Local radiofrequency ablation

Unresectable and chemorefractory malignant tumors in the liver are a major cause of death in solid tumors. Potentially curative surgery is uncommon for these patients. A number of liver-directed therapies are now available and are making important contributions to quality of life, prolonged time to liver progression, and overall survival. Limited surgery involving laparoscopy and percutaneous access approaches enables local tumor resection, cryotherapy, laser-induced interstitial thermotherapy, and radiofrequency ablation. 

Bricault I, Kikinis R, Morrison PR et al (2006) Liver metastases 3D shape-based analysis of CT scans for detection of local recurrence after radiofrequency ablation. Radiology 241 243-250... 

The ultimate goal for radiofrequency ablation (RFA) is to prolong survival of the patients. Therefore, the indications for local ablative treatment are similar to those established for resection - however with some modifications (Table 3.5.1). There is general... 

Rossi S, Fornari F, Pathies C et al (1990) Thermal lesions induced by 480 kHz localized current field in guinea pig and pig liver. Tumori 76 54-57 Scheele J, Stang R, Altendorf-Hofmann A et al (1995) Resection of colorectal liver metastases. World J Surg 19 59-71 Siperstein AE, Berber E (2001) Cryoablation, percutaneous alcohol injection, and radiofrequency ablation for treatment of neuroendocrine liver metastases. World J Surg 25 693-696... 

Vaughn C, Mychaskiw G, Sewell P (2002) Massive hemorrhage during radiofrequency ablation of a pulmonary neoplasm. Anesth Analg 94 1149-1151 Visioli AG, Rivens IH, ter Haar GR, Norwich A, Huddart RA, Moskovic E et al (1999) Preliminary results of a phase I dose escalation clinical trial using focused ultrasound in the treatment of localized tumours. Eur J Ultrasound 9(1) 11-18... 

Recently a significant shift from PEI to radiofrequency ablation (RFA) procedures has been seen, reflected by the respective literature (Fig. 8.1). Fewer RFA treatment sessions are needed compared to PEI to obtain the same response, which, together with a superior local control rate, makes RFA the... 

Radiofrequency thermal ablation (RFTA) S. Rossi et al. (1990, 1993) were the first to introduce this procedure. Under analgosedation and local anaesthesia, an expandable, cooled-tip needle electrode is inserted per-cutaneously into the tumour with the help of US, CT or MR guidance. There are various types of probes with some differences. Due to high-frequency alternating current (480-500 kHz), the tumour tissue is gradually heated (up to max. 105 °C). A necrosis voume of 4(-5) cm in diameter can be achieved. An indication is given for 1-3 foci, each with a maximum size of 5 cm in diameter. This also applies to compromised liver func-... 

Recently, several minimally invasive, image-guided therapies have been developed for the local treatment of primary and secondary neoplasms, in patients who are poor surgical candidates. These minimally invasive methods of therapy permit the destruction of tumor without necessitating their removal and rely on different mechanisms for tumor destruction. Radiofrequency, microwave, and laser ablation all destroy tumor by thermal injury. Cryoablation and... 

Results from published series have demonstrated prolonged survival and excellent rates of local control after percutaneous ablation, especially in patients with HCC (Gazelle et al 2000 McGhana and Dodd 2001 Rossi et al. 1995 Solbiati et al. 2001). Table 8.1 summarizes results from various reported series of percutaneous radiofrequency treatment of malignant liver tumors. 

Transarterial chemoembolization (TACE) has widely been proposed as the palliative treatment of choice. However, most data indicate a limited benefit from TACE in patients with advanced liver cirrhosis (Llovet et al. 2003). In the past percutaneous tumor ablation by radiofrequency (RFA) or laser-induced thermo therapy (LITT) has supplemented ethanol injection. Any of these methods has hmitations with respect to tumor size, perfusion and localization, as described above. 

Tumors not suitable for local ablative therapy such as radiofrequency and laser ablation... 

---