Radiofrequency Ablation Of Liver Metastases Research Articles

CT-guided radiofrequency ablation prolonged metastatic survival in patients with liver metastases from nasopharyngeal carcinoma

Purpose: The aim of this retrospective study was to evaluate the technical efficacy and survival following CT-guided radiofrequency ablation (RFA) of liver metastases (LM) from nasopharyngeal carcinoma (NPC) and to determine prognostic factors.Materials and methods: Between 2000 and 2008, 376 patients with LM from NPC were identified. Of these 17 patients with 31 LM from NPC underwent CT-guided percutaneous RFA. We assessed the technical effectiveness, complications and prognostic value of LM characteristics including timing (synchronous versus metachronous), number, size, presence of extra hepatic metastases and treatment regimen. Survival rates were calculated using the Kaplan–Meier method.Results: Technical success was achieved in 30/31 metastases (96.7%). The median overall survival was 16.5 months from the time of diagnosis of LM for all the 376 NPC patients with LM, and 48.1 months for the 17 NPC patients with LM who received RFA treatment. Of the 376 patients, 111 had 1–3 LM who did not receive RFA treatment, with a median survival of 25.9 months compared to 48.1 months for the 14 patients with 1–3 LM who received RFA.Conclusion: CT-guided RFA of LM from NPC can be performed with a high degree of technical effectiveness and offers the promise of improved survival in selected patients.

Volumetric Arterial Enhancement Fraction Predicts Tumor Recurrence After Hepatic Radiofrequency Ablation of Liver Metastases: Initial Results

The objective of our study was to investigate the diagnostic value of the volumetric arterial enhancement fraction of the liver with color mapping for the early detection of tumor relapse after hepatic radiofrequency ablation (RFA). Fifty-three patients (24 men, 29 women; mean age ± SD, 65 ± 10 years) with a total of 215 liver metastases treated by RFA and a mean postinterventional follow-up period of 20 ± 15 (SD) months were included in this retrospective study. Quantitative arterial enhancement fraction color maps of the whole liver were computed from triple-phase contrast-enhanced MDCT images. Follow-up examinations served as the standard of reference. The diagnostic performance of the arterial enhancement fraction color maps to predict subsequent tumor occurrence before tumor was visible on routine multiphase CT images was evaluated. The mean arterial enhancement fraction of segments that developed metastases (62% ± 23%) was significantly higher than the mean of segments that did not develop metastases (39% ± 20%) (p < 0.0001). Receiver operating characteristic curve analysis revealed a probability of 77% for arterial enhancement fraction values to be higher in case of subsequent metastases as compared with liver parenchyma without tumor recurrence. The arterial enhancement fraction provides incremental value in the imaging surveillance for liver metastases after RFA. Arterial enhancement fraction color maps may be suited to predict tumor recurrence earlier than routine assessment using contrast-enhanced MDCT.

Radiofrequency Ablation for Liver Metastasis of Colorectal Cancer

Radiofrequency Ablation for Liver Metastasis of Colorectal Cancer

Percutaneous radiofrequency ablation approach through the spleen: initial case report for pancreatic tail gastrinoma

Gastrinoma has a low incidence, and the pancreas-originated gastrinoma is rare. Pancreatic gastrinoma patients with liver metastases have poor prognosis and short survival. Local treatment to reduce the tumor burden helps to improve symptoms and slows down tumor progression for patients with unresectable tumors. We report a case of pancreatic tail gastrinoma with unresectable liver metastases. The patient received a comprehensive minimally invasive interventional treatment, that is, chemoembolization and radiofrequency ablation for liver metastases, and percutaneous transplenic radiofrequency ablation combined with radioactive 125I seed implantation for pancreatic tail gastrinoma. The patient was followed up for more than 20 months, and showed no clear evidence of tumor recurrence. We explored the safety and feasibility of percutaneous transplenic radiofrequency ablation for unresectable pancreatic tail gastrinoma. This transplenic approach allow more indications for minimally invasive therapy and provides a new treatment option not only for patients with unresectable pancreatic tail tumor but also for patients refusing surgery.

