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CardioVascular and Interventional Radiology

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01.06.2012 | Clinical Investigation

Stereotactic Radiofrequency Ablation (SRFA) of Liver Lesions: Technique Effectiveness, Safety, and Interoperator Performance

verfasst von: Gerlig Widmann, Peter Schullian, Marion Haidu, Reto Bale

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 3/2012

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Abstract

Purpose

To evaluate technique effectiveness, safety, and interoperator performance of stereotactic radiofrequency ablation (SRFA) of liver lesions.

Methods

Retrospective review including 90 consecutive patients from January 2008 to January 2010 with 106 computed tomography-guided SRFA sessions using both single and multiple electrodes for the treatment of 177 lesions: 72 hepatocellular carcinoma (HCC) and 105 metastases with a mean size of 2.9 cm (range 0.5–11 cm). Technique effectiveness and 1-year local recurrence were evaluated by computed tomographic scans. Complications, mortality, and hospital days were recorded. The performance between an experienced and inexperienced interventional radiologist was compared.

Results

The overall technique effectiveness after a single SRFA was 95.5% (93.1% for HCC and 97.1% for metastases). Four of the eight unsuccessfully treated lesions could be retreated (secondary technique effectiveness of 97.7%). Local recurrence at 1 year was 2.9%. Technique effectiveness was significantly different for lesions <5 cm (96.7%) and >5 cm (87.5%) (P = 0.044) but not for lesions <3 cm (95.9%) and 3–5 cm (100%). Compared to clear parenchymal property (97.3%), vessel vicinity (93.3%) (P = 0.349) and subcapsular (95.2%) (P = 0.532) had no, but hollow viscera vicinity (83.3%) had a significantly lower technique effectiveness (P = 0.020). Mortality rate was 0.9%. Major complications and hospital days were higher for cirrhosis Child-Pugh B (20%, 7.2 days) than Child-Pugh A (3.1%, 4.7 days) patients and for metastases (5.1%, 4.3 days). There was no significant difference in interoperator performance.

Conclusion

SRFA allowed for efficient, reliable, and safe ablation of large-volume liver disease.

Bale R, Widmann G (2007) Navigated CT-guided interventions. Minim Invasive Ther Allied Technol 16:196–204PubMedCrossRef

Bale R, Widmann G, Stoffner DI (2010) Stereotaxy: breaking the limits of current radiofrequency ablation techniques. Eur J Radiol 75:32–36PubMedCrossRef

Bale R, Widmann G, Haidu M (2010) Stereotactic radiofrequency ablation. Cardiovasc Intervent Radiol. doi:10.1007/s00270-010-9966-z

Chen MH, Wei Y, Yan K et al (2006) Treatment strategy to optimize radiofrequency ablation for liver malignancies. J Vasc Interv Radiol 17:671–683PubMedCrossRef

Crocetti L, de Baere T, Lencioni R (2010) Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Intervent Radiol 33:11–17PubMedCrossRef

Dupuy DE, Goldberg SN (2001) Image-guided radiofrequency tumor ablation: challenges and opportunities—part II. J Vasc Interv Radiol 12:1135–1148PubMedCrossRef

Gazelle GS, Goldberg SN, Solbiati L, Livraghi T (2000) Tumor ablation with radio-frequency energy. Radiology 217:633–646PubMed

Goldberg SN, Gazelle GS, Mueller PR (2000) Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 174:323–331PubMed

Goldberg SN, Grassi CJ, Cardella JF et al (2009) Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 20(7 Suppl):S377–S390PubMedCrossRef

10.

Head HW, Dodd GD III, Dalrymple NC et al (2007) Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: frequency of diaphragmatic injury. Radiology 243:877–884PubMedCrossRef

11.

Hori T, Nagata K, Hasuike S et al (2003) Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol 38:977–981PubMedCrossRef

12.

Jacob AL, Regazzoni P, Steinbrich W, Messmer P (2000) The multifunctional therapy room of the future: image guidance, interdisciplinarity, integration and impact on patient pathways. Eur Radiol 10:1763–1769PubMedCrossRef

13.

Lau WY, Lai EC (2009) The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review. Ann Surg 249:20–25PubMedCrossRef

14.

Lee JM, Han JK, Kim HC et al (2007) Switching monopolar radiofrequency ablation technique using multiple, internally cooled electrodes and a multichannel generator: ex vivo and in vivo pilot study. Invest Radiol 42:163–171PubMedCrossRef

15.

Lencioni R, Della Pina C, Bartolozzi C (2005) Percutaneous image-guided radiofrequency ablation in the therapeutic management of hepatocellular carcinoma. Abdom Imaging 30:401–408PubMedCrossRef

16.

Lin SM, Lin CC, Chen WT et al (2007) Radiofrequency ablation for hepatocellular carcinoma: a prospective comparison of four radiofrequency devices. J Vasc Interv Radiol 18:1118–1125PubMedCrossRef

17.

Livraghi T, Goldberg SN, Lazzaroni S et al (1999) Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 210:655–661PubMed

18.

