Long-term Efficacy Of Radiofrequency Ablation Research Articles

Is radiofrequency ablation effective in treating patients with chronic knee osteoarthritis? A meta-analysis of randomized controlled trials.

This meta-analysis aimed to evaluate the short-term and long-term efficacy of radiofrequency ablation (RFA) and explore the role of diagnostic genicular nerve blocks in predicting treatment outcomes. A comprehensive literature search was conducted, and nine randomized controlled trials involving 714 participants were included in the analysis. Data extraction, risk of bias assessment, and subgroup analyses were performed. The primary outcome measures were pain scores at 6 and 12 months, assessed using visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The meta-analysis revealed that RFA demonstrated a significant short-term efficacy in reducing pain compared to the control group at 6 months, as indicated by the pain scores [weighted mean difference (WMD): -2.69, 95% CI: -3.99, -1.40]. Similarly, WOMAC scores at 6 months favored the RFA group (WMD: -4.40, 95% CI: -7.12, -1.68). However, the long-term efficacy of RFA at 12 months remained uncertain for both pain scores (WMD: -0.88, 95% CI: -2.36, 0.61) and WOMAC (WMD: 0.03, 95% CI: -0.25, 0.32). Subgroup analysis suggested that a positive result from the diagnostic genicular nerve blocks test was associated with a more favourable short-term outcome. This meta-analysis provides moderate-quality evidence supporting the short-term efficacy of RFA in reducing pain in patients with knee osteoarthritis. The inclusion of a diagnostic genicular nerve blocks test prior to RFA may help identify patients likely to benefit from the procedure. But it still needs more large sample studies to verify the results. However, further research is needed to determine the long-term efficacy of RFA in managing knee osteoarthritis pain.

Risk factors for the recurrence of early hepatocellular carcinoma treated by percutaneous radiofrequency ablation with a multiple-electrode switching system: a multicenter prospective study

Purpose To investigate the long-term efficacy of radiofrequency ablation (RFA) with a multiple-electrode switching system (MESS) in the treatment of early hepatocellular carcinoma (HCC) and evaluate the patterns and risk factors of intrahepatic recurrence of HCC after RFA. Methods In total, 139 patients with early HCC who underwent RFA with MESS as primary treatment at multiple centers were prospectively enrolled according to the inclusion criteria. We evaluated the local tumor progression (LTP), intrahepatic distant recurrence (IDR), the incidence of cumulative disease-free survival (DFS), LTP-free survival, IDR-free survival, and overall survival. We also analyzed the associated risk factors. Results A total of 139 patients were included in the study and the median follow-up time was 64 months, ranging from 11 to 72 months. The complete ablation rate was 98.56%. Sixty-nine (49.64%) were found to have intrahepatic recurrence (LTP, n = 15; IDR, n = 55) during follow-up. The 1-year, 3-year and 5-year cumulative DFS, LTP-free survival, and IDR-free survival rates were 74.82, 94.46 and 78.75%; 54.68, 88.03 and 61.79%; and 51.80, 85.67 and 60.17%, respectively. In the multivariable analysis, tumor size > 4 cm was the only important risk factor for LTP. The alkaline phosphatase (ALP) level and the number of tumors were independent risk factors for IDR; α-fetoprotein (AFP) level > 400 µg/L and recurrence interval were risk factors for the overall survival period. Conclusions The MESS-RFA is an effective method for local control of tumors in early HCC. Early HCC with multiple high-ALP tumors has a higher rate of recurrence, which mainly occurs in an IDR pattern. Early HCC with high AFP levels and a shorter initial recurrence interval resulted in a poorer prognosis. Thus, treatments such as liver transplantation or surgical resection may be a good strategy in those cases. ClinicalTrials.gov ID NCT02046356.