Efficacy and feasibility of radiofrequency ablation for liver metastases from gastric adenocarcinoma

Purpose: Optimal treatment for liver metastases from gastric cancer remains a matter of debate. The aim of our study is to evaluate the efficacy of radiofrequency ablation (RFA) for the treatment of liver-only metastases from gastric adenocarcinoma.Materials and methods: We retrospectively reviewed medical records of 29 patients who developed liver-only metastases from gastric adenocarcinoma and subsequently underwent gastric resection and RFA (n = 20) or gastric resection and systemic chemotherapy (n = 9) between January 1995 and February 2008. Overall survival was estimated using the Kaplan-Meier method, and was compared using the log rank test to evaluate RFA efficacy.Results: Twenty patients who underwent RFA showed a median overall survival of 30.7 months (range: 2.9 to 90.9 months), a median progression-free survival of 6.8 months (range: 0.8 to 45.2 months), and median overall one-, three-, and five-year survival rates were 66.8%, 40.1%, and 16.1% respectively. The RFA group showed a 76% decreased death rate compared to the chemotherapy-only group (30.7 months versus 7 months, hazard ratio, 0.24; p = 0.004). Most patients tolerated RFA well, and complications were found to be minor (transient fever (20%) and/or right upper quadrant pain (25%)). One case of treatment-related death occurred due to sepsis that originated from a liver abscess at the ablation site.Conclusions: The data suggest that a use of RFA as a liver-directed treatment may provide greater survival benefit than chemotherapy and is an alternative option for the treatment of liver-only metastases from gastric cancer.

Experience in diagnosis and treatment of malignant pancreatic endocrine tumor

Objective To investigate the clinical features, diagnosis and treatment of malignant pancreatic endocrine tumor. Methods The clinical data of 38 patients with malignant pancreatic endocrine tumor who had been admitted to First Affiliated Hospital of Nanjing Medical University from January 1969 to December 2008 were analyzed retrospectively. Of all patients, 6 were with insulinoma, 23 with pancreatic polypeptide tumor, 4 with glucagonoma and 5 with pancreatic carcinoid. Results All patients except 1 with insulinoma were found with pancreatic lesion by imaging examination. The resection rate was 87% (33/38). Pathological examination found 7 patients with liver metastasis, 5 with lymph node metastasis, 1 with tumor thrombus in vessels and lymphatic vessels, and 28 with local invasion. Twenty-four patients were followed up, and neither recurrence nor metastasis was found except 1 patient with insulinoma who received reoperation for local recurrence and 1 patient with pancreatic carcinoid who received radiofrequency ablation for liver metastasis. Conclusions The diagnosis of pancreatic endocrine tumor mainly depends on imaging examination. The malignancy of pancreatic endocrine tumor is determined after the comprehensive analysis of preoperative imaging findings, intraoperative examination, post-operative pathological examination and the data obtained during follow-up. The malignant pancreatic endocrine tumor should be managed actively by resection because of its relatively low malignancy, high operative resectability and relatively good prognosis. Key words: Pancreatic neoplasms; Islet cells; Diagnosis; Treatment

Laparoscopic colorectal resection combined with simultaneous radiofrequency ablation for liver metastases

Objective To assess the clinical value of laparoscopic colorectal resection combined with simultaneous radiofrequency ablation for liver metastases.Methods Twenty-two patients with colorectal cancer and synchronous liver metastases were treated by laparoscopie colorectal resection and simultaneous radiofrequency ablation(RFA)in Third People's Hospital of Chengdu from December 2001 to July 2006.Areas of colliquative necrosis were detected by contrast-enhanced computed tomography postoperatively.The outcomes were analyzed by chi-square test.Results Of all patients,8 had muhiple liver metastases,16 had complications.Thirty-one liver metastases were treated by RFA,and no complication oecurred.The mean postoperative hospital stay was(14±5)days,and there was no perioperative death.Five of the 22 patients were identified as incomplete ablation of the tumor,and the RFA was reperformed.The recurrence of liver metastases in the RFA necrotic zone was observed in 4 patients,and RFA was reperformed on 2 of them.Six patients died,and 2 of them died of liver metastases recurrence in the RFA necrotic zone.The recurrence rate of liver metastases and mortality was 18%(4/22)and 27%(6/22),respectively.The recurrence rate of patients with the diameter of the metastatic lession≥2.0 cm was significantly higher than those with the diameter of the metastatic lession＜2.0 cm(x2=5.867,P＜0.05).Conclusions Laparoseopie colorectal resection combined with simultaneous RFA provide a curative opportunity for colorectal cancer patients who are old and have multiple liver metastases,complications,poor tolerance of operation,and for patients whose tumors are difficult to resect. Key words: Colorectal neoplasms; Liver metastasis; Laparoscopy; Catheter ablation,radiofrequeney DOI:10.3760/cma.j.issn.1673-9752.2009.01.011