Livraghi T, Goldberg SN, Lazzaroni S et al (2000) Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 214:761–768PubMed

19.

Livraghi T, Solbiati L, Meloni MF et al (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226:441–451PubMedCrossRef

20.

Livraghi T, Solbiati L, Meloni F et al (2003) Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the “test-of-time approach”. Cancer 97:3027–3035PubMedCrossRef

21.

Mulier S, Mulier P, Ni Y et al (2002) Complications of radiofrequency coagulation of liver tumours. Br J Surg 89:1206–1222PubMedCrossRef

22.

Mulier S, Ni Y, Jamart J et al (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171PubMedCrossRef

23.

Nakai M, Sato M, Sahara S et al (2009) Radiofrequency ablation assisted by real-time virtual sonography and CT for hepatocellular carcinoma undetectable by conventional sonography. Cardiovasc Intervent Radiol 32:62–69PubMedCrossRef

24.

Ng KK, Poon RT, Lo CM et al (2008) Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg 12:183–191PubMedCrossRef

25.

Okuwaki Y, Nakazawa T, Shibuya A et al (2008) Intrahepatic distant recurrence after radiofrequency ablation for a single small hepatocellular carcinoma: risk factors and patterns. J Gastroenterol 43:71–78PubMedCrossRef

26.

Rhim H, Goldberg SN, Dodd GD III et al (2001) Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. Radiographics 21(Spec No):S17–S35

27.

Rhim H, Dodd GD III, Chintapalli KN et al (2004) Radiofrequency thermal ablation of abdominal tumors: lessons learned from complications. Radiographics 24:41–52PubMedCrossRef

28.

Rhim H, Lim HK, Kim YS et al (2008) Radiofrequency ablation of hepatic tumors: lessons learned from 3000 procedures. J Gastroenterol Hepatol 23:1492–1500PubMedCrossRef

29.

Rhim H, Choi D, Kim YS et al (2010) Ultrasonography-guided percutaneous radiofrequency ablation of hepatocellular carcinomas: a feasibility scoring system for planning sonography. Eur J Radiol 75:253–258PubMedCrossRef

30.

Sakuhara Y, Shimizu T, Abo D et al (2007) Influence of surgical staples on radiofrequency ablation using multitined expandable electrodes. Cardiovasc Intervent Radiol 30:1201–1205PubMedCrossRef

31.

Seror O, N’Kontchou G, Ibraheem M et al (2008) Large (≥5.0-cm) HCCs: multipolar RF ablation with three internally cooled bipolar electrodes—initial experience in 26 patients. Radiology 248:288–296PubMedCrossRef

32.

Solbiati L, Livraghi T, Goldberg SN et al (2001) Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 221:159–166PubMedCrossRef

33.

Stang A, Fischbach R, Teichmann W et al (2009) A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases. Eur J Cancer 45:1748–1756PubMedCrossRef

34.

Stoffner R, Augscholl C, Widmann G et al (2009) Accuracy and feasibility of frameless stereotactic and robot-assisted CT-based puncture in interventional radiology: a comparative phantom study. Rofo 181:851–858PubMedCrossRef

35.

Tacke J, Mahnken A, Roggan A, Gunther RW (2004) Multipolar radiofrequency ablation: first clinical results. Rofo 176:324–329PubMedCrossRef

36.

Wagner A, Schicho K, Birkfellner W et al (2002) Quantitative analysis of factors affecting intraoperative precision and stability of optoelectronic and electromagnetic tracking systems. Med Phys 29:905–912PubMedCrossRef

37.

Widmann G, Bodner G, Bale R (2009) Tumour ablation: technical aspects. Cancer Imaging 9(Spec No A):S63–S67

38.

Widmann G, Schullian P, Haidu M et al (2010) Respiratory motion control for stereotactic and robotic liver interventions. Int J Med Robot 6:343–349PubMedCrossRef

39.

Widmann G, Schullian P, Haidu M et al (2011) Targeting accuracy of CT-guided stereotaxy for radiofrequency ablation of liver tumours. Minim Invasive Ther Allied Technol. doi:10.3109/13645706.2010.533923

40.

Wood BJ, Zhang H, Durrani A et al (2005) Navigation with electromagnetic tracking for interventional radiology procedures: a feasibility study. J Vasc Interv Radiol 16:493–505PubMedCrossRef

41.

Zhang H, Banovac F, Lin R et al (2006) Electromagnetic tracking for abdominal interventions in computer aided surgery. Comput Aided Surg 11:127–136PubMed

Titel: Stereotactic Radiofrequency Ablation (SRFA) of Liver Lesions: Technique Effectiveness, Safety, and Interoperator Performance
verfasst von: Gerlig Widmann
Peter Schullian
Marion Haidu
Reto Bale
Publikationsdatum: 01.06.2012
Verlag: Springer-Verlag
Erschienen in: CardioVascular and Interventional Radiology / Ausgabe 3/2012
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-011-0200-4

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