Radiofrequency Ablation Of Liver Metastases Research Articles

Percutaneous radiofrequency ablation of liver metastases from colorectal cancer: Development of a prognostic score to predict overall survival

PurposeTo develop a model for pretreatment prediction of overall survival (OS) after radiofrequency ablation (RFA) for colorectal liver metastasis (CRLM). MethodThis retrospective study included 491 patients (median age, 61 years; 348 men) who underwent percutaneous RFA for CRLM between 2000 and 2021. The Kaplan–Meier method was used to estimate OS rates. Independent factors affecting OS were investigated using multivariable Cox regression analysis. Risk scores were assigned to the risk factors and pretreatment prediction models were created using the risk factors. ResultsAfter RFA, the 5-, 10-, and 20-year OS rates were 44 %, 31 %, and 24 %, respectively, and the median OS was 46 months. Multivariate Cox regression analysis showed that a largest tumor size ≥ 2 cm (P<0.001), positive nodal status of primary tumor (P<0.001), carcinoembryonic antigen level > 30 ng/mL (P=0.049), multiple tumors (P=0.008), and T4 stage of the primary tumor (P=0.029) were independently associated with OS. In patients with a single CRLM, tumor diameter (P<0.001), positive nodal status of primary tumor (P=0.001), disease-free interval <12 months (P=0.045), and subcapsular location (P=0.03) were risk factors affecting OS. According to our prediction models, which included the aforementioned risk factors, OS rates progressively decreased as the risk scores increased, with significantly different OS rates between contiguous groups (P<0.001). ConclusionsOur prediction models can be used as a prognostic stratification tool in patients with CRLM, and can help select those candidates who will benefit most from RFA.

Synchronous metastatic colon carcinoma presenting as ovarian metastasis: a case report

The aim of the study was to discuss a rare case of synchronously metastatic colon cancer, which clinically manifested as intestinal obstruction due to the presence of ovarian metastasis.&#x0D; Materials and methods. The clinical case of a 47-year-old patient with synchronously metastatic colorectal cancer with an affected disease, peritoneal carcinomatosis and metastatic ovarian lesions was analyzed.&#x0D; Case presentation. In July 2021, patient R., 47 years old, developed a clinic of sub-compensated intestinal obstruction. According to CT and MRI data, a volume formation of the small pelvis with a diameter of about 15 cm with compression of the surrounding soft tissues and metastases of the 6th and 4a segments of the liver were determined. According to a colonoscopy, a neoplasm of the sigmoid colon was verified as adenocarcinoma. The presence of peritoneal carcinomatosis was determined intraoperatively; the operation was performed in the following scope: SS-0 (complete cytoreduction) – right-sided ovariectomy with a tumour, resection of the sigmoid colon with a tumour, resection of the rectum with TME, extirpation of the cervical stump with the left ovary and pelvic peritonectomy en block resection and diathermocoagulation of foci of peritoneal carcinomatosis on the visceral peritoneum of the small intestine, omentectomy, radiofrequency ablation of a liver tumour under ultrasound guidance. According to histopathological examination: adenocarcinoma (G2) with foci of mucus production in the sigmoid colon, metastatic lesion of the right ovary, cervix, peritoneum, and liver.&#x0D; Subsequently, from September 2021 to July 2022, the patient underwent 8 courses of adjuvant polychemotherapy according to the FOLFOX scheme and 2 courses according to the FOLFOX scheme and bevacizumab. In August 2022, due to signs of disease progression, the patient underwent SS-0 cytoreductive surgery: removal of tumour nodes of the parietal and visceral peritoneum, partial peritonectomy of the anterior abdominal wall, argon plasma coagulation of foci of peritoneal carcinomatosis of the parietal and visceral peritoneum, resection of the round ligament of the liver, NIRES. According to the results of the histological examination, metastases of mucinous adenocarcinoma of the intestinal type with the II-III degree of medical pathomorphosis were determined.&#x0D; From September 2022, the patient received 2 courses according to the IRINOX + bevacizumab regimen and 6 courses according to the FOLFIRI + bevacizumab regimen.&#x0D; According to the control MRI of the abdominal organs with intravenous contrast, metastases of the 7th and 8th segments of the liver were determined.&#x0D; Performed percutaneous radiofrequency ablation of liver metastases under ultrasound control&#x0D; Results. According to the results of the MRI of the OCP with intravenous contrast, there are currently no data on the progression of the disease. The patient's quality of life is satisfactory; the ESOG score is 0. It has been 22 months since the onset of the disease.&#x0D; Conclusions. Cytoreductive surgical interventions for synchronously metastatic colorectal cancer can significantly improve patients' quality of life and their oncological outcomes rather than only symptomatic treatment.