Radiofrequency ablation of liver metastases from cancer of unknown primary site (cup)

This retrospective study was performed to review the efficacy of local radiofrequency ablation (RFA) in all the management of liver cancer of unknown primary site (CUP), and to identify possible prognostic features and complications that affect the efficacy of this treatment on survival. From April 2003 to December 2007, 22 patients (15 men, 7 women) with a total of 36 liver metastasis of CUP and poor response to prior systemic chemotherapy were treated with computed tomography-guided RFA. The median age of patients was 66 years. All patients (22/22) had 1-, 3-, and 6- month follow-up and 8/22 of them had a 12-month followup. The overall median survival of all 22 patients was 10.9 months. Survival was better in patients with lesions 3 cm or smaller. No severe complications, including local seeding, were occured. Our study revealed that RFA appears to be an effective, safe and relatively simple alternative procedure for the local ablation of these lesions. These results are more encouraging for lesions 3 cm or smaller, all of which were successfully treated, as proved by the imaging criteria and the statistical analysis. Further prospective trials are needed to determine whether RFA should be proposed for standard protocols.

CT-Guided Radiofrequency Ablation in Patients with Hepatic Metastases from Breast Cancer

The purpose of this study was to evaluate technical success, technique effectiveness, and survival following radiofrequency ablation for breast cancer liver metastases and to determine prognostic factors. Forty-three patients with 111 breast cancer liver metastases underwent CT-guided percutaneous radiofrequency (RF) ablation. Technical success and technique effectiveness was evaluated by performing serial CT scans. We assessed the prognostic value of hormone receptor status, overexpression of human epidermal growth factor receptor 2 (HER2), and presence of extrahepatic tumor spread. Survival rates were calculated using the Kaplan-Meier method. Technical success was achieved in 107 metastases (96%). Primary technique effectiveness was 96%. During follow-up local tumor progression was observed in 15 metastases, representing a secondary technique effectiveness of 86.5%. The overall time to progression to the liver was 10.5 months. The estimated overall median survival was 58.6 months. There was no significant difference in terms of survival probability with respect to hormone receptor status, HER2 overexpression, and presence of isolated bone metastases. Survival was significantly lower among patients with extrahepatic disease, with the exception of skeletal metastases. We conclude that CT-guided RF ablation of liver metastases from breast cancer can be performed with a high degree of technical success and technique effectiveness, providing promising survival rates in patients with no visceral extrahepatic disease. Solitary bone metastases did not negatively affect survival probability after RF ablation.

