Radiofrequency Ablation of Hepatocellular Carcinoma
Section snippets
Principles and techniques
The treatment of thermoablation with RF exploits the conversion of the energy of an electromagnetic wave into heat. A generator is used that converts normal energy supplied by an electric alternating current of 90 Hz into the RF band of 500 KHz. The current is linked to an active electrode in the form of a needle, which is inserted into the tumor so that the body becomes part of the electric circuit, and is dispersed with a passive electrode in the form of a plate, which is applied to the skin
RFA equipment
Several generators are commercially available, some of which have incorporated circuitry that enables measurements of generator output (wattage and milliamperage), tissue impedance, and electrode tip temperature. The most widely used instruments are made by 3 companies: RadioTherapeutics Corporation (Sunnyvale, CA, USA), acquired by Boston Scientific; RITA Medical Systems (Mountain View, CA, USA), acquired by AngioDynamics; and Radionics (Burlington, MA, USA), acquired by Covidien, a division
Procedure
RFA is generally performed percutaneously under ultrasound (US) guidance, because this real-time control allows faster execution, precise centering of the electrode on the target, continuous monitoring of distribution of vapor bubbles, and determination of the appropriate amount of energy to give each time. A hyperechoic focus, which represents microbubbles of gas that form in the heated tissue, increases in size during the procedure, starting from the distal part of the uninsulated tip and
Evaluation of therapeutic efficacy
To evaluate the therapeutic response, that is to determine whether the tumor has become completely necrotic or whether areas of neoplastic tissue are still present, a combination of investigations and serum assays for tumor markers is used. They are the same as those adopted during initial staging and controls. Because there have been many investigations and some of them are comparable, we prefer to routinely use only contrast-enhanced US (CEUS) (with SonoVue [Bracco, Milan, Italy])25 and
Complications
Multicenter or monocenter studies focused on complications registered mortality ranging from 0.3% to 1.4%, and a major complication rate ranging from 2.2% to 10.6%.
An Italian study reported first the complications encountered in 41 centers using percutaneous internally cooled electrodes.26 Enrollment included 2320 patients with 3554 lesions (1610 had HCC, 693 had metastases prevalently from colorectal cancer, and 17 had cholangiocellular carcinoma). Six deaths (0.3%) were noted, including 2
Indications
The Barcelona Clinic Liver Cancer (BCLC) therapeutic flowchart for patients with HCC and its recommendations, because it is endorsed by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases (AASLD), are the most applied worldwide.35 This situation means that in many centers the choice of treatment is decided according to its suggestions. This strictness is intrinsic and usual in every protocol referring to cancer treatment, but the
Summary
Advances in diagnostic imaging and fine-needle biopsy techniques have permitted the development of PATs. RFA, generally performed under US guidance, is currently considered the gold standard among them. On the strength of some recent randomized trials, its indications include operable patients with small HCC, and inoperable patients with more advanced disease also in combination with other procedures. However, RFA needs adequate training because the learning curve was shown to be an independent
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Cited by (29)
Interventional oncology for hepatocellular carcinoma
2016, Clinics and Research in Hepatology and GastroenterologyCost-effectiveness analysis of stereotactic body radiation therapy compared with radiofrequency ablation for inoperable colorectal liver metastases
2016, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Treatment-related complications rates for SBRT were limited to severe toxicities (grade 3 or higher complications, such as duodenal ulceration, perforation, and radiation-induced liver disease). Additionally, for RFA, we included complications that required extended hospital stays, such as hepatic abscess, intrahepatic bleeding, and grade 3-4 diarrhea (39). Although such severe toxicities, which need intervention by adding costs, are generally uncommon with SBRT (0%-3%; Table 1), lesser toxicities (grade 1 and 2) such as nausea, diarrhea, abdominal pain, and skin reaction may occur but are frequently underreported in existing studies.
Radiofrequency ablation in nodular thyroid diseases
2013, Journal of Medical UltrasoundCitation Excerpt :In the past two decades, the principal use of radiofrequency ablation was for liver malignancies, both primary and secondary. A lot of research related to the development and improvement of radiofrequency techniques to treat liver cancer with satisfactory results has been published [19]. The strategy to destroy a malignant lesion completely is different from the treatment of cardiac arrhythmia.
Long-term effectiveness of Radiofrequency Ablation for solitary small Hepatocellular Carcinoma: A retrospective analysis of 363 patients
2013, Digestive and Liver DiseaseCitation Excerpt :In addition, recent papers [11–13] have shown that RFA can be offered to patients with HCC nodules up to 2 cm instead of surgical resection since overall survival and local control of the disease are not different from surgical series dealing with similar HCC stage. These suggestions have prompted many authorities to consider RFA as the first line treatment in very early HCC (stage 0) unless OLT is under consideration [14–16]. The aim of this multicentre study was to gather data on RFA ablation of single HCC nodules ≤3 with sustained ablation (at least 6 months after first interventional procedure) over the last decade with special emphasis on technique complications, overall survival, tumour recurrence and disease-free survival.
The author has nothing to disclose.