Diaphragmatic hernia after radiofrequency ablation of liver metastases: a case report and review of the literature.

A diaphragmatic hernia is the protrusion of abdominal tissues into the thoracic cavity secondary to a defect in the diaphragm. Reviewing the literature, we found only 44 references to diaphragmatic hernia secondary to percutaneous radiofrequency treatment. The vast majority of these cases were secondary to the treatment of hepatocellular carcinoma in segments V and VIII. Nevertheless, to date, this is the first reported case of diaphragmatic hernia after radiofrequency ablation of a liver metastasis from colorectal cancer. Complications secondary to diaphragmatic hernias are very diverse. The principal risk factor for complications is the contents of the hernia; when small bowel or colon segments protrude in the thoracic cavity, they can become incarcerated. Asymptomatic cases have also been reported in which the diaphragmatic hernia was discovered during follow-up. The pathophysiological mechanism is not totally clear, but it is thought that these diaphragmatic hernias might be caused by locoregional thermal damage. Given that most communications correspond to asymptomatic and/or treated cases, it is likely that the incidence is underestimated. However, due to the advent of percutaneous treatments, this complication might be reported more often in the future. Most cases are treated with primary herniorrhaphy, done with a laparoscopic or open approach at the surgeon's discretion; no evidence supports the use of one approach over the other. Nevertheless, it seems clear that surgery is the only definitive treatment, as well as the treatment of choice if complications develop. However, in asymptomatic patients in whom a diaphragmatic hernia is discovered in follow-up imaging studies, management should probably be guided by the patient's overall condition, taking into account the potential risks of complications (contents, diameter of the opening into the thoracic cavity …).

Hematological and immune disorders in colorectal cancer patients with liver metastases after radiofrequency ablation

Background. Colorectal cancer (CRC) is one of the most common malignant neoplasms in the world. It ranks third in the structure of oncological morbidity and second in the structure of mortality. The liver is the most common site of metastatic spread of CR and 14 to 18% of patients have liver metastases at diagnosis. Radiofrequency ablation is currently the most promising method of treating metastatic lesions.&#x0D; Рurpose – to study quantitative changes in hematoimmunological indicators and their influence on antitumor reactivity in patients with colorectal cancer after RFA of liver metastases.&#x0D; Materials and Methods. Clinical and laboratory examination was carried out in 12 patients with colorectal cancer with metastases in the liver, the majority of patients were over 60 years old. Adenocarcinoma was histologically determined in all patients, and most of them had a moderate degree of malignancy (G2). The study was carried out in three stages: I – one day before radiofrequency ablation (RFA), II – 3 days after RFA, III – 14 days after RFA of liver metastases.&#x0D; Results. Immune and hematological indicators of the development of the inflammatory response after RFA in patients with colorectal cancer with liver metastases were established. On the 3rd day (II stage) after RFA, a significant increase in the total number of leukocytes, the ratio of neutrophils to lymphocytes, the number of eosinophils, a violation of the balance of CD4+ and CD8+ lymphocytes, a decrease in the number of NK- and NKT-cells, an increase in the percentage of CD3+ HLA-Dr -, CD4 +PD1+, CD8+PD1+ lymphocytes. On the 14th day (stage III), most of the parameters were close to those determined before the treatment, except for the reduced number of NK and NKT cells and the increase in the level of platelets.&#x0D; Conclusions. A number of hematological changes on the 3rd day after RFA related to the inflammatory reaction were identified: an increase in the total number of leukocytes, an increase in the ratio of neutrophils/lymphocytes from 1.72 to 4.12, a significant decrease in the relative and absolute number of eosinophils. But on the 14th day, after the inflammatory reaction subsided, the normalization of most of the studied indicators was observed. A violation of the subpopulation composition of lymphocytes was established in patients with CR metastases in the liver, on the 3rd day after RFA. Those that had taken place even before the intervention (low number of CD8+ lymphocytes and NK cells) and additional ones appeared (increased CD4+/CD8+ ratio, increased percentage of CD3+ cells HLA-Dr+, CD4+ and CD8+ lymphocytes PD1+ (CD279+), decrease in the number of NKT cells). On the 14th day, the picture approached the initial one, with the exception of the number of NK and NKT cells. We believe that timely correction of inflammatory immunosuppression in the early days after RFA can shorten the period of vulnerability to recurrence of CR, and in the long term potentiate the positive effect of RFA on antitumor reactivity.

