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Semin intervent Radiol 2013; 30(01): 049-055
DOI: 10.1055/s-0033-1333653
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Radiofrequency Ablation of Liver Tumors

Shaunagh McDermott
1   Division of Abdominal Imaging and Interventional Radiology, Department of Radiology
,
Debra A. Gervais
1   Division of Abdominal Imaging and Interventional Radiology, Department of Radiology
2   Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
27 February 2013 (online)

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Abstract

Radiofrequency ablation (RFA) is an alternative therapy for hepatocellular carcinoma and liver metastases when resection cannot be performed or, in the case of hepatocellular carcinoma, when transplant cannot be performed in a timely enough manner to avoid the risk of dropping off the transplant list. RFA has the advantage of being a relatively low-risk minimally invasive procedure used in the treatment of focal liver tumors. This review article discusses the current evidence supporting RFA of liver tumors, as well as the indications, complications, and follow-up algorithms used after RFA.

Keywords

radiofrequency ablation - liver - hepatocellular carcinoma - metastases - technique
 

  • References

  • 1 Lencioni R, Crocetti L. Radiofrequency ablation of liver cancer. Tech Vasc Interv Radiol 2007; 10 (1) 38-46
    CrossrefPubMedGoogle Scholar
  • 2 Rhim H, Goldberg SN, Dodd III GD , et al. Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. Radiographics 2001; 21 (Spec No) S17-S35 ; discussion S36–S39
    PubMedGoogle Scholar
  • 3 Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000; 174 (2) 323-331
    CrossrefPubMedGoogle Scholar
  • 4 Dodd III GD, Frank MS, Aribandi M, Chopra S, Chintapalli KN. Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations. AJR Am J Roentgenol 2001; 177 (4) 777-782
    CrossrefPubMedGoogle Scholar
  • 5 Koda M, Murawaki Y, Hirooka Y , et al. Complications of radiofrequency ablation for hepatocellular carcinoma in a multicenter study: an analysis of 16 346 treated nodules in 13,283 patients. Hepatol Res 2012; 42 (11) 1058-1064
    CrossrefPubMedGoogle Scholar
  • 6 Chang IS, Rhim H, Kim SH , et al. Biloma formation after radiofrequency ablation of hepatocellular carcinoma: incidence, imaging features, and clinical significance. AJR Am J Roentgenol 2010; 195 (5) 1131-1136
    CrossrefPubMedGoogle Scholar
  • 7 Lam VW, Ng KK, Chok KS , et al. Safety and efficacy of radiofrequency ablation for periductal hepatocellular carcinoma with intraductal cooling of the central bile duct. J Am Coll Surg 2008; 207 (2) e1-e5
    PubMedGoogle Scholar
  • 8 Ohnishi T, Yasuda I, Nishigaki Y , et al. Intraductal chilled saline perfusion to prevent bile duct injury during percutaneous radiofrequency ablation for hepatocellular carcinoma. J Gastroenterol Hepatol 2008; 23 (8 Pt 2) e410-e415
    CrossrefPubMedGoogle Scholar
  • 9 Ogawa T, Kawamoto H, Kobayashi Y , et al. Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma—cooling effect by endoscopic nasobiliary drainage tube. Eur J Radiol 2010; 73 (2) 385-390
    CrossrefPubMedGoogle Scholar
  • 10 Song I, Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol 2009; 19 (11) 2630-2640
    CrossrefPubMedGoogle Scholar
  • 11 Kondo Y, Yoshida H, Shiina S, Tateishi R, Teratani T, Omata M. Artificial ascites technique for percutaneous radiofrequency ablation of liver cancer adjacent to the gastrointestinal tract. Br J Surg 2006; 93 (10) 1277-1282
    CrossrefPubMedGoogle Scholar
  • 12 Iwai S, Sakaguchi H, Fujii H , et al. Benefits of artificially induced pleural effusion and/or ascites for percutaneous radiofrequency ablation of hepatocellular carcinoma located on the liver surface and in the hepatic dome. Hepatogastroenterology 2012; 59 (114) 546-550