The Long-Term Efficacy of Radiofrequency Ablation Versus Laparoscopic Hepatectomy for Small Hepatocellular Carcinoma in East Asia: A Systematic Review and Meta-Analysis

Context: Hepatocellular carcinoma (HCC) is a common malignant cancer and the second leading cause of cancer-related deaths around the world. Radiofrequency ablation (RFA) and laparoscopic hepatectomy (LH) have been adopted for the treatment of HCC. The aim of the meta-analysis was to explore the long-term efficacy of RFA compared with LH for small HCC (sHCC) patients in the East Asian population. Evidence Acquisition: We performed a systematic review and meta-analysis by the literature search on PubMed, Cochrane Library, EMBASE, Chinese Biological Medical Literature (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang from their inception until October 10, 2019, for comparing the long-term efficacy outcomes of RFA with LH. Results: Fourteen retrospective studies with 1,390 subjects were included in the meta-analysis. Compared with the LH-treated group, RFA could raise the local recurrence rate under median follow-up duration and reduce disease-free survival (DFS) rates at 1 - 3 years. However, it failed to affect 5-year overall survival (OS) and DFS rates. In the subgroup analyses, different RFA approaches had significantly higher local recurrence rates than the LH group. A similar effect on OS and DFS rates within five years for single early (≤ 3 cm) HCCs and on the 1- and 5-year DFS rates for nodules ≤ 5 cm were observed between the two groups, but RFA approaches could reduce the 3-y OS and DFS rates for single nodules ≤ 5 cm. The percutaneous radiofrequency ablation (PRFA) group had significantly lower 3- and 5-year OS and the 1- and 3-year DFS rates than the LH group, while no significant difference in OS and DFS rates in the laparoscopic radiofrequency ablation (LRFA) approach. The RFA approach improved the 3-year OS compared with the LH group in Japan, but reduced the 3-year OS and DFS rates within 3 years in China. Conclusions: Our results support that LH treating sHCC had a better long-term efficacy and a lower local recurrence rate than RFA in the East Asian population. Further high-quality prospective studies are required to confirm the long-term efficacy.

Long-term Efficacy of Radiofrequency Ablation Combined with Chemotherapy in the Treatment of Patients with Advanced Non-small Cell Lung Cancer --A Retrospective Study

背景与目的肺癌射频消融术（radiofrequency ablation, RFA）联合化疗对于晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）近期疗效的改善具有一定的意义，但其是否可以改善晚期NSCLC患者的远期生存仍然存在争议。本研究回顾性分析了射频消融术联合化疗治疗与单纯化疗对于晚期NSCLC患者的远期疗效的差异。方法选择2012年9月-2015年12月在首都医科大学宣武医院胸外科进行肺癌射频消融术并进行化疗的Ⅲb期与Ⅳ期NSCLC患者77例作为实验组，选择同期只进行化疗未进行射频消融术的Ⅲb期与Ⅳ期NSCLC患者56例作为对照组。对两组患者进行电话随访，询问患者目前的生存情况与死亡时间。运用R3.4.1软件进行统计分析，使用“survival”程序包，用卡方检验比较两组数据基线水平，运用Cox比例风险模型处理混杂偏倚，并使用协变量均值取代法绘制经过校对的生存曲线。结果两组基线齐，实验组的1年生存率为70.74%，2年生存率为39.31%，中位生存期为22.1个月；对照组的1年生存率为54.54%，2年生存率为19.49%，中位生存期为18.1个月。组间差异有统计学意义（P < 0.05）。结论对于Ⅲb期-Ⅳ期NSCLC患者，肺癌射频消融术联合化疗治疗可以显著提高患者的2年生存率。

Left Atrial Size and Left Ventricular End-Systolic Dimension Predict the Progression of Paroxysmal Atrial Fibrillation After Catheter Ablation.

