Liver Metastases: Ablative Methods written and compiled by doctordee | Search LMS site |

Cryoablation RFA {Radio Frequency Ablation] Microwave Ablation
Cryoablation
Cryo ablation of hepatic metastases is safe, provides excellent palliation of symptoms, and in selected patients can be performed with curative intent. Indications for cryosurgical ablation included bilobar and centrally located disease [multiple unresectable liver metastases], poor medical risk, insufficient hepatic reserve, and involved margin after wedge resection. Cryosurgical ablation of hepatic tumors relies on nonspecific tissue necrosis due to freezing, as well as microvascular thrombosis. The tumor is flash frozen by the cryosurgery trochar to a very low temperature. It is then allowed to defrost, and in that process the spicules of ice crystals formed physically tear apart the membrane of the cell. The freezing-defrost cycle is repeated, so that all cells are lysed [broken apart]. Patients with selected primary and metastatic hepatic malignancies who are NOT candidates for surgical resection are afforded potentially curative benefit using this technique. Although hepatic cryosurgery offers some unequivocal and other potential advantages over surgical resection for colorectal metastases to the liver, the published data do not support its use in patients with resectable disease. Surgical resection remains the treatment of choice for hepatic metastases of LMS. Reference 1 Reference 2 Reference 3 Whether used alone or in association with surgical resection, cryotherapy of liver metastases is a specialized technique that should be done in a specialized liver facility, as should surgical resections of the liver. Intraoperative ultrasound should be used in all patients to help locate the tumor and guide the cryosurgical trochar to the lesions. Complications of the procedure include: the liver tissue cracking with subsequent bleeding--possibly requiring transfusion, bile leaks, injury to surrounding structures/organs [i.e. inferior vena cava], pleural effusions [water on the lung], postoperative biliary stenosis [bile duct narrowing]. See Webpage on Cryoablation See Cryoablation FAQs For the latest information, Search PubMed for Cryosurgery and Liver Metastases Below are some selected abstracts of medical journal articles that deal with cryotherapy of liver metastases. Cryosurgery in the Treatment of Liver Metastases Selected Annotated Medical Journal References [For the full abstract, use the links provided, or search on Pubmed. Ed.] Anticancer Res 2000 Sep-Oct;20(5C):3785-90 Cryosurgery as a means to improve surgical treatment of patients with multiple unresectable liver metastases. Rivoire M, De Cian F, Meeus P, Gignoux B, Frering B, Kaemmerlen P. Department of Surgery, Centre Leon Berard, 28, Rue Laennec, 69373 Lyon, France. rivoire@lyon.fnclcc.fr ... The aim of the study was to evaluate the results of cryosurgery in patients with multiple (five or more), heavily pretreated, unresectable liver metastases. ... 140 metastases were identified in 19 patients (mean, 7; range, 5-25) and 13 patients had a synchronous liver resection. Cryosurgery was used to treat 90 metastases (mean diameter, 30 mm; range, 10-135). There were no treatment-related deaths and the overall rate of complications was 21%. During a mean follow-up of 28 months (range, 5-60), tumours recurred at the site of cryosurgery in two patients (10%), in the remaining liver in nine patients (47%) and elsewhere in five patients (26%). Three patients had no evidence of disease 48, 50 and 60 months after liver cryosurgery, respectively. ... Cryosurgery may be effective in the treatment of patients with multiple unresectable liver metastases and should be investigated in multimodality treatment programmes. Fetch PMID: 11268455 Clin Exp Dermatol 1995 Jan;20(1):22-6 Response of leiomyosarcoma to cryosurgery: clinicopathological and ultrastructural study. Montes LF, Ocampo J, Garcia NJ, Vaccaro F, Arra A, Abulafia J, Wilborn WH, Lembrande RG. Structural Research Center, Mobile, AL, USA. Two elderly patients with primary leiomyosarcoma (LMS) of the scalp were treated cryosurgically. Complete involution of both tumours with full epithelialization of the affected sites was achieved. Pretreatment biopsies and sequential biopsies obtained after treatment allowed observation of microscopical changes taking place during