Successful radiofrequency ablation of liver metastases from prostate cancer

Patients with liver metastases from prostate cancer show poor prognosis. We performed metastases-directed therapy using radiofrequency ablation of liver metastases in an attempt to improve the prognosis in a patient with metastatic prostate cancer. We present the case of a 66-year-old man who was treated for metastatic castration-resistant prostate cancer. Evaluation showed isolated liver metastases together with elevated serum prostate-specific antigen levels. We performed metastases-directed therapy using radiofrequency ablation of the liver tumor. The patient showed no recurrent liver metastases for 42 months and survived for 66 months after diagnosis of metastatic prostate cancer. To our knowledge, this is the first report that describes radiofrequency ablation of liver metastases from prostate cancer. This procedure may be a useful therapeutic option for metastases-directed therapy in patients with liver metastases from prostate cancer.

Single-centre survival analysis over 10\xa0years after MR-guided radiofrequency ablation of liver metastases from different tumour entities

BackgroundRadiofrequency ablation (RFA) is a minimal-invasive, local therapy in patients with circumscribed metastatic disease. Although widely used, long time survival analysis of treated liver metastases is still pending while also analysing the patients’ experience of MR-based radiofrequency.MethodsMonocentric, retrospective analysis of long-time overall and progression free survival (OS; PFS) of 109 patients, treated with MRI-guided hepatic RFA between 1997 and 2010, focusing on colorectal cancer patients (CRC). Complimentary therapies were evaluated and Kaplan Meier-curves were calculated. Patients’ experience of RFA was retrospectively assessed in 28 patients.Results1-, 3-, 5-, 10-year OS rates of 109 patients with different tumour entities were 83.4%, 53.4%, 31.0% and 22.9%, median 39.2 months, with decreasing survival rates for larger metastases size. For 72 CRC patients 1-, 3-, 5-, 10-year OS rates of 90.2%, 57.1%, 36.1% and 26.5% were documented (median 39.5 months). Thereof, beneficial outcome was detected for patients with prior surgery of the CRC including chemotherapy (median 53.0 months), and for liver metastases up to 19 mm (28.5% after 145 months). Hepatic PFS was significantly higher in patients with liver lesions up to 29 mm compared to larger ones (p = 0.035). 15/28 patients remembered RFA less incriminatory than other applied therapies.ConclusionsThis is the first single-centre, long-time OS and PFS analysis of MRI-guided hepatic RFA of liver metastases from different tumour entities, serving as basis for further comparison studies. Patients’ experience of MR based RFA should be analysed simultaneously to the performed RFA in the future.

Periprocedural risk factors for incomplete radiofrequency ablation of liver metastases from colorectal cancer: a single-center retrospective analysis

Objective To explore independent risk factors for incomplete radiofrequency ablation (iRFA) of colorectal cancer liver metastases (CRLM) and evaluate adverse outcomes following iRFA. Materials and Methods Magnetic resonance imaging data of CRLM patients who received percutaneous RFA were randomized into training (70%) and validation set 1 (30%) data sets. An independent validation set 2 was derived from computed tomography scans. Uni- and multivariate analyses identified independent risk factors for iRFA. Area under the curve (AUC) values were used to evaluate the predictive model performance. Risk points were assigned to independent predictors, and iRFA was predicted according to the total risk score. Kaplan–Meier curves were used to assess new intrahepatic metastases (NIHM), unablated tumor progression, and overall survival (OS). Results Multivariate regression determined as independent iRFA risk factors perivascular tumor location, subcapsular tumor location, tumor size ≥20 mm, and minimal ablative margin ≤5 mm. The AUC values of the model in the training set, validation set 1, and validation set 2 were 0.867, 0.772, and 0.820, respectively. The respective AUC values of the total risk score were 0.864, 0.768, and 0.817. During the 6-year follow-up, the cumulative OS was significantly shorter in the iRFA than in the complete RFA group, and NIHM (hazard ratio [HR] = 2.79; 95% confidence interval [CI]: 1.725, 4.513) and unablated tumor progression (HR = 3.473; 95% CI: 1.506, 8.007) were more severe. Conclusions Perivascular tumor location, subcapsular tumor location, tumor size ≥20 mm, and minimal ablative margin ≤5 mm were independent risk factors for iRFA. iRFA may be a potential predictor of NIHM, unablated tumor progression, and OS.