Although rare, some paroxysmal atrial fibrillations (AF) still progress despite radiofrequency (RF) ablation. In the study, we evaluated the long-term efficacy of RF ablation and the predictors of AF progression. A total of 589 paroxysmal AF patients (404 men and 185 women; aged 54 ± 12 years) who received 3-dimensional mapping and ablation were enrolled. Their clinical parameters and electrophysiological characteristics were collected. They were divided into Group 1 (N = 13, with AF progression) and Group 2 (N = 576, no AF progression). AF progression was defined as recurrence of persistent AF. Group 1 patients had larger left atrial (LA) diameter, larger left ventricle (LV) end-systolic and end-diastolic diameters, poorer LV systolic function, and more amiodarone use at baseline. After 1.2± 0.5 procedures, 123 (21%) patients experienced recurrence during 56 ± 29 months' follow-up. In the multivariate analysis, LA diameter (P = 0.018, HR = 1.12, 95% CI = 1.02-1.24) and LV end-systolic diameter (P = 0.005, HR = 1.10, 95% CI = 1.03-1.17) independently predicted AF progression. LA diameter >43 mm and LV end-systolic diameter >31 mm were the best cut-off values for predicting AF progression by ROC analysis. AF progression rate achieved 19% if they had both larger LA diameter (>43mm) and LV end-systolic diameter (>31 mm). RF ablation prevents the progression of paroxysmal AF effectively, except in patients with increased LA diameter and LV end-systolic diameter on echocardiogram, suggesting more aggressive rhythm control therapies should be considered in these patients.

Radiofrequency ablation for chronic low back pain: a systematic review of randomized controlled trials.

Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established. To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low back pain and the coccyx. A systematic review was conducted. Medline, EMBASE, PubMed, SPORTDiscus, CINAHL and the Cochrane Library were searched up to August 2013. Abstracts and full-text articles were reviewed in duplicate. Included articles were sham-controlled randomized controlled trials (RCTs), assessed the efficacy of RFA, reported at least one month of follow-up and included participants who had experienced back pain for at least three months. Data were extracted in duplicate and quality was assessed using the Cochrane Risk of Bias tool. Due to heterogeneity, as well as a lack of reported mean differences and SDs, meta-analysis was not possible using these data. The present systematic review retrieved 1063 abstracts. Eleven sham-controlled RCTs were included: three studies involving discogenic back pain; six studies involving lumbar facet joint pain; and two studies involving sacroiliac joint pain. No studies were identified assessing the coccyx. The evidence supports RFA as an efficacious treatment for lumbar facet joint and sacroiliac joint pain, with five of six and both of the RCTs demonstrating statistically significant pain reductions, respectively. The evidence supporting RFA for the treatment of discogenic pain is mixed. While the majority of the studies focusing on lumbar facet joints and sacroiliac joints suggest that RFA significantly reduces pain in short-term follow-up, the evidence base for discogenic low back pain is mixed. There is no RCT evidence for RFA for the coccyx. Future studies should examine the clinical significance of the achieved pain reduction and the long-term efficacy of RFA.

Radiofrequency Ablation is a Valuable Therapeutic Option in the Treatment of Liver Metastases From Gastrointestinal Stromal Tumors