tumour involution. Gradual shrinkage of both LMS, closely monitored under the operating microscope, started immediately after the initial freezing. Light and electron microscopic observation of the shrinking LMS revealed a rapid disappearance of the tumoral architecture. ... Two years after treatment, both patients showed no signs of recurrence. These results suggest cryosurgery--performed in an extended protracted fashion--can be a valuable therapeutic choice in the management of LMS, particularly when surgical excision is not feasible. Fetch PMID: 7671391 Am J Surg 1999 Dec;178(6):592-9 Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Pearson AS, Izzo F, Fleming RY, Ellis LM, Delrio P, Roh MS, Granchi J, Curley SA. Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. ... The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, multifocality, or inadequate functional hepatic reserve. Cryoablation has become a common treatment in select groups of these patients with unresectable liver tumors. However, hepatic cryoablation is associated with significant morbidity. Radiofrequency ablation (RFA) is a technique that destroys liver tumors in situ by localized application of heat to produce coagulative necrosis. In this study, we compared the complication and early local recurrence rates in patients with unresectable malignant liver tumors treated with either cryoablation or RFA. ... Cryoablation was performed on 88 tumors in 54 patients, and RFA was used to treat 138 tumors in 92 patients. Treatment-related complications, including 1 postoperative death, occurred in 22 of the 54 patients treated with cryoablation (40.7% complication rate). In contrast, there were no treatment-related deaths and only 3 complications after RFA (3.3% complication rate, P<0.001). With a median follow-up of 15 months in both patient groups, tumor has recurred in 3 of 138 lesions treated with RFA (2.2%), versus 12 of 88 tumors treated with cryoablation (13.6%, P<0.01). ...RFA is a safe, well-tolerated treatment for patients with unresectable hepatic malignancies. This study indicates that (1) complications occur much less frequently following RFA of liver tumors compared with cryoablation of liver tumors, and (2) early local tumor recurrence is infrequent following RFA. Fetch PMID: 10670879 J Surg Oncol 1998 Aug;68(4):242-5 Cryosurgical ablation of unresectable hepatic metastases. [None are Sarcomas. ed.] Dale PS, Souza JW, Brewer DA. Division of Surgical Oncology, Mercer University School of Medicine, Macon, Georgia, USA. ... Recent advancements in the technology of cryosurgery along with the development and refinement of intraoperative ultrasound have led to a feasible alternative for some patients with unresectable hepatic malignancy. This paper reports our first year's experience with cryosurgical ablation of unresectable hepatic malignancies... CONCLUSIONS: Cryosurgical ablation is a safe method of treating unresectable hepatic malignancies and it may extend survival in carefully selected patients. Fetch PMID: 9721710 Am J Surg 1997 Dec;174(6):614-7; discussion 617-8 Cryosurgical ablation of hepatic tumors. [None are Sarcomas...ed.] Crews KA, Kuhn JA, McCarty TM, Fisher TL, Goldstein RM, Preskitt JT. Department of Surgery, Baylor University Medical Center, Dallas 75246, USA. BACKGROUND: Cryosurgical ablation of hepatic tumors relies on nonspecific tissue necrosis due to freezing as well as microvascular thrombosis. Patients with selected primary and metastatic hepatic malignancies who are not candidates for surgical resection are afforded potentially curative benefit using this technique. ... Intraoperative ultrasound (IOUS) was used in all patients to help locate the tumor and guide the cryosurgical trocar to the lesions. ... Indications for cryosurgical ablation included bilobar and centrally located disease, poor medical risk, insufficient hepatic reserve, and involved margin after wedge resection. Major complications included hepatic parenchyma cracking requiring transfusion in 5 patients, 1 postoperative biliary stenosis, and 1 inferior vena cava injury. There were 3 postoperative deaths from non-hepatic-related events. ... The pattern of failure was identified at the site of cryosurgical ablation in 2 of 88 lesions. ...Cryosurgical ablation of selected hepatic malignancies is a safe and viable treatment for patients not amenable to surgical resection. Fetch PMID: 9409584 Am Surg 1997 Jan;63(1):63-8 Cryosurgical ablation of hepatic metastases from colorectal carcinomas. Yeh KA, Fortunato L, Hoffman JP, Eisenberg BL. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA. Surgical resection remains the only curative therapy for hepatic metastases from colon and rectal carcinoma. Many patients will be unresectable or have close microscopic margins. Cryoablation may improve local control and survival in those cases. ... We conclude that cryoablation of unresectable hepatic metastases or close resection margins is safe and may allow for improved survival in selected patients with metastatic colon and rectal carcinoma. Fetch PMID: 8985074
RFA {Radio Frequency Ablation]
Surgical Resection remains the therapeutic option of choice in the treatment of liver tumors. However, the majority of primary and metastatic tumors of the liver are not amenable to surgical resection at presentation. Radiofrequency ablation (RFA) is a new modality for local tumor destruction with minimal local and systemic complications. Radiofrequency heat ablation is useful as a primary treatment for unresectable liver cancers. The procedure can be used to treat the small residual tumor load in the contralateral [other side] lobe following liver resection in those considered unresectable at the first presentation. This new therapeutic strategy increases surgical resectability in patients previously judged unresectable. RFA can also be combined with cryoablation. Percutaneous RFA should be considered in high-risk patients or those with small local recurrences. Radiofrequency Ablation is a specialized technique, and should be carried out in a specialized liver treatment center. Celiotomy [abdominal incision] or laparoscopic approaches are preferred for RFA because they allow IOUS [intraoperative ultrasound], which may demonstrate hidden additional metastases. Operative RFA also allows concomitant resection, Cryoablation, or placement of a hepatic artery infusion pump, and isolation of the liver from adjacent organs. Laparoscopy and intraoperative ultrasound are essential in staging patients with hepatic malignant neoplasms. RFA can be carried out percutaneously [through the skin--meaning without a surgical incision.] Percutaneous RFA should be reserved for patients at high risk for anesthesia, those with recurrent or progressive lesions, and those with smaller lesions sufficiently isolated from adjacent organs. Radiofrequency ablation when combined with Cryoablation reduces the morbidity of multiple freezes. Although RFA is safer than Cryoablation and can be performed via different approaches (percutaneously, laparoscopically, or at celiotomy); it is usually limited by tumor size (<3 cm). However, in some organs, RFA is used to "nibble" at large tumors, and can ablate them in skilled hands. Complications of RFA can include bleeding into the chest or abdominal cavities or other structures, burns of vascular structures or skin or diaphragm, persistent pain, pleural effusions [water on the lung], cholecystitis [gall bladder inflammation], abcesses, trauma to the liver, and liver failure. Some of the RFA complications can be fatal. RFA is a safe and effective alternative for the attempted ablation of unresectable hepatic malignancies and when used along with it, can reduce the morbidity of cryosurgery. Percutaneous and laparoscopic RFA can be performed effectively with less than 24 hours of hospitalization. Radiofrequency ablation alone or combined with Surgical Resection or Cryoablation resulted in reduced blood loss and shorter hospital stay. For more information go to the RFA webpage For the latest updates, Search Pubmed for RFA and Treatment of Liver Metastases References for this section are below. RFA and Liver Metastases Selected Medical Journal Article Annotated References [For the full abstract, use the links provided, or search on Pubmed. Ed.] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2000 Nov;172(11):905-10 [Percutaneous radiofrequency ablation of hepatic neoplasms using a "cluster" electrode--first clinical results]. [Article in German] Trubenbach J, Konig CW, Duda SH, Schick F, Huppert PE, Claussen CD, Pereira PL. Abteilung fur Radiologische Diagnostik, Eberhard-Karls-Universitat Tubingen. jochen.truebenbach@med.uni-tuebingen.de ... A total of 17 percutaneous RFA was performed. The mean total procedure time was 2.0 h (1.5-2.5 h). Placement of the clustered electrode within the neoplasms using a inter- or subcostal approach under local anesthesia was possible in all cases. Complications related to percutaneous treatment and technical problems were not encountered. Diameter of the ablated areas ranged between 3.0-7.0 cm. Technical success was observed in 13 of 15 neoplasms (86.6%). During a mean follow-up of 7.25 months (range 3-12 months) 8 of 12 neoplasms showed a complete necrosis...... Percutaneous RFA using a clustered electrode is a feasible, safe and effective procedure for the treatment of hepatic neoplasms up to 6 cm in size. Clinical trial Fetch PMID: 11142123 Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2000 Aug;172(8):692-700 [MRI-guided percutaneous radiofrequency ablation of hepatic neoplasms--first technical and clinical experiences]. [Article in German] Huppert PE, Trubenbach J, Schick F, Pereira P, Konig C, Claussen CD. Abteilung fur Radiologische Diagnostik, Eberhard-Karls-Universitat Tubingen. PeterHuppert@t-online.de ... 16 hepatic neoplasms (1.3-3.0 cm in diameter) in 11 patients were treated by 22 percutaneous RFA sessions during a prospective study. .... Pretreatment studies, evaluation of tumor necrosis (one week after last RFA), and further follow-up studies every 3 months were performed using 1.5 Tesla MR systems. ... The mean procedure time was 2.8 (1.5-3.3) h. Complications related to percutaneous treatment were not encountered. 14 of 16 neoplasms (87%) showed no CM enhancement during MRI after the last RFA and were judged to be completely necrotic. In 11 tumors one treatment session was necessary, in 4 tumors two and in one tumor three. Follow-up studies revealed persistent complete necrosis in 13 of 14 (93%) tumors during a period of 3-18 (median: 11.8) months. In 5 patients new intrahepatic tumors developed that were not suitable for further RFA treatment because of their number, size and location. CONCLUSION: MR-guided RFA using single cooled tip electrodes is safe and technically effective for treatment of hepatic neoplasms up to 3 cm in size, however further improvements are necessary. Publication Types: Clinical trial Fetch PMID: 11013611 Ann Surg Oncol 2000 Sep;7(8):593-600 Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Wood TF, Rose DM, Chung M, Allegra DP, Foshag LJ, Bilchik AJ. Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California 90404, USA. ... Radiofrequency ablation (RFA) is increasingly used for the local destruction of unresectable hepatic malignancies. There is little information on its optimal approach or potential complications. ...: Since late 1997, we have undertaken 91 RFA procedures to ablate 231 unresectable primary or metastatic liver tumors in 84 patients. RFA was performed via celiotomy (n = 39), laparoscopy (n = 27), or a percutaneous approach (n = 25). ... ...Intraoperative ultrasound (IOUS) detected intrahepatic disease not evident on the preoperative scans of 25 of 66 patients (38%) undergoing RFA via celiotomy or laparoscopy. In 38 of 84 patients (45%), RFA was combined with resection or cryosurgical ablation (CSA), or both. RFA was used to treat an average of 2.8 lesions per patient, and the median size of treated lesions was 2 cm (range, 0.3-9 cm). The average hospital stay was 3.6 days overall (1.8 days for percutaneous and laparoscopic cases). Ten patients underwent a second RFA procedure (sequential ablations) and, in one case, a third RFA procedure for large (one patient), progressive (seven patients), and/or recurrent (three patients) lesions. Seven (8%) patients had complications: one skin burn; one postoperative hemorrhage; two simple hepatic abscesses; one hepatic abscess associated with diaphragmatic heat necrosis following sequential percutaneous ablations of a large lesion; one postoperative myocardial infarction; and one liver failure. There were three deaths, one (1%) of which was directly related to the RFA procedure. Three of the complications, including one RFA-related death, occurred after percutaneous RFA. At a median follow-up of 9 months (range, 1-27 months), 15 patients (18%) had recurrences at an RFA site, and 36 patients (43%) remained clinically free of disease. ... Celiotomy or laparoscopic approaches are preferred for RFA because they allow IOUS, which may demonstrate occult hepatic disease. Operative RFA