Radiofrequency ablation of liver metastasis: potential impact on immune checkpoint inhibitor therapy.

Percutaneous radiofrequency ablation (RFA), a generally accepted alternative therapy for patients with liver metastases, is a minimally invasive approach with a favorable safety profile and a lower rate of major complications. The use of RFA or combined RFA plus resection can produce total tumor clearance in patients with unresectable liver metastases. However, the relatively high rate of local tumor progression has prevented the widespread use of RFA. Furthermore, its efficacy is controversial because there have been no comparisons for its effect on overall survival compared with standard options such as systemic chemotherapy. Meanwhile, immunotherapy has become a major research focus for oncology based on the recent successes reported for immune checkpoint inhibitors for melanoma, non-small cell lung cancer, gastric cancer, and other cancers. Immune checkpoints negatively regulate T cell function, and inhibition prevents the blockade of the immune system by cancer cells to prevent their destruction. Unfortunately, only some patients (< 25%) respond to immuno-oncology drugs, whereas other patients acquire resistance. However, RFA can induce massive necrotic cell death which might activate immunity and the presentation of cryptic antigens to induce tumor-specific T cell response. Because RFA can induce the rapid release of large amounts of tumor antigens, it can potentially stimulate transient immune responses to much tumor antigens. Combination therapies have induced synergistic enhancement of anticancer immune response in preclinical studies, indicating great promise for the future of oncologic treatment.Key Points • Only some patients respond to immuno-oncology drugs. • RFA causes the release of large amounts of cellular debris, a source of tumor antigens that elicit immune responses against tumors. • Combination RFA for liver metastases and immune checkpoint inhibitor therapies might synergistically enhance antitumor immunity.

Radiofrequency Ablation of Liver Metastases from Colorectal Cancer Induces a Cancer-Specific T Cell Repertoire in Humans

Introduction: For patients with otherwise non-resectable primary and secondary cancer manifestations within the liver or contraindications against surgery, radiofrequency ablation (RFA) is a potentially curative treatment option. Heat causes coagulative necrosis and breaks local immune tolerance with subsequent release of cellular content like soluble danger signals which may reshape adaptive anti-tumor immune responses. The induction of effective functional tumor-specific T cells and in situ tumor-recognition remain a major challenge for immunotherapy, frequently limiting therapeutic effects. In this study, the induction of antigen-specific T cells against patient-individual, naturally presented tumor antigens and the infiltration of immune cells into distant liver metastasis after RFA were evaluated.Methods: Six patients suffering from at least two metastatic sites in different liver lobes derived from colorectal carcinoma (CRC) were enrolled. As an initial step, RFA was performed on those manifestations that were inaccessible by surgery. Patients subsequently underwent liver surgery of the residual metastases. These specimen were used for HLA-ligandome analyses of tumor and corresponding non-malignant liver (NML) tissues by uHPLC-coupled tandem mass spectrometry (MS) following HLA-immunoprecipitation. The identified naturally presented HLA-ligands were screening against an extensive HLA-ligand database containing data from non-malignant tissues from different origins to assess tumor specificity of single peptides. Further, whole transcriptome sequencing (WTS) was performed and correlated with MS data selecting HLA-ligands of interest. Functional T cell reactivity against selected antigens was analyzed by intracellular cytokine staining (ICS). Immune cell infiltrates of surgically resected liver metastases were assessed by immunohistochemistry staining (IHC including antibodies specific for CD3, CD4, CD8, CD56, HLA class I and II, and heat shock protein 70) in 11 and 5 patients undergoing hemihepatectomy with or without previous RFA, respectively.Results: 32 tumor-exclusive T cell epitope candidates were selected based on WTS and ligandome analyses. Antigen-specific T cells were detected in all included patients at least at one timepoint (including boosting of preexisting immune responses and de novo induction). Of note, one patient exhibited RFA-mediated induction of antigen-specific CD4+ T cells against one mutation-derived HLA-class II peptide. This epitope was predicted on the basis of the WST data, but could not be corroborated in MS data as a naturally presented HLA-ligand. Immunohistochemistry of immune cell infiltrates in the lesions resected after RFA did not reveal any significantly increased immune infiltrates in RFA pre-treated patients as compared to the control group.Conclusions: Specific T cell responses directed against tumor-antigens were detected in every patient investigated. Most notably, T cell responses were boosted or induced in 3 out of 6 patients following RFA, including in one patient against a tumor-specific neoantigen. Still, this tumor-specific immunity per se is probably insufficient to eradicate established tumors. This is underlined by the observation that no increased immune infiltrates in distant metastases were shown. Therefore, our findings support the clinical development of combinatorial therapies, combining RFA with suitable immune stimulatory agents. DisclosuresKowalewski:Immatics Biotechnologies GmbH: Employment.