    PubMedGoogle Scholar
  • 13 Nam SY, Rhim H, Kang TW , et al. Percutaneous radiofrequency ablation for hepatic tumors abutting the diaphragm: clinical assessment of the heat-sink effect of artificial ascites. AJR Am J Roentgenol 2010; 194 (2) W227-W231
    CrossrefPubMedGoogle Scholar
  • 14 Llovet JM, Vilana R, Brú C , et al; Barcelona Clínic Liver Cancer (BCLC) Group. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001; 33 (5) 1124-1129
    CrossrefPubMedGoogle Scholar
  • 15 Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev 2007; 33 (5) 437-447
    CrossrefPubMedGoogle Scholar
  • 16 Komorizono Y, Oketani M, Sako K , et al. Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer 2003; 97 (5) 1253-1262
    CrossrefPubMedGoogle Scholar
  • 17 Hori T, Nagata K, Hasuike S , et al. Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol 2003; 38 (10) 977-981
    CrossrefPubMedGoogle Scholar
  • 18 Kang TW, Rhim H, Kim EY , et al. Percutaneous radiofrequency ablation for the hepatocellular carcinoma abutting the diaphragm: assessment of safety and therapeutic efficacy. Korean J Radiol 2009; 10 (1) 34-42
    CrossrefPubMedGoogle Scholar
  • 19 Sartori S, Tombesi P, Macario F , et al. Subcapsular liver tumors treated with percutaneous radiofrequency ablation: a prospective comparison with nonsubcapsular liver tumors for safety and effectiveness. Radiology 2008; 248 (2) 670-679
    CrossrefPubMedGoogle Scholar
  • 20 Cho YK, Rhim H, Ahn YS, Kim MY, Lim HK. Percutaneous radiofrequency ablation therapy of hepatocellular carcinoma using multitined expandable electrodes: comparison of subcapsular and nonsubcapsular tumors. AJR Am J Roentgenol 2006; 186 (5, Suppl) S269-S274
    CrossrefPubMedGoogle Scholar
  • 21 Lu DS, Raman SS, Limanond P , et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003; 14 (10) 1267-1274
    CrossrefPubMedGoogle Scholar
  • 22 Thanos L, Mylona S, Galani P, Pomoni M, Pomoni A, Koskinas I. Overcoming the heat-sink phenomenon: successful radiofrequency thermal ablation of liver tumors in contact with blood vessels. Diagn Interv Radiol 2008; 14 (1) 51-56
    PubMedGoogle Scholar
  • 23 Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Intervent Radiol 2010; 33 (1) 11-17
    CrossrefPubMedGoogle Scholar
  • 24 Kele PG, de Jong KP, van der Jagt EJ. Increase in volume of ablation zones during follow-up is highly suggestive of ablation site recurrence in colorectal liver metastases treated with radiofrequency ablation. J Vasc Interv Radiol 2012; 23 (4) 537-544
    CrossrefPubMedGoogle Scholar
  • 25 Llovet JM, Fuster J, Bruix J. Barcelona-Clínic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl 2004; 10 (2) (Suppl. 01) S115-S120
    CrossrefPubMedGoogle Scholar
  • 26 Peng ZW, Lin XJ, Zhang YJ , et al. Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study. Radiology 2012; 262 (3) 1022-1033
    CrossrefPubMedGoogle Scholar
  • 27 Chen MS, Li JQ, Zheng Y , et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006; 243 (3) 321-328
    CrossrefPubMedGoogle Scholar
  • 28 Huang J, Yan L, Cheng Z , et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 2010; 252 (6) 903-912
    CrossrefPubMedGoogle Scholar
  • 29 Chok KS, Ng KK, Poon RT , et al. Comparable survival in patients with unresectable hepatocellular carcinoma treated by radiofrequency ablation or transarterial chemoembolization. Arch Surg 2006; 141 (12) 1231-1236
    CrossrefPubMedGoogle Scholar
  • 30 Murakami T, Ishimaru H, Sakamoto I , et al. Percutaneous radiofrequency ablation and transcatheter arterial chemoembolization for hypervascular hepatocellular carcinoma: rate and risk factors for local recurrence. Cardiovasc Intervent Radiol 2007; 30 (4) 696-704
    CrossrefPubMedGoogle Scholar
  • 31 Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2011; 98 (9) 1210-1224