also allows concomitant resection, CSA, or placement of a hepatic artery infusion pump, and isolation of the liver from adjacent organs. Percutaneous RFA should be reserved for patients at high risk for anesthesia, those with recurrent or progressive lesions, and those with smaller lesions sufficiently isolated from adjacent organs. Complications may be minimized when these approaches are applied selectively. Publication Types: Clinical trial Clinical trial, phase ii Fetch PMID: 11005558 Eur Radiol 2000;10(6):926-9 Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis. Francica G, Marone G, Solbiati L, D'Angelo V, Siani A. Divisione di Gastroenterologia, Ospedale Cardinale Ascalesi, Naples, Italy. giampierofrancica@libero.it ... The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures. Fetch PMID: 10879704 Arch Surg 2000 Jun;135(6):657-62; discussion 662-4 Cryosurgical ablation and radiofrequency ablation for unresectable hepatic malignant neoplasms: a proposed algorithm. Bilchik AJ, Wood TF, Allegra D, Tsioulias GJ, Chung M, Rose DM, Ramming KP, Morton DL. John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif 90404, USA. bilchika@jwci.org ...Thermal ablation of unresectable hepatic tumors can be achieved by cryosurgical ablation (CSA) or radiofrequency ablation (RFA). The relative advantages and disadvantages of each technique have not yet been determined. ...Laparoscopy identified extrahepatic disease in 12% of patients, and intraoperative hepatic ultrasound identified additional lesions in 33% of patients, despite extensive preoperative imaging. Radiofrequency ablation alone or combined with resection or CSA resulted in reduced blood loss (P<.05), thrombocytopenia (P<.05), and shorter hospital stay compared with CSA alone (P<.05). Median ablation times for lesions greater than 3 cm were 60 minutes with RFA and 15 minutes with CSA (P<.001). Local recurrence rates for lesions greater than 3 cm were also greater with RFA (38% vs 17%). CONCLUSIONS: Laparoscopy and intraoperative ultrasound are essential in staging patients with hepatic malignant neoplasms. Radiofrequency ablation when combined with CSA reduces the morbidity of multiple freezes. Although RFA is safer than CSA and can be performed via different approaches (percutaneously, laparoscopically, or at celiotomy), it is limited by tumor size (<3 cm). Percutaneous RFA should be considered in high-risk patients or those with small local recurrences. Fetch PMID: 10843361 Radiology 2000 Mar;214(3):761-8 Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Ierace T, Solbiati L, Gazelle GS. Department of Radiology, Ospedale Civile, Vimercate, Italy. lalivra@tin.it PURPOSE: To study local therapeutic efficacy, side effects, and complications of radio-frequency (RF) ablation in the treatment of medium and large hepatocellular carcinoma (HCC) lesions in patients with cirrhosis or chronic hepatitis. ... One-hundred fourteen patients who were under conscious sedation or general anesthesia had 126 HCCs greater than 3.0 cm in diameter treated with RF by using an internally cooled electrode. Eighty tumors were medium (3.1-5.0 cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating, and 51 were considered infiltrating. ...Complete necrosis was attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining 26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated successfully significantly more often than large and/or infiltrating tumors. Two major complications (death, hemorrhage requiring laparotomy) and five minor complications (self-limited hemorrhage, persistent pain) were observed. The single death was due to a break in sterile technique rather than to the RF procedure itself. CONCLUSION: RF ablation appears to be an effective, safe, and relatively simple procedure for the treatment of medium and large HCCs. Fetch PMID: 10715043 Am J Surg 1999 Dec;178(6):592-9 Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Pearson AS, Izzo F, Fleming RY, Ellis LM, Delrio P, Roh MS, Granchi J, Curley SA. Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. ... The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, multifocality, or inadequate functional hepatic reserve. Cryoablation has become a common treatment in select groups of these patients with unresectable liver tumors. However, hepatic cryoablation is associated with significant morbidity. Radiofrequency ablation (RFA) is a technique that destroys liver tumors in situ by localized application of heat to produce coagulative necrosis. In this study, we compared the complication and early local recurrence rates in patients with unresectable malignant liver tumors treated with either cryoablation or RFA. ... ...Treatment-related complications, including 1 postoperative death, occurred in 22 of the 54 patients treated with cryoablation ... In contrast, there were no treatment-related deaths and only 3 complications after RFA (3.3% complication rate, P<0.001). With a median follow-up of 15 months in both patient groups, tumor has recurred in 3 of 138 lesions treated with RFA (2.2%), versus 12 of 88 tumors treated with cryoablation (13.6%, P<0.01). ... RFA is a safe, well-tolerated treatment for patients with unresectable hepatic malignancies. This study indicates that (1) complications occur much less frequently following RFA of liver tumors compared with cryoablation of liver tumors, and (2) early local tumor recurrence is infrequent following RFA. Fetch PMID: 10670879 Cancer J Sci Am 1999 Nov-Dec;5(6):356-61 Radiofrequency ablation: a minimally invasive technique with multiple applications. Bilchik AJ, Rose DM, Allegra DP, Bostick PJ, Hsueh E, Morton DL. John Wayne Cancer Institute at Saint John's Health ...RFA is a safe and effective alternative for the ablation of unresectable hepatic malignancies and when used adjunctively can reduce the morbidity of cryosurgery. Percutaneous and laparoscopic RFA can be performed effectively with less than 24 hours of hospitalization. Intraoperative ultrasonography is essential for accurate staging. Fetch PMID: 10606477 Am Surg 1999 Nov;65(11):1009-14 Radiofrequency ablation: a novel primary and adjunctive ablative technique for hepatic malignancies. Rose DM, Allegra DP, Bostick PJ, Foshag LJ, Bilchik AJ. John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA. The majority of primary and metastatic tumors of the liver are not amenable to surgical resection at presentation. Radiofrequency ablation (RFA) is a new modality for local tumor destruction with minimal local and systemic complications. We prospectively reviewed the experience with RFA at a single institute as a primary or adjunctive ablative technique in the treatment of hepatic malignancies. .... RFA is a safe and effective method of tumor ablation for hepatic malignancies. This technique can be performed laparoscopically, at celiotomy, or percutaneously and can be used as a primary technique or in conjunction with other interventional procedures. Fetch PMID: 10551746 Ann Surg 1999 Jul;230(1):1-8 Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Curley SA, Izzo F, Delrio P, Ellis LM, Granchi J, Vallone P, Fiore F, Pignata S, Daniele B, Cremona F. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. ... To describe the safety and efficacy of radiofrequency ablation (RFA) to treat unresectable malignant hepatic tumors in 123 patients. ... The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, or multifocality or inadequate functional hepatic reserve. Local application of heat is tumoricidal; therefore, the authors investigated a novel RFA system to treat patients with unresectable hepatic cancer. ... All treated tumors were completely necrotic on imaging studies after completion of RFA treatments. With a median follow-up of 15 months, tumor has recurred in 3 of 169 treated lesions (1.8%), but metastatic disease has developed at other sites in 34 patients (27.6%). ... RFA is a safe, well-tolerated, and effective treatment to achieve tumor destruction in patients with unresectable hepatic malignancies. Because patients are at risk for the development of new metastatic disease after RFA, multimodality treatment approaches that include RFA should be investigated. Publication Types: Clinical trial Fetch PMID: 10400029 Am J Surg 1999 Apr;177(4):303-6 Clinical short-term results of radiofrequency ablation in primary and secondary liver tumors. Jiao LR, Hansen PD, Havlik R, Mitry RR, Pignatelli M, Habib N. Liver Surgery Section, Imperial College School of Medicine, The Hammersmith Hospital, London, England, U.K. ... Radiofrequency ablation (RFA) is emerging as a new therapeutic method for management of solid tumors. We report here our experience in the use of this technique for management of primary and secondary unresectable liver cancers. ...Radiofrequency