Radiofrequency ablation of liver metastases of endocrine tumors: what is the limit of the number. a case report

Radiofrequency ablation of liver metastases of endocrine tumors: what is the limit of the number. a case report

A case of long-term survival after repeated response to oxaliplatin-based chemotherapy and repeated thermoablation of liver metastases from colorectal cancer. Should we introduce the concept of oxaliplatin-resistant tumors?

The management of advanced colorectal cancer patients differs among cancer centers. International guidelines recommend offering all the recognized active regimens in order to obtain survival advantage, but little information is given about the sequence and combination in which such regimens should be administered. We report the case of a man with multiple liver metastasis from colorectal cancer followed for more than 78 months at our Institution. Repeated response to the same oxaliplatin, 5-fluorouracil and folinic acid chemotherapy schedule was achieved, and repeated radiofrequency ablation of liver metastases was performed until progression of lung and brain disease at 50 and 72 months, respectively, after the diagnosis of advanced disease. Although the tumor became oxaliplatin and chemo-resistant after the onset of extra-hepatic disease, a more aggressive chemotherapy regimen, including a doublet with a biological, halted tumor growth. The patient survived for more than 78 months without experiencing a major impact on his quality of life. This case reflects the importance of following tumor biology in the therapeutic decision-making process, reintroducing oxaliplatin whenever possible, and adopting a more aggressive strategy when the tumor becomes oxaliplatin-resistant.

Combined treatment of colorectal cancer followed by metastatic liver injury

To increase the effectiveness of treatment of colorectal cancer followed by metastatic liver lesion. This study included 319 patients with colorectal cancer and metastatic liver lesion Gennari grade I, II, and III for the period from 2002 to 2017. All patients received combined treatment. 107 patients underwent liver resections: right-sided hemihepatectomy - 10, advanced right-sided hemihepatectomy - 7, left-sided hemihepatectomy - 9, triple segmentectomy - 33, bisegmentectomy - 29, segmentectomy - 19 cases. Radiofrequency ablation of liver metastases was performed in 105 patients. Cool tip device with a power of 200 W was used for destruction. Fifty-seven patients underwent microwave destruction of liver tumor (AveCure MWG 881, 34 W). Transarterial chemoembolization by doxorubicin and HepaSpheres 150-250 ng was applied in 34 patients. Annual, 2-, 3- and 5-year survival was 83.1%, 73.5%, 60.2% and 24.6%, respectively after liver resection. RFA of liver metastases was followed by annual, 2- and 3-year survival near 73.5%, 53.3% and 32.1%, respectively. In case of MWA of liver metastases annual survival was 78.5%, 2-year - 63.3%, 3-year - 58.3%. Chemotherapy combined with targeted therapy, radiofrequency and microwave ablation is able to increase resectability up to 35-40% in patients with colorectal cancer followed by liver metastases. Minimally invasive procedures (RFA, MWA) reduce surgical risk in critically ill patients.

Bilious pleuritis following transpulmonary radiofrequency ablation of liver metastases

A 55-year-old man with pancreatic cancer metastatic to the liver underwent percutaneous radiofrequency ablation (RFA) of the liver deposits. The liver harboured four metastatic foci, the largest of which was...

Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Metastasis From Ovarian Cancer: A Single-Center Initial Experience.

