p < 0.05). The mean follow-up time was 15.5 months (range: 3-38 months). 3D Iso-C C-arm navigation-guided RFA is a safe and effective option for the treatment of osteoid osteomas and may be considered in place of intraoperative CT-guided and open resection. C-arm image-guided percutaneous RFA mitigates the need for pre-operative CT as well as intraoperative scintigraphy, provides real-time imaging of the anatomy, facilitates accurate resection of the tumour and enables immediate confirmation of excision.

Percutaneous treatment of hepatocellular carcinoma in patients with cirrhosis: A comparison of the safety of cryoablation and radiofrequency ablation

PurposeTo compare the safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis. Materials and methodsThis retrospective HIPAA-compliant study received institutional review board approval. Forty-two adult patients with cirrhosis underwent image-guided percutaneous ablation of hepatocellular carcinoma from 2003 to 2011. Twenty-five patients underwent 33 cryoablation procedures to treat 39 tumors, and 22 underwent 30 radiofrequency ablation procedures to treat 39 tumors. Five patients underwent both cryoablation and radiofrequency ablation procedures. Complication rates and severity per procedure were compared between the ablation groups. Potential confounding patient, procedure, and tumor-related variables were also compared. Statistical analyses included Kruskal–Wallis, Wilcoxon rank sum, and Fisher's exact tests. Two-sided P-values <0.05 were considered significant. ResultsThe overall complication rates, 13 (39.4%) of 33 cryoablation procedures versus eight (26.7%) of 30 radiofrequency ablation procedures and severe/fatal complication rates, two (6.1%) of 33 cryoablation procedures versus one (3.3%) of 30 radiofrequency ablation procedures, were not significantly different between the ablation groups (both P=0.26). Severe complications included pneumothoraces requiring chest tube insertion during two cryoablation procedures. One death occurred within 90 days of a radiofrequency ablation procedure; all other complications were managed successfully. ConclusionNo significant difference was seen in the overall safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis.

Continuous registration based on computed tomography for breathing motion compensation.

IntroductionImage guidance for intervention is applied for complex and difficult anatomical regions. Nowadays, it is typically used in neurosurgery, otolaryngology, orthopedics and dentistry. The application of the image-guided system for soft tissues is challenging due to various deformations caused by respiratory motion, tissue elasticity and peristalsis.AimThe main task for the presented approach is continuous registration of preoperative computed tomography (CT) and patient position in the operating room (OR) without touching the patient and compensation of breathing motion. This approach is being developed as a step to image-guided percutaneous liver RF tumor ablation.Material and methodsUp to ten integrated radiological markers are placed on the patient's skin before CT scans. Then the anatomical model based on CT images is calculated. Point-to-point registration based on the Horn algorithm during a few breathing cycles is performed using a videometric tracking system. The transformation which corresponds to the minimum fiducial registration error (FRE) is found during the registration and it is treated as the initial transformation for calculating local deformation field of breathing motion compensation based on the spline approach.ResultsFor manual registration of the abdominal phantom, the mean values of target registration error (TRE), fiducial localization error (FLE) and FRE are all below 4 mm for the rigid transformation and are below 1 mm for the affine transformation. For the patient's data they are all below 9 mm and 6 mm, respectively. For the automatic method, different marker configurations have been evaluated while dividing the respiratory cycle into inhale and exhale. Average median values for FRE, TRE rigid estimation and TRE based on spline deformation were 15.56 mm, 0.82 mm and 7.21 mm respectively.ConclusionsIn this application two registration methods of abdominal preoperative CT anatomical model and physical patient position in OR were presented and compared. The presented approach is being developed as a step to image-guided percutaneous liver radiofrequency ablation tumor ablation. Implementation of the automated registration method to clinical practice is easier because of shortening of preparation time in OR, no necessity of touching the patient, and no dependency on the physician's experience.

Efficacy of Imaging-Guided Percutaneous Radiofrequency Ablation for the Treatment of Biopsy-Proven Malignant Cystic Renal Masses

The purpose of this study was to determine the efficacy of imaging-guided percutaneous radiofrequency ablation (RFA) for the treatment of Bosniak category III and IV cystic renal lesions. Our database was searched to assemble a cohort of biopsy-proven malignant Bosniak category III and IV cystic renal lesions that were treated with imaging-guided percutaneous RFA from 2004 to 2012. The clinical history, imaging features, procedural complications, pathologic results, imaging follow-up, and clinical outcomes of each case were reviewed. A total of 16 patients and 23 biopsy-proven malignant cystic renal lesions were included; two patients with von Hippel-Lindau syndrome had four and three treated lesions each, and a patient with multiple renal tumors had three treated lesions. The other 13 patients each had a single lesion. Clinical follow-up ranged from 2 to 110 months (average, 24 months). The primary treatment efficacy of RFA was 91% (21/23 lesions), and the secondary treatment efficacy was 96% (22/23 lesions). A minority of patients experienced partial loss of renal function. There were no complications related to bleeding or tumor seeding. Imaging-guided percutaneous RFA is safe and effective for the treatment of Bosniak category III and IV cystic renal lesions.