We read with great interest the article entitled ‘‘A Role for Adjuvant RFA in Managing Hepatic Metastases from Gastrointestinal Stromal Tumors (GIST) After Treatment with Targeted Systemic Therapy Using Kinase Inhibitors’’ by Hakime et al. [1] indicating that radiofrequency ablation (RFA) in patients with GIST liver metastases, previously treated with tyrosine kinase inhibitor, has few complications and little toxicity and that the combination of RFA and imatinib seems to have improved progression-free survival rates compared with historical controls in similar patients treated with imatinib alone. These findings suggest that RFA is a potentially valuable therapeutic option in the treatment of GIST liver metastases. However, there are still some issues worthy of our deeper consideration. First, we fully agree with the author that ‘‘for primary and metastatic liver tumors of 3 cm or smaller, the rate of local control after radiofrequency ablation (RFA) has been found to be equivalent to that of resection . . . .’’ In fact, a growing number of recent studies have confirmed that RFA has been widely used for liver cancer as a rapid development of minimally invasive techniques [2–4]. Its advantages include convenient maneuvering, decreased open operation ratio, shorter hospital stays, precise curative effect, and relatively low cost. For patients with small hepatocellular carcinoma (tumors \3 cm in diameter), the long-term efficacy of RFA is similar to or even better than liver resection [2–4]. Although RFA for the treatment of GIST liver metastases has been rarely reported [1, 5], we can also learn, to some extent, from the experience of RFA in the treatment of colorectal liver metastases. Second, the essence of RFA treatment is to precisely inactivate tumor lesions entirely and minimize damage to normal liver tissue. Accurate identification of tumor-infiltrating scope and satellite lesions is the first premise. Therefore, great emphasis is placed on precise imaging before treatment. In recent years, contrast-enhanced ultrasound (CEUS) has played an important role in the RFA treatment of liver cancer and can help to confirm the actual size and shape of the tumor, the range of tumor infiltration, and the number of small tumors and satellite lesions, as well as provide a reliable reference for the development of RFA planning [6–8]. Combined with results from the existing literature [6–8] as well as our center’s experience, in addition to traditional US, computed tomography, and magnetic resonance imaging examinations, CEUS is worthy of being considered for RFA treatment of GIST liver metastases. Last, and most important, in April 2008, a National Institutes of Heath expert group re-discussed the risk stratification of primary GIST after resection and reached a new consensus: The original tumor site and tumor rupture can also serve as basic prognostic evaluation indicators [9]. Therefore, we should pay more attention to avoiding iatrogenic tumor rupture and seeding during surgery and preventing the probability of a higher postoperative recurrence and metastasis, whether in surgery or during other minimally invasive treatments, including RFA for the treatment of GIST. To achieve this goal, determining the location of tumor lesions should be especially focused. Based on our single-center experience, if the tumor is located in the liver parenchyma, the choice of RFA is feasible. However, if the tumor is located in the visceral surface of liver (especially greater than one-third of the Q.-K. Sun W. Wang (&) W.-D. Jia Department of Hepatic Surgery, Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, People’s Republic of China e-mail: whouwei@sina.com

Long-term efficacy of radiofrequency ablation in treatment of common and palmo-plantar warts

Current treatments for warts induce significant local tissue damage and do not prevent recurrence. We evaluated the efficacy of localised radiofrequency heat (RFH) therapy in inducing the long-term resolution of common and palmo-plantar warts in a placebo-controlled randomised single blind trial. Our data show that RFH therapy is a safe, cosmetically acceptable and long-term effective treatment for warts.

Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma.

To assess the long-term efficacy of radiofrequency ablation (RFA) and percutaneous ethanol (EtOH) injection treatment of local recurrence or focal distant metastases of well-differentiated thyroid cancer (WTC). RFA and EtOH injection techniques are new minimally invasive surgical alternatives for treatment of recurrent WTC. We report our experience and long-term follow-up results using RFA or EtOH ablation in treating local recurrence and distant focal metastases from WTC. Twenty patients underwent treatment of biopsy-proven recurrent WTC in the neck. Sixteen of these patients had lesions treated by ultrasound-guided RFA (mean size, 17.0 mm; range, 8-40 mm), while 6 had ultrasound-guided EtOH injection treatment (mean size, 11.4 mm; range, 6-15 mm). Four patients underwent RFA treatment of focal distant metastases from WTC. Three of these patients had CT-guided RFA of bone metastases (mean size, 40.0 mm; range, 30-60 mm), and 1 patient underwent RFA for a solitary lung metastasis (size, 27 mm). Patients were then followed with routine ultrasound, I whole body scan, and/or serum thyroglobulin levels for recurrence at the treatment site. No recurrent disease was detected at the treatment site in 14 of the 16 patients treated with RFA and in all 6 patients treated with EtOH injection at a mean follow-up of 40.7 and 18.7 months, respectively. Two of the 3 patients treated for bone metastases are free of disease at the treatment site at 44 and 53 months of follow-up, respectively. The patient who underwent RFA for a solitary lung metastasis is free of disease at the treatment site at 10 months of follow-up. No complications were experienced in the group treated by EtOH injection, while 1 minor skin burn and 1 permanent vocal cord paralysis occurred in the RFA treatment group. RFA and EtOH ablation show promise as alternatives to surgical treatment of recurrent WTC in patients with difficult reoperations. Further long-term follow-up studies are necessary to determine the precise role these therapies should play in the treatment of recurrent WTC.