The aim of this study was to evaluate the feasibility, effectiveness, and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) for the treatment of liver metastasis from ovarian cancer (OC). A retrospective review was performed on 11 patients (mean age, 53.0 ± 10.1 years) with 22 liver metastases (mean diameter, 2.0 ± 0.8 cm) from OC undergone RFA. Radiofrequency ablation was carried out with Starburst XL electrodes (RITA Medical System, Mountain View, CA) or Cool-tip electrodes (Cool-tip Systems; Valleylab, Boulder, CO). The tumor response, time to progression, and survival after RFA were assessed. Complete ablation was achieved for all lesions. The technique effectiveness was 100%. During the follow-up period, local tumor progression was observed in 1 (4.5%) of 22 lesions. The median time to progression was 8.0 months after RFA. Three patients died because of disease progression after 13, 18, and 24 months, respectively. The mean overall survival time after RFA was 53.1 ± 10.0 months, with the 1-, 3-, and 5-year overall survival rates of 100%, 61%, and 61%, respectively. No major complications were encountered. Radiofrequency ablation as an alternative treatment strategy is feasible and effective for selected patients with liver metastasis from OC, providing a high rate of local tumor control.

Radiofrequency ablation for liver metastases in patients with gastric cancer as an alternative to hepatic resection

BackgroundThe purpose of this retrospective study was to determine whether RFA could provide an alternative treatment modality for selected patients who are not candidates for hepatic resection.MethodsA total of 18 consecutive patients with liver metastases alone from gastric cancer treated with radiofrequency ablation (RFA, n = 11) or hepatic resection (HR, n = 7) at Seoul St. Mary’s Hospital, Korea, between January 2000 and September 2014, were enrolled.ResultsThe median OS and DFS in the RFA group were 40.5 ± 22.3 and 10.3 ± 1.07 months, respectively. There was no significant difference between the RFA and HR groups in terms of baseline characteristics except for performance status. Mean survival and DFS times of all patients were 60.1 ± 9.4 and 40.9 ± 10.2 months, respectively. Mean OS times in the HR and RFA groups were 67.5 ± 15.4 and 51.1 ± 9.8 months (P = 0.671), respectively, and the mean DFS time in the HR group (74.1 ± 14.2 months) was longer than that in the RFA group (26.9 ± 9.2 months), but the difference was not significant (P = 0.076).ConclusionsIn patients who are not candidates for surgical treatment, RFA may be an alternative to HR.

CT Perfusion for Early Response Evaluation of Radiofrequency Ablation of Focal Liver Lesions: First Experience.

To investigate the value of perfusion CT (P-CT) for early assessment of treatment response in patients undergoing radiofrequency ablation (RFA) of focal liver lesions. 20 consecutive patients (14 men; mean age 64±14) undergoing P-CT within 24h after RFA of liver metastases (n=10) or HCC (n=10) were retrospectively included. Two readers determined arterial liver perfusion (ALP, mL/min/100mL), portal liver perfusion (PLP, mL/min/100mL), and hepatic perfusion index (HPI,%) in all post-RFA lesions by placing a volume of interest in the necrotic central (CZ), the transition (TZ), and the surrounding parenchymal (PZ) zone. Patients were classified into complete responders (no residual tumor) and incomplete responders (residual/progressive tumor) using imaging follow-up with contrast-enhanced CT or MRI after a mean of 57±30days. Prediction of treatment response was evaluated using the area under the curve (AUC) from receiver operating characteristic analysis. Mean ALP/PLP/HPI of both readers were 4.8/15.4/61.2 for the CZ, 9.9/16.8/66.3 for the TZ and 20.7/29.0/61.8 for the PZ. Interreader agreement of HPI was fair for the CZ (intraclass coefficient 0.713), good for the TZ (0.813), and excellent for the PZ (0.920). For both readers, there were significant differences in HPI of the CZ and TZ between responders and nonresponders (both, P<0.05). HPI of the TZ showed the highest AUC (0.911) for prediction of residual tumor, suggesting a cut-off value of 76%. Increased HPI of the transition zone assessed with P-CT after RFA might serve as an early quantitative biomarker for residual tumor in patients with focal liver lesions.