heat ablation is useful as a primary treatment for unresectable liver cancers. The procedure can be used to treat the small residual tumor load in the contralateral lobe following liver resection in those considered unresectable at the first presentation. This new therapeutic strategy seems to increase surgical resectability in patients judged unresectable. Publication Types: Clinical trial Fetch PMID: 10326848 Radiology 1999 Mar;210(3):655-61 Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS. Department of Radiology, Ospedale Civile, Vimercate, Italy. PURPOSE: To compare the effectiveness of radio-frequency (RF) ablation with that of percutaneous ethanol injection in the treatment of small hepatocellular carcinoma (HCC). ...: Complete necrosis was achieved in 47 of 52 tumors with RF ablation (90%) and in 48 of 60 tumors with percutaneous ethanol injection (80%). These results were obtained with an average of 1.2 sessions per tumor with RF ablation and 4.8 sessions per tumor with percutaneous ethanol injection. One major complication (hemothorax that required drainage) and four minor complications (intraperitoneal bleeding, hemobilia, pleural effusion, cholecystitis) occurred in patients treated with RF ablation; no complications occurred in patients treated with percutaneous ethanol injection. ... RF ablation results in a higher rate of complete necrosis and requires fewer treatment sessions than percutaneous ethanol injection. However, the complication rate is higher with RF ablation than with percutaneous ethanol injection. RF ablation is the treatment of choice for most patients with HCC. Fetch PMID: 10207464
Microwave Ablation
Liver Metastases & Microwave Ablation Surgery remains the treatment of choice for patients with resectable hepatic tumors. However, when there are multiple tumors caused by intrahepatic metastases, multidisciplinary treatments consisting of reduction surgery, microwave ablation, ethanol injection, and intra-arterial chemotherapy might be useful. Non-resectable situations are often improved to resectable ones by use of the newer modalities. Furthermore, in situations where an operation is contraindicated, ablative techniques can still offer the possibility of cure, if other tumor is not present. Theoretical studies have suggested that microwave energy can increase the depth of heating compared with radiofrequency energy. Complications would be similar to RFA treatments. For the latest update, Search Pubmed for Microwave Ablation and Hepatic Metastases References for this Section are below. Liver Metastases & Microwave Ablation Selected Medical Journal Article Annotated References [For the full abstract, use the links provided, or search on Pubmed. Ed.] Cancer 2000 Jul 15;89(2):276-84 Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Shibata T, Niinobu T, Ogata N, Takami M. Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan. ... Compared with other treatments, microwave coagulation is a relatively less invasive treatment for various kinds of solid tumors. Although its effectiveness in primary hepatocellular carcinoma has been shown, its effectiveness in the treatment of hepatic metastases from colorectal carcinoma has been unclear. The aim of this study was to evaluate its effectiveness in the treatment of multiple hepatic metastases from colorectal carcinoma by comparing this technique with that of hepatic resection. One-, 2-, and 3-year survival rates and mean survival times were 71%, 57%, 14%, and 27 months, respectively, in the microwave group, whereas they were 69%, 56%, 23%, and 25 months, respectively, in the hepatectomy group. The difference between these two groups was statistically not significant (P = 0.83). On the other hand, the amount of intraoperative blood loss in the microwave group (360 +/- 230 mL) was smaller than that in the hepatectomy group (910 +/- 490 mL, P < 0.05). ... Microwave coagulation therapy is suggested to be equally effective as hepatic resection in the treatment of multiple (two to nine) hepatic metastases from colorectal carcinoma, whereas its surgical invasiveness is less than that of hepatic resection. Copyright 2000 American Cancer Society. Publication Types: Clinical trial Randomized controlled trial Fetch PMID: 10918156 Gan To Kagaku Ryoho 2000 Oct;27(12):1842-5 [Assessment of colorectal cancer patients exhibiting bilobular multiple hepatic