Imaging-guided radiofrequency ablation of solid renal tumors.

We performed a retrospective review of imaging-guided radiofrequency ablation of solid renal tumors. Since May 2000, 35 tumors in 20 patients have been treated with radiofrequency ablation. The size range of treated tumors was 0.9-3.6 cm (mean, 1.7 cm). Reasons for patient referrals were a prior partial or total nephrectomy (nine patients), a comorbidity excluding nephrectomy or partial nephrectomy (10 patients), or a treatment alterative to nephron-sparing surgery (one patient who refused surgery). Tumors were classified as exophytic, intraparenchymal, or central. Sixteen patients had 31 lesions that showed serial growth on CT or MR imaging. Of these 16 patients, four patients with 10 lesions had a history of renal cell carcinoma, and two patients with 11 lesions had a history of von Hippel-Lindau disease. Four patients had incidental solid masses, two of which were biopsied and shown to represent renal cell carcinoma, and the remaining two masses were presumed malignant on the basis of imaging features. Successful ablation was regarded as any lesion showing less than 10 H of contrast enhancement on CT or no qualitative evidence of enhancement after IV gadolinium contrast-enhanced MR imaging. Of the 35 tumors, 22 were exophytic and 13 were intraparenchymal. Twenty-seven of the 35 were treated percutaneously using either sonography (n = 22) or CT (n = 5). Two patients had eight tumors treated intraoperatively using sonography. Patients were followed up with contrast-enhanced CT (n = 18), MR imaging (n = 5), or both (n = 5) with a follow-up range of 1-23 months (mean, 9 months). No residual or recurrent tumor and no major side effects were seen. Preliminary results with radiofrequency ablation of exophytic and intraparenchymal renal tumors are promising. Radiofrequency ablation is not associated with significant side effects. Further follow-up is necessary to determine the long-term efficacy of radiofrequency ablation.

Radiofrequency catheter ablation of the bundle branch reentrant ventricular tachycardia.

Bundle branch reentrant ventricular tachycardia (BBRVT) has a suitable anatomic substrate for radiofrequency catheter ablation. However, the experience with this treatment is still small. In the current study, we examined the safety and the long-term efficacy of radiofrequency ablation in the cure of patients with BBRVT. Four patients with BBRVT, identified during electrophysiological study, underwent temperature-controlled radiofrequency ablation of the right bundle branch (RBB). All of them had syncope and structural heart disease with reduced left ventricular ejection fraction. The baseline examination revealed an intraventricular block, prolonged HV interval and inducible sustained VT because of bundle branch reentry in all patients. RBB was successfully abolished in all patients after the delivery of 3 +/- 1 radiofrequency pulses. After ablation, a permanent pacemaker was implanted in one patient with significantly prolonged HV interval. All patients were free of BBRVT during a mean follow-up of 20 months. One patient received implantable cardioverter-defibrillator for myocardial VT five months after ablation. Two patients developed congestive heart failure. Radiofrequency catheter ablation of the RBB is a safe and highly effective therapeutic procedure for definitive cure of BBRVT. Long-term prognosis of these patients depends mainly on the underlying heart disease and the treatment of other VT.

Percutaneous ethanol injection and radio-frequency ablation for the treatment of nonresectable colorectal liver metastases – techniques and results

Percutaneous ethanol injection (PEI) and radio-frequency (RF) ablation are possible palliative treatment modalities for patients with non-resectable liver metastases of colorectal carcinomas. The different techniques are explained and reviewed. PEI did not show promising results for the treatment of liver metastases. RF results were more encouraging; some studies showed improved mean survival times for patients when a complete necrosis of the metastases could be achieved. The maximum diameter of the necrotic area possible in a single session is about 5 cm. PEI and RF are palliative last-line treatment strategies for patients with non-resectable liver metastases and should only be applied if chemotherapy is not sufficient or not possible. The long-term efficacy of RF ablation in this group of patients has to be evaluated.