Image-guided multipolar radiofrequency ablation of liver tumours: initial clinical results

The local effectiveness and clinical usefulness of multipolar radiofrequency (RF) ablation of liver tumours was evaluated. Sixty-eight image-guided RF sessions were performed using a multipolar device with bipolar electrodes in 53 patients. There were 45 hepatocellular carcinomas (HCC) and 42 metastases with a diameter ≤3 cm (n = 55), 3.1–5 cm (n = 29) and >5 cm (n = 3); 26 nodules were within 5 mm from large vessels. Local effectiveness and complications were evaluated after RF procedures. Mean follow-up was 17 ± 10 months. Recurrence and survival rates were analysed by the Kaplan-Meier method. The primary and secondary technical effectiveness rate was 82% and 95%, respectively. The major and minor complication rate was 2.9%, respectively. The local tumour progression at 1- and 2-years was 5% and 9% for HCC nodules and 17% and 31% for metastases, respectively; four of 26 nodules (15%) close to vessels showed local progression. The survival at 1 year and 2 years was 97% and 90% for HCC and 84% and 68% for metastases, respectively. Multipolar RF technique creates ablation zones of adequate size and tailored shape and is effective to treat most liver tumours, including those close to major hepatic vessels.

[1]  Osman Ratib,et al.  OsiriX: An Open-Source Software for Navigating in Multidimensional DICOM Images , 2004, Journal of Digital Imaging.

[2]  Fernando Burdío,et al.  Bipolar saline-enhanced electrode for radiofrequency ablation: results of experimental study of in vivo porcine liver. , 2003, Radiology.

[3]  G. Gazelle,et al.  Variables affecting proper system grounding for radiofrequency ablation in an animal model. , 2000, Journal of vascular and interventional radiology : JVIR.

[4]  Shinpei Sato,et al.  Percutaneous radiofrequency ablation for hepatocellular carcinoma , 2005, Cancer.

[5]  C-J. S. Lin,et al.  Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less , 2005, Gut.

[6]  M. Sherman,et al.  Needle tract seeding after radiofrequency ablation of hepatic tumors. , 2005, Journal of vascular and interventional radiology : JVIR.

[7]  J. Bruix,et al.  Management of hepatocellular carcinoma , 2005, Hepatology.

[8]  L Pagliaro,et al.  Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. , 2001, Journal of hepatology.

[9]  T. de Baère,et al.  Adverse events during radiofrequency treatment of 582 hepatic tumors. , 2003, AJR. American journal of roentgenology.

[10]  M. Rosen,et al.  Classifying complications of interventional procedures: a survey of practicing radiologists. , 2001, Journal of vascular and interventional radiology : JVIR.

[11]  Sylvain Terraz,et al.  Percutaneous treatment of liver tumors with an adapted probe for cooled-tip, impedance-controlled radio-frequency ablation under open-magnet MR guidance: initial results , 2003, European Radiology.

[12]  T. Livraghi,et al.  Multimodal image‐guided tailored therapy of early and intermediate hepatocellular carcinoma: Long‐term survival in the experience of a single radiologic referral center , 2004, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[13]  S. Silverman,et al.  Society of Interventional Radiology Technology Assessment Committee; International Working Group on Image-Guided Tumour Ablation , 2005 .

[14]  Christopher L Brace,et al.  Multiple-electrode radiofrequency ablation creates confluent areas of necrosis: in vivo porcine liver results. , 2006, Radiology.

[15]  G. Gandini,et al.  Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC) , 2006, European Radiology.

[16]  J. G. Webster,et al.  Hepatic bipolar radiofrequency ablation creates coagulation zones close to blood vessels: A finite element study , 2003, Medical and Biological Engineering and Computing.

[17]  R W Günther,et al.  Multipolar radiofrequency ablation: first clinical results. , 2004, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[18]  Dieter Haemmerich,et al.  Multiple probe radiofrequency ablation: pilot study in an animal model. , 2003, Journal of vascular and interventional radiology : JVIR.

[19]  Carlo Bartolozzi,et al.  Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. , 2005, Radiology.

[20]  Pierre Schnyder,et al.  Radio-frequency tissue ablation of the liver: in vivo and ex vivo experiments with four different systems , 2003, European Radiology.

[21]  Luigi Solbiati,et al.  Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. , 2003, Radiology.

[22]  S Nahum Goldberg,et al.  Image-guided tumor ablation: standardization of terminology and reporting criteria. , 2005, Journal of vascular and interventional radiology : JVIR.

[23]  W. Lees,et al.  Radio-frequency ablation of colorectal liver metastases in 167 patients , 2004, European Radiology.

[24]  James Sayre,et al.  Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the "heat sink" effect. , 2002, AJR. American journal of roentgenology.

[25]  A. Güemes,et al.  Evolving technology in bipolar perfused radiofrequency ablation: assessment of efficacy, predictability and safety in a pig liver model , 2006, European Radiology.

[26]  G. Poston.  Radiofrequency ablation of colorectal liver metastases: where are we really going? , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  L. Ellis,et al.  Significant Long-Term Survival After Radiofrequency Ablation of Unresectable Hepatocellular Carcinoma in Patients with Cirrhosis , 2005, Annals of Surgical Oncology.

[28]  Thomas Albrecht,et al.  Multipolar radiofrequency ablation of hepatic tumors: initial experience. , 2005, Radiology.

[29]  G. Gazelle,et al.  Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection , 2003, Cancer.

[30]  M. Hiraoka,et al.  Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode. , 2006, Radiology.

[31]  T. de Baère,et al.  Intraductal cooling of the main bile ducts during radiofrequency ablation prevents biliary stenosis. , 2004, Journal of the American College of Surgeons.

[32]  Gerhard J. Mueller,et al.  Investigations on bipolar radio-frequency current application for interstitial thermotherapy (RF-ITT) , 1996, European Conference on Biomedical Optics.

[33]  E F Halpern,et al.  Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. , 2001, Radiology.

[34]  Philippe L Pereira,et al.  Radiofrequency ablation: in vivo comparison of four commercially available devices in pig livers. , 2004, Radiology.

[35]  Philippe L Pereira,et al.  Multipolar radiofrequency ablation with internally cooled electrodes: experimental study in ex vivo bovine liver with mathematic modeling. , 2006, Radiology.

[36]  T. Kawabe,et al.  Radiofrequency ablation for hepatocellular carcinoma in so‐called high‐risk locations , 2006, Hepatology.

[37]  Jae Young Lee,et al.  Hepatic Radiofrequency Ablation Using Multiple Probes: Ex Vivo and In Vivo Comparative Studies of Monopolar versus Multipolar Modes , 2006, Korean journal of radiology.

[38]  J. McGahan,et al.  Hepatic ablation using bipolar radiofrequency electrocautery. , 1996, Academic radiology.

[39]  S. Mulier,et al.  Electrodes and multiple electrode systems for radiofrequency ablation: a proposal for updated terminology , 2005, European Radiology.

[40]  Steven S Raman,et al.  Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. , 2005, Radiology.

[41]  I. B. Borel Rinkes,et al.  Multipolar radiofrequency ablation of large hepatic metastases of endocrine tumours. , 2006, European journal of gastroenterology & hepatology.

[42]  John G. Webster,et al.  Hepatic bipolar radio-frequency ablation between separated multiprong electrodes , 2001, IEEE Transactions on Biomedical Engineering.

[43]  L Solbiati,et al.  Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? , 1998, Journal of vascular and interventional radiology : JVIR.

[44]  E. Berber,et al.  Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.