metastases]. [Article in Japanese] Shibata T, Shimano T, Kitada M, Niinobu T, Fukushima Y, Hata S, Fujita J, Ikeda K, Hayashida H, Takahashi Y, et.al. Dept. of Surgery, Toyonaka Municipal Hospital. We assessed 23 patients who underwent surgical therapy of hepatectomy or microwave coagulation therapy (MCT) for bilobular multiple hepatic metastatic foci following curative resection of the primary lesion of colorectal cancer. .... MCT was considered to be useful local therapy for cancer as the first therapy and as a therapy following recurrence. Fetch PMID: 11086426 Radiographics 2000 Jan-Feb;20(1):9-27 Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough. Dodd GD 3rd, Soulen MC, Kane RA, Livraghi T, Lees WR, Yamashita Y, Gillams AR, Karahan OI, Rhim H. Department of Radiology, University of Texas Health Science Center at San Antonio, 78284-7800, USA. Six existing minimally invasive techniques for the treatment of primary and secondary malignant hepatic tumors--radio-frequency ablation, microwave ablation, laser ablation, cryoablation, ethanol ablation, and chemoembolization--are reviewed and debated by noted authorities from six institutions from around the world. All of the authors currently believe that surgery remains the treatment of choice for patients with resectable hepatic tumors. However, the clinical results of each of the minimally invasive techniques presented have exceeded those obtained with conventional chemotherapy or radiation therapy. Thus, for nonsurgical patients, these techniques are becoming standard independent or adjuvant therapies. In addition, with continued improvement in technology and increasing clinical experience, one or more of these minimally invasive techniques may soon challenge surgical resection as the treatment of choice for patients with limited hepatic tumor. Fetch PMID: 10682768 Endoscopy 2000 Aug;32(8):591-7 Laparoscopic microwave coagulation therapy for hepatocellular carcinoma. Seki S, Sakaguchi H, Kadoya H, Morikawa H, Habu D, Nishiguchi S, Shiomi S, Kitada T, Kuroki T. Third Dept. of Internal Medicine, Osaka City University Medical School, Osaka, Japan. s.seki@med.osaka-cu.ac.jp ... Several different effective forms of treatment are available, singly or in combination, for patients with hepatocellular carcinoma (HCC). These include surgical resection, transcatheter arterial embolization, percutaneous ethanol injection, and percutaneous microwave coagulation therapy. In this study, we carried out laparoscopic microwave coagulation therapy (LMCT), using laparoscopic microwave electrodes to treat HCC. ...The mean longest axis of the ... coagulated areas including the nodules was 40 mm, with additional therapy being required in two patients. Complete efficacy of the treatment was observed in 21 patients (87.5%), but local recurrences were seen in three of them one year after LMCT. The three-year survival rate was 92%... Hemostasis was complete, but mild pneumothorax occurred in three patients. ... LMCT under local anesthesia is a minimally invasive and effective therapy when carried out on a single occasion to treat HCCs located near the liver surface, and it can be safely performed under direct visual guidance. Fetch PMID: 10935786 Am J Gastroenterol 1999 Jul;94(7):1914-7 Standards for selecting percutaneous ethanol injection therapy or percutaneous microwave coagulation therapy for solitary small hepatocellular carcinoma: consideration of local recurrence. Horigome H, Nomura T, Saso K, Itoh M. First Department of Internal Medicine, Nagoya City University Medical School, Japan. ... Percutaneous ethanol injection therapy (PEIT) and percutaneous microwave coagulation therapy (PMCT) are effective treatments for small hepatocellular carcinoma (HCC). There are no clear standards, however, for the selection of PEIT or PMCT. We determined standards based on local recurrence. ...PEIT was effective for treating well-differentiated HCC, and PMCT was effective for treating HCC measuring < or = 15 mm in diameter. PMCT was superior to PEIT for treating patients with HCC measuring < or = 15 mm in diameter. In such cases with well-differentiated HCC, PEIT was as effective as PMCT. CONCLUSIONS: The selection of PEIT or PMCT to treat patients with HCC should be based on tumor size and cell differentiation. Fetch PMID: 10406259 Compiled by doctordee May 2001

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