Abstract
Image-guided percutaneous radiofrequency ablation (RFA) is a viable treatment option for unresectable liver metastasis from gastrointestinal cancer. With optimized technology and sufficient safety margins, RFA reaches oncologic results comparable to surgery. However, use of RFA for resectable liver metastases is controversially discussed. The feasibility and success of RFA depend on the size and location of the liver lesion. Single-needle in-plane techniques have important limitations and may be largely overcome by multineedle approaches using 3D treatment planning and stereotactic needle guidance. The major obstacle for the acceptance of RFA is the current lack of an international standardized definition and documentation of treatment success. In analogy to surgical R0 resection, A0 ablation including a 3D safety margin of at least 5 mm, objectively verified and documented by true fusion of post- with preablation images has to be demanded. Considering the patient’s huge advantage of a minimal invasive local therapy, options for RFA should be discussed in interdisciplinary oncologic boards and communicated to the patient. Randomized controlled studies for getting answers to whether A0 ablation may prove as a true alternative to surgical resection in liver metastasis from gastrointestinal cancer are heavily awaited.
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References
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 Feb;174(2):323–31.
Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002 Jun;235(6):759–66.
Robertson DJ, Stukel TA, Gottlieb DJ, Sutherland JM, Fisher ES. Survival after hepatic resection of colorectal cancer metastases: a national experience. Cancer. 2009 Feb 15;115(4):752–9.
Virani S, Michaelson JS, Hutter MM, Lancaster RT, Warshaw AL, Henderson WG, et al. Morbidity and mortality after liver resection: results of the patient safety in surgery study. J Am Coll Surg. 2007 Jun;204(6):1284–92.
Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg. 2002 Oct;89(10):1206–22.
Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003 Feb;226(2):441–51.
Curley SA, Marra P, Beaty K, Ellis LM, Vauthey JN, Abdalla EK, et al. Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg. 2004 Apr;239(4):450–8.
Llovet JM, Lencioni R, Di Bisceglie AM, Galle PR, Dufour JF, Greten TF, Raymond E, Roskams T, De Baere T, Ducreux M, Mazzaferro V, Bernardi M, Bruix J, Colombo M, Zhu A. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012 Apr;56(4):908–43.
Solbiati L, Livraghi T, Goldberg SN, Ierace T, Meloni F, Dellanoce M, et al. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology. 2001 Oct;221(1):159–66.
Livraghi T, Solbiati L, Meloni F, Ierace T, Goldberg SN, Gazelle GS. Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the “test-of-time approach”. Cancer. 2003 Jun 15;97(12):3027–35.
Bareck E, Ba-Ssalamah A, Brodowicz T, Eisterer W, Hafner M, Hogenauer C, et al. Gastrointestinal stromal tumors: diagnosis, therapy and follow-up care in Austria. Wien Med Wochenschr. 2013 Mar;163(5–6):137–52.
Dittmar Y, Altendorf-Hofmann A, Rauchfuss F, Gotz M, Scheuerlein H, Jandt K, et al. Resection of liver metastases is beneficial in patients with gastric cancer: report on 15 cases and review of literature. Gastric Cancer. 2012 Apr;15(2):131–6.
Timmerman RD, Bizekis CS, Pass HI, Fong Y, Dupuy DE, Dawson LA, et al. Local surgical, ablative, and radiation treatment of metastases. CA Cancer J Clin. 2009 May–Jun;59(3):145–70.
Ahmad A, Chen SL, Kavanagh MA, Allegra DP, Bilchik AJ. Radiofrequency ablation of hepatic metastases from colorectal cancer: are newer generation probes better? Am Surg. 2006 Oct;72(10):875–9.
Lencioni R, Crocetti L, Cioni D, Della Pina C, Bartolozzi C. Percutaneous radiofrequency ablation of hepatic colorectal metastases: technique, indications, results, and new promises. Invest Radiol. 2004 Nov;39(11):689–97.
Machi J, Oishi AJ, Sumida K, Sakamoto K, Furumoto NL, Oishi RH, et al. Long-term outcome of radiofrequency ablation for unresectable liver metastases from colorectal cancer: evaluation of prognostic factors and effectiveness in first- and second-line management. Cancer J. 2006 Jul–Aug;12(4):318–26.
Veltri A, Sacchetto P, Tosetti I, Pagano E, Fava C, Gandini G. Radiofrequency ablation of colorectal liver metastases: small size favorably predicts technique effectiveness and survival. Cardiovasc Intervent Radiol. 2008 Sep–Oct;31(5):948–56.
Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi M, Goldberg SN. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology. 2012 Dec;265(3):958–68.
Mulier S, Ni Y, Jamart J, Michel L, Marchal G, Ruers T. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol. 2008 Jan;15(1):144–57.
Widmann G, Schullian P, Bale R. [Radiofrequency ablation of hepatocellular carcinoma]. Wien Med Wochenschr. 2013 Mar;163(5–6):132–6.
Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006 Mar;243(3):321–8.
Widmann G, Bodner G, Bale R. Tumour ablation: technical aspects. Cancer Imaging. 2009;9 Spec No A:S63–7.
Dodd GD, 3rd, 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 Oct;177(4):777–82.
Bale R, Widmann G, Schullian P, Haidu M, Pall G, Klaus A, et al. Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases. Eur Radiol. 2012 Apr;22(4):930–7.
Hammill CW, Billingsley KG, Cassera MA, Wolf RF, Ujiki MB, Hansen PD. Outcome after laparoscopic radiofrequency ablation of technically resectable colorectal liver metastases. Ann Surg Oncol. 2011 Jul;18(7):1947–54.
Widmann G, Schullian P, Haidu M, Bale R. Stereotactic radiofrequency ablation (SRFA) of liver lesions: technique effectiveness, safety, and interoperator performance. Cardiovasc Intervent Radiol. 2012 Jun;35(3):570–80.
Bale R, Widmann G, Haidu M. Stereotactic radiofrequency ablation. Cardiovasc Intervent Radiol. 2011 Aug;34(4):852–6.
Bale R, Widmann G, Stoffner DI. Stereotaxy: breaking the limits of current radiofrequency ablation techniques. Eur J Radiol. 2010 Jul;75(1):32–6.
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Widmann, G., Bale, R. Radiofrequency ablation in gastrointestinal cancer: obstacles and goals. memo 6, 212–214 (2013). https://doi.org/10.1007/s12254-013-0097-5
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DOI: https://doi.org/10.1007/s12254-013-0097-5