Neuroendocrine Tumors: Characterization with Contrast-Enhanced Ultrasonography

The aim of this study was to characterize the ultrasonographic features of neuroendocrine tumors (NET) and their metastases with contrast-enhanced ultrasonography (CEUS) and to compare this to clinical data. During a period of 5 years, 82 patients with 83 histologically proven NET were prospectively examined using conventional US and pulse inversion US with a second generation contrast agent (SonoVue, Contrast Pulse Sequencing) focusing on the arterial (10-20 s p. i.), capillary (20-25 sec p.i.), portal venous (25-120 sec p.i.), and late phases (>120 sec p.i.). 69 patients had metastases in the abdominal tract, including eight patients with poorly differentiated neuroendocrine carcinomas with high-grade behavior. In 31 patients the proliferation index (MIB-1) of the NET was < or = 2%, in 46 patients > 2%, in 6 patients > or = 20%. Thirteen patients had one primary lesion without metastases. In NET of the lung, stomach, and colon we found only hypoechoic or isoechoic liver metastases. NET of the small intestine and pancreas represented hypoechoic, isoechoic, and/or hyperechoic liver lesions, sometimes combined. Insulin producing tumors (6) had hypoechoic metastases. Necrotic areas (25/83) were detected after interferon therapy, embolization, systemic chemotherapy, and radiofrequency ablation of liver metastases, but did not develop after somatostatin receptor radionuclide therapy. In large NET (> 3 cm) with a proliferation index of > 2%, necrotic areas appeared spontaneously. In 93% (77/83) of the cases the NET and their metastases showed an early arterial influx of microbubbles. Rim-like contrast enhancement occurred during the capillary phase in 78% (65/83) of all lesions, and hypervascularization occurred during the arterial phase and at the beginning of the capillary phase in 95% (79/83). The hypervascularized tissue was found in the primary lesions, in liver, lymph node metastases and any kind of abdominal metastases. In liver metastases with a proliferation index >2%, tumor arteries showed a chaotic growth pattern. In 93% (77/83) the NET lesions appeared as dark "defects" at the beginning of the late phase. CEUS with CPS demonstrates typical NET imaging characteristics. Differences in imaging features may depend on their primary lesion, size, proliferation marker, and extent of the degenerative changes. In most cases real-time CEUS may replace other imaging techniques.

Role of [18F]FDG-PET/CT after radiofrequency ablation of liver metastases: preliminary results

Focal metastasis may be treated with radiofrequency ablation (RFA), a low invasive method yet limited by the lack of direct evidence of radicality of treatment. We, hereby, aimed at assessing the role of positron emission tomography-computed tomography (PET/CT) with fluoride radiolabeled deoxy-glucose ([(18)F]FDG) in RFA treatment success evaluation and early diagnosis of local relapse of liver metastasis after RFA procedure. RFA was performed in nine patients on 12 liver metastasis, serially imaged through [(18)F]FDG-PET/CT and multidetector CT (MDCT) at 1, 3, 6, and 9 months after treatment. Eight lesions were also scanned with [(18)F]FDG-PET/CT at 1 week after treatment. Imaging analyses were performed on 47 [(18)F]FDG-PET/CT and 51 MDCT. Imaging reading outcomes were compared to each other and to biopsy tissue results when available. In one case, [(18)F]FDG-PET/CT revealed radiotracer uptake at RFA site a week after procedure. Negative concordant outcome was obtained on eight lesions at 1 month after RFA, on eight cases at 3 months, on four at 6 months, and on two cases at 9 months. Extra-liver (peritoneal) disease was detected in one case by both [(18)F]FDG-PET/CT and MDCT. In seven cases, [(18)F]FDG-PET/CT revealed the presence of local recurrence earlier than MDCT. In no cases did MDCT detect local relapse earlier than [(18)F]FDG-PET/CT. [(18)F]FDG-PET/CT may detect RFA treatment failure as well as local relapse after RFA earlier than MDCT.

Radiofrequency Ablation for Hepatic Metastasis from Gastric Adenocarcinoma

The prognosis for gastric cancer with liver metastasis continues to be poor. We present our preliminary findings from 4 cases of liver metastasis from gastric adenocarcinomas treated using radiofrequency ablation (RFA). Between 1995 and 2004, the clinical history and course of 4 patients who underwent radiofrequency ablation for liver metastases from gastric cancer were reviewed. Two patients with smaller metachronous metastasis are currently alive without recurrence at 16 and 14 months and the other patients with larger synchronous metastatic lesions died after 4 and 12 months after RFA. Although this study was limited to a few cases and had a short follow-up duration, our findings suggest that RFA may provide an alternative treatment modality for liver metastasis resulting from gastric adenocarcinoma. Additional study is needed with a larger group of patients and longer follow up to evaluate the efficacy of RFA.

Radiofrequency ablation in liver metastasis: Authors′ reply

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A Pilot Study of Early 18F-FDG PET to Evaluate the Effectiveness of Radiofrequency Ablation of Liver Metastases

The objective of our study was to collect pilot data about the use of FDG PET within hours after radiofrequency ablation (RFA) of liver metastases. Total photopenia on early PET can potentially be regarded as a macroscopic tumor-free margin; focal uptake can be regarded as macroscopic residual tumor.

