Journal of Vascular and Interventional Radiology
Review articleAblation of Liver Metastases: Current Status
Section snippets
Radiofrequency Ablation
Using RF energy in the treatment of malignancies is nothing new. This technology, in its most rudimentary form, has been around for nearly a century. The first report of using RF was in neurosurgery as an electrocautery device. This application of RF energy would end up becoming a staple in every operating room, as the Bovie knife (11). As this technology evolved, other uses came to light. In the 1980s, RF energy was shown to cause coagulative necrosis in hepatic tissue. This was translated
Ablation of Colorectal Liver Metastasis
Although the incidence of colorectal cancer continues to decrease, it still remains the third most common cause of cancer mortality (14). The mean survival time for patients with untreated liver metastasis from CRC is 6–13 months, and the median survival time on the most effective chemotherapy is 20 months, whereas resecting hepatic metastases increases the 5-year survival rate from 0%–1% to 31%–58% (7, 8, 9, 10, 15, 16). There is also a recent report of 5-year survival rate of 71% and 10-year
Other Liver Metastasis
Up to 50% of patients with a malignancy will have metastatic disease to the liver; however, focal therapy or resection does not uniformly affect survival as with colorectal metastasis. Usually this therapy is reserved for liver-only metastatic disease; for symptomatic relief, ie, neuroendocrine metastasis; or with a malignant processes in which cytoreduction has been shown to positively affect outcome, ie, ovarian carcinoma (45, 46, 47, 48, 49). However, very few reports examine the outcome of
Other Ablative Techniques
The two other most frequently available ablative technologies in the United States are cryoablation and microwave. To date, there have been no studies directly comparing all three in the treatment of metastatic disease to the liver. Instead, like with RF ablation, most of the published data are in reference to HCC.
Complications
Ablative techniques share many of the same major complications, with the most common including bleeding, hepatic abscess, bile duct injuries, injury to the adjacent bowel, hepatic failure, and the late complication of track seeding (94, 95). Given the variety of study design and limited case reports, it is difficult to accurately address the individual complication incidence between the different ablative techniques in treating liver metastasis. The complication rate appears to be proportional
Follow-up
Imaging protocols after ablative therapy are widely variable and institution dependent. Most centers report initial imaging either immediately before discharge or up to one month after the procedure. Subsequent imaging is variable, but a typical protocol might be follow-up imaging every three months for two years, then biannually (36, 37, 40, 56). Berber and Siperstein (38) found that 84% of local progression was evident by one year, and 96% were evident by two years. The modality is typically
Conclusion
Local ablative therapy for the treatment of metastatic disease to the liver has been evaluated most extensively in CRC with 5-year survival rates up to 55% after RF ablation. (23) Recent findings suggest selected patients with other malignant processes may benefit as well, but conclusive evidence is limited. Multiple modalities are used to accomplish local tumor control via a surgical or percutaneous approach, of which, RF ablation, cryoablation, and microwave ablation have been evaluated the
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Cited by (31)
Imaging of the Liver Following Interventional Therapy for Hepatic Neoplasms
2015, Radiologic Clinics of North AmericaCitation Excerpt :Significant damage to the gallbladder resulting in cholecystitis is rare, occurring in less than 0.05%, and perforation is even rarer.80 Cholangitis may also complicate ablation and, as other forms of infection, is more prevalent after bilioenteric anastomosis.78 Injury to adjacent viscera, such as colon, stomach, diaphragm, and less commonly small bowel and rib periosteum, can occur with thermal ablation.4,7
Evidence for tumor cell spread during local hepatic ablation of colorectal liver metastases
2012, Journal of Surgical ResearchRadiofrequency coil for the creation of large ablations: Ex vivo and in vivo testing
2012, Journal of Vascular and Interventional RadiologyCitation Excerpt :The unique nature of the coil’s power deposition pattern and subsequent heating pattern results in larger, more uniform ablation zones. Like microwave ablation devices that do not rely solely on heat diffusion, the ability of the RF coil to inductively heat results in uniform tissue coagulation within a short treatment time that may reduce the heat-sink effects of perfusion (3,19). The complete depletion of NADH surrounding vessels indicates cell necrosis and supports this hypothesis.
Radiofrequency ablation of liver metastasis in patients with locally controlled pancreatic ductal adenocarcinoma
2012, Journal of Vascular and Interventional RadiologyCitation Excerpt :In the present study, patients with liver metastases alone from pancreatic ductal adenocarcinoma that were detected at the time of surgery or during follow-up underwent RF ablation. RF ablation was chosen as the treatment modality because there is no established therapeutic option for hepatic metastatic lesions and because RF ablation of liver lesions has been shown to be safe in patients with hepatocellular carcinoma or liver metastases arising from other organs such as colorectal cancer (7–9,13). The effectiveness of local control of liver metastasis arising from pancreatic ductal adenocarcinoma is inconclusive.
Percutaneous radiofrequency ablation using internally cooled wet electrodes for treatment of colorectal liver metastases
2012, Clinical RadiologyCitation Excerpt :RFA has become an established method to treat patients with liver metastases from CRC.1–5 RFA is less invasive, less expensive, and has fewer contraindications than surgical resection.24,36 Furthermore, as many patients will develop liver metastases after surgery, the test-of-time approach7 may be feasible with RFA in patients with liver metastases arising from CRC.
D.A.G. is a paid consultant for, and received a research grant from, Covidien; it was not used to fund this paper. V.L.F. has not identified a conflict of interest.