    CrossrefPubMedGoogle Scholar
  • 32 Zhang YJ, Liang HH, Chen MS , et al. Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: a prospective randomized trial. Radiology 2007; 244 (2) 599-607
    CrossrefPubMedGoogle Scholar
  • 33 Yang P, Liang M, Zhang Y, Shen B. Clinical application of a combination therapy of lentinan, multi-electrode RFA and TACE in HCC. Adv Ther 2008; 25 (8) 787-794
    CrossrefPubMedGoogle Scholar
  • 34 Morimoto M, Numata K, Kondou M, Nozaki A, Morita S, Tanaka K. Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer 2010; 116 (23) 5452-5460
    CrossrefPubMedGoogle Scholar
  • 35 Yao FY, Bass NM, Nikolai B , et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver Transpl 2003; 9 (7) 684-692
    CrossrefPubMedGoogle Scholar
  • 36 Fisher RA, Maluf D, Cotterell AH , et al. Non-resective ablation therapy for hepatocellular carcinoma: effectiveness measured by intention-to-treat and dropout from liver transplant waiting list. Clin Transplant 2004; 18 (5) 502-512
    CrossrefPubMedGoogle Scholar
  • 37 Brillet PY, Paradis V, Brancatelli G , et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma before liver transplantation: a prospective study with histopathologic comparison. AJR Am J Roentgenol 2006; 186 (5, Suppl) S296-S305
    CrossrefPubMedGoogle Scholar
  • 38 Lu DS, Yu NC, Raman SS , et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Hepatology 2005; 41 (5) 1130-1137
    CrossrefPubMedGoogle Scholar
  • 39 Lau WY, Lai EC. The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review. Ann Surg 2009; 249 (1) 20-25
    CrossrefPubMedGoogle Scholar
  • 40 Park J, Kim MH, Kim KP , et al. Natural history and prognostic factors of advanced cholangiocarcinoma without surgery, chemotherapy, or radiotherapy: a large-scale observational study. Gut Liver 2009; 3 (4) 298-305
    CrossrefPubMedGoogle Scholar
  • 41 Kim JH, Won HJ, Shin YM, Kim KA, Kim PN. Radiofrequency ablation for the treatment of primary intrahepatic cholangiocarcinoma. AJR Am J Roentgenol 2011; 196 (2) W205-9
    PubMedGoogle Scholar
  • 42 Kim KH, Yoon YS, Yu CS , et al. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. J Korean Surg Soc 2011; 81 (1) 25-34
    CrossrefPubMedGoogle Scholar
  • 43 Van Tilborg AA, Meijerink MR, Sietses C , et al. Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention. Br J Radiol 2011; 84 (1002) 556-565
    CrossrefPubMedGoogle Scholar
  • 44 Park JB, Kim YH, Kim J , et al. Radiofrequency ablation of liver metastasis in patients with locally controlled pancreatic ductal adenocarcinoma. J Vasc Interv Radiol 2012; 23 (5) 635-641
    CrossrefPubMedGoogle Scholar
  • 45 Park SY, Kim JH, Won HJ, Shin YM, Kim PN. Radiofrequency ablation of hepatic metastases after curative resection of extrahepatic cholangiocarcinoma. AJR Am J Roentgenol 2011; 197 (6) W1129-W1134
    CrossrefPubMedGoogle Scholar
  • 46 Gamblin TC, Christians K, Pappas SG. Radiofrequency ablation of neuroendocrine hepatic metastasis. Surg Oncol Clin N Am 2011; 20 (2) 273-279 , vii–viii
    CrossrefPubMedGoogle Scholar
  • 47 Illing R, Gillams A. Radiofrequency ablation in the treatment of breast cancer liver metastases. Clin Oncol (R Coll Radiol) 2010; 22 (9) 781-784
    CrossrefPubMedGoogle Scholar
  • 48 Kim HR, Cheon SH, Lee KH , et al. Efficacy and feasibility of radiofrequency ablation for liver metastases from gastric adenocarcinoma. Int J Hyperthermia 2010; 26 (4) 305-315
    CrossrefPubMedGoogle Scholar
  • 49 Oshowo A, Gillams A, Harrison E, Lees WR, Taylor I. Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases. Br J Surg 2003; 90 (10) 1240-1243
    CrossrefPubMedGoogle Scholar
  • 50 Cirocchi R, Trastulli S, Boselli C , et al. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev 2012; 6: CD006317
    PubMedGoogle Scholar