US-US Fusion Imaging in Radiofrequency Ablation for Liver Metastases

Objective: Radiofrequency ablation (RFA) induces gas bubbles in ablation zones, and the ablative margin cannot be evaluated accurately on ultrasound (US) during and immediately after RFA. This study assessed the usefulness of US-US fusion imaging to visualize the ablative margin of RFA for liver metastasis. Methods: RFA guided by US-US fusion imaging was performed on 12 targeted tumors in 10 patients. Secondary hepatic malignancies included patients with colorectal cancer (n = 4), breast cancer (n = 2), lung cancer (n = 1), gastrointestinal stromal tumor (n = 1), pancreatic neuroendocrine tumor (n = 1), and adrenocortical carcinoma (n = 1). The maximal diameter of the tumors ranged from 0.8 to 4.0 cm (mean ± SD 1.6 ± 0.9 cm). Results: The mean number of electrode insertions was 1.6 per session (range 1-3). Technically, effective ablation was achieved in a single session in all patients, and safety ablative margins were confirmed on contrast-enhanced CT for early assessment of tumor response. There were no serious adverse events or procedure-related complications. During the follow-up period (median 220 days, range 31-417 days), none of the patients showed local tumor progression. Conclusion: US-US fusion imaging could show the tumor images before ablation and the ablative area on US in real time. The image overlay of US-US fusion imaging made it possible to evaluate the ablative margin three dimensionally according to the US probe action. Therefore, US-US fusion imaging can contribute to RFA therapy with a safety margin, that is, the so-called precise RFA.

Co-occurrence of liver metastasis of gastrointestinal stromal tumor and hepatocellular carcinoma: a case report.

Gastrointestinal stromal tumors (GISTs) are potentially malignant mesenchymal tumors that can give rise to distant metastases, mainly in the liver. The co-occurrence of synchronous primary liver tumors (e.g., hepatocellular carcinoma (HCC)) in patients with GIST is extremely rare. This report describes a 77-year-old male patient with liver metastasis of GIST originating in the small intestine and synchronous HCC. The patient had undergone resection of the small intestine for the primary GIST 3 years earlier and partial hepatectomy and radiofrequency ablation for liver metastases of GIST 1 year earlier. Despite the continuation of adjuvant therapy with imatinib, two new lesions in the liver were detected by follow-up computed tomography scanning, which showed the gradual enlargement of one tumor. A second hepatectomy was performed. Pathological examination revealed that one tumor was a liver metastasis of GIST and the other was a primary HCC. To our knowledge, this is the first report of the synchronous co-occurrence of a liver metastasis of GIST and a primary HCC.

ECG Changes during Radiofrequency Ablation of Liver Metastasis under General Anaesthesia - A Dilemma with Cardiac Event

Electrocardiogram (ECG) monitoring is one of the mandatory monitoring during surgery under anaesthesia for identifying any cardiac event like arrthymias or ischemic changes. The operating room is increasingly being studded with various electrical equipments. These electrical gadgets may interfere with the ECG monitoring and thus produce various artifacts mimicking arrthymias or ischemic changes.We report a case of ECG changes induced artifactually by the use of radiofrequency ablation (RFA) for ablating hepatic metastasis under general anaesthesia. Our case emphasizes that awareness of such artifacts in ECG during radiofrequency ablation is required and if it occurs it should be cautiously interperated and managed.

18F-FDOPA PET/CT-Guided Radiofrequency Ablation of Liver Metastases from Neuroendocrine Tumours: Technical Note on a Preliminary Experience.

To review our preliminary experience with 6-L-18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT-guided radiofrequency ablation (RFA) of liver metastases from neuroendocrine tumours (NETs). Three patients (mean age 51.3years; range 43-56) with gastro-entero pancreatic NET (GEP-NET) liver metastases underwent 18F-FDOPA PET/CT-guided RFA. Patients were referred with oligometastatic hepatic-confined disease (1-6 metastases; <3cm) on 18F-FDOPA PET/CT; poor lesion visualisation on US, CT, and MR; and ongoing symptoms. Procedures were performed in an interventional PET/CT scanner under general anaesthesia using a split-dose protocol. Lesion characteristics, procedural duration and technical success (accurate probe placement and post-procedural ablation-zone photopaenia), complications, patient and operator dose, and clinical outcomes were evaluated. Thirteen liver metastases (mean size 11.4mm, range 8-16) were treated in three patients (two presented with "carcinoid syndrome"). Technical success was 100% with a mean procedural duration of 173.3min (range 90-210) and no immediate complications. Mean patient dose was 2844mGy·cm (range 2104-3686). Operator and radiographer doses were acceptable other than the operator's right hand in the first case (149µSv); this normalised in the second case. There was no local tumour or extra-hepatic disease progression at mid-term follow-up (mean 12.6months; range 6-20); however, two cases progressed with new liver metastases at different sites. There was 100% clinical success (n=2) in resolving carcinoid syndrome symptoms. 18F-FDOPA PET/CT-guided RFA appears technically feasible, safe, and effective in patients with GEP-NETs and low-burden hepatic metastases. Further prospective studies are required to elucidate its precise role in tailored multimodality management of GEP-NET liver metastases.