Radiofrequency Tissue Ablation Using Cooled Tip for Liver Metastases of Endocrine Tumors

Abstract

Tumors derived from hormone-producing cells are generally highly differentiated, and vast experience indicates benefit with combinations of surgical and medical treatment for metastatic disease. Tumor debulking surgery is an accepted approach for reducing hormonal symptoms and to establish better conditions for medical treatment. Radiofrequency treatment (RF), a novel method for destroying liver tumors, was used to treat 43 liver metastases in 21 patients with endocrine tumors (12 with midgut carcinoid disease; 4 with nonfunctional endocrine pancreatic tumors; 1 with a VIPoma; 1 with a glucagonoma; 1 with a gastrinoma; 2 with adrenal carcinomas). Among these patients we treated with intention to cure in 14 by RF alone or RF plus surgery. Ablation was performed either percutaneously or intraoperatively using a cooled-tip needle, applying 50 to 90 watts over 10 to 12 minutes under ultrasound guidance. Contrast-enhanced computed tomography, liver function tests, and tumor markers were followed before and after RF. There were two complications: One patient suffered from conservatively treated bile leakage, and another had pleural effusion and fever for 7 days post-RF. Two lesions developed signs of incomplete necrosis after 6 months, yielding a local recurrence rate of (4.6%). Of the 15 patients treated with curative intent, we attained cure (i.e., no residual macroscopic tumor) in 4 patients. We conclude that RF using cooled-tip needles is safe and efficient; it may be performed percutaneously and intraoperatively; and it may expand the indications for liver resection.

Metastatic Carcinoid Tumors: A Clinical Review

“…Local tumor control has been reported in almost all patients, and a symptomatic and biochemical response has been reported in about 60%-80% of patients. However, local recurrence and the development of new metastases are frequently reported [73].…”

Treatment of endocrine pancreatic tumors

“…Ablation of liver metastases using RF has shown promising results, but needs further clarification before used as standard treatment [27,28]. Liver transplantation is exciting, but additional studies are required to state which patients are suitable for this approach and the shortage of donor organs also needs to be considered [29 Á/31].…”

“…Today, radiofrequency ablation (RF) has been increasingly used to induce tumor necrosis. Recently, a paper was published on treatment with RF using a cooled-tip needle in 21 patients with mixed endocrine tumors [27]. Forty-three liver metastases were locally ablated using this technique with a success rate, defined as complete radiological necrosis, of 96%.…”

An Overview of the Surgical Management of Hepatic Neuroendocrine Metastases

“…Hellman et al [26] looked at 21 patients who underwent either percutaneous or intra-operative RFA. In total they looked at 43 metastases and had a mean follow up of 2.1 years.…”