Radiofrequency ablation of liver metastases from colorectal cancer

Objective: To assess the effectiveness of radiofrequency ablation (RFA) of liver metastases from colorectal cancer (CRC).

Endocrine pancreatic tumors with glucagon hypersecretion: a retrospective study of 23 cases during 20 years

Glucagon-secreting endocrine pancreatic tumor is a rare disease, hence controlled studies on clinical management are lacking. In an attempt to assess the efficacy of diagnostic and therapeutic measures in patients with glucagonoma, a retrospective study was performed using the archives of a tertiary care center. Records from 340 patients with endocrine pancreatic tumors were reassessed and 23 patients with malignant endocrine pancreatic tumor and elevated plasma glucagon levels were identified. About 7% of patients with histologically verified tumors fullfilled our criteria for glucagonoma. Only 22% of these patients had developed diabetes prior to the diagnosis of glucagonoma. Seventy eight percent had metastatic disease to the liver at diagnosis. Necrolytic migratory erythema was diagnosed or clinically suspected in 52%. Somatostatin receptor scintigraphy was positive in 95%. Nineteen patients received chemotherapy at some point, in 18 cases streptozotocin and 5 FU. With this treatment, objective radiological responses were seen in 50% of evaluable patients. Other treatment modalities used were interferon, somatostatin analogs, hepatic artery embolization, radio-frequency ablation of liver metastases, and radiolabeled somatostatin analogs. During the study period, 11 patients died at a median of 80 months from diagnosis whereas 11 patients are still alive after a median follow up of 52 months. One patient was lost to follow-up. Glucagonomas represent 7% of our comprehensive referral material of endocrine pancreatic tumors. Necrolytic migratory erythema was a common finding (52%) and diabetes less frequent at presentation than previously reported. Tumors were positive on somatostatin receptor scintigraphy and objective responses were seen to chemotherapy.

Initial Report of PET/CT–guided Radiofrequency Ablation of Liver Metastases

Computed tomography (CT) and ultrasonography (US) are commonly employed to guide positioning of radiofrequency electrodes within target tumors. However, this technique cannot be used when the tumor is detectable only by positron emission tomography (PET). In such cases, even the use of intraprocedural coregistered PET/CT will not prevent malpositioning of the electrode tip relative to a lesion visualized only on PET as a result of patient breathing and organ shifts during CT-guided electrode placement. The present report describes a single case of successful targeting and complete ablation of a lesion invisible on CT and US with the use of a method to visualize electrode tip positioning by PET.

Endoscopic management of biliopleural fistula and biloma after percutaneous radiofrequency ablation of liver metastasis

Endoscopic management of biliopleural fistula and biloma after percutaneous radiofrequency ablation of liver metastasis

Radiofrequency ablation of liver metastases improves the survival rate of patients with metastatic colorectal disease

The liver is the main target organ for metastases in colorectal cancer. This cancer type is one of the most frequent causes of cancer and cancer death, and about 50% of patients are destined to dev...

Actual role of radiofrequency ablation of liver metastases

The liver is, second only to lymph nodes, the most common site for metastatic disease irrespective of the primary tumour. More than 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality. Although the surgical resection leads to an improved survival in patients with colorectal metastases, only approximately 20% of patients are eligible for surgery. Thermal ablation and especially radiofrequency ablation emerge as an important additional therapy modality for the treatment of liver metastases. RF ablation shows a benefit in life expectancy and may lead in a selected patient group to cure. Percutaneous RF ablation appears safer (versus cryotherapy), easier (versus laser), and more effective (versus ethanol instillation and transarterial chemoembolisation) compared with other minimally invasive procedures. RF ablation can be performed by a percutaneous, laparoscopical or laparotomic approach, and may be potentially combined with chemotherapy and surgery. At present ideal candidates have tumours with a maximum diameter less than 3.5 cm. An untreatable primary tumour or a systemic disease represents contraindications for performing local therapies. Permanent technical improvements of thermal ablation devices and a better integration of thermal ablation in the overall patient care may lead to prognosis improvement in patients with liver metastases.