Safety and efficacy of stereotactic radiofrequency ablation for very large (≥8 cm) primary and metastatic liver tumors

Abstract

To assess the safety and clinical outcomes of multi-probe stereotactic radiofrequency ablation (SRFA) for very large (≥8 cm) primary and metastatic liver tumors with curative treatment intent. A retrospective, single center study carried out between 01.2005 and 06.2018. 34 consecutive patients had a total of 41 primary and metastatic liver tumors with a median size of 9.0 cm (8.0-18.0 cm) at initial SRFA. Patients were treated under CT guidance using a 3D navigation system. Endpoints consisted of (i) technical efficacy; primary-requiring one treatment, and secondary-requiring two treatments (ii) complication and mortality rates (iii) local and distant recurrence (LR), (iv) disease free survival (DFS), (v) overall survival (OS). 33/41 tumors were successfully ablated at initial SRFA (80.5% primary technical efficacy rate (PTE)). Four tumors required repeat ablation, resulting in a secondary technical efficacy (STE) rate of 90.2%. Local tumor recurrence (LR) developed in 4 of 41 tumors (9.8%). The 30day perioperative mortality was 2.3% (1/ 44 ablations). The total major complication rate was 20.5% (9 of 44 ablations). Three of nine (33.3%) major complications, such as pleural effusion, pneumothoraces or perihepatic hemorrhages were relatively easy to treat. The overall survival (OS) rates at 1-, 3-, and 5-years from the date of the first SRFA were 87.1%, 71.8%, and 62.8% for patients with hepatocellular carcinoma (HCC) and 87.5%, 70.0% and 70.0% for patients with intrahepatic cholangiocarcinoma (ICC) respectively. Patients with metastatic disease had OS rates of 77.8% and 22.2% at 1-and 3-years. The clinical results of SRFA in this study are encouraging and warrant a prospective multicenter study. SRFA may become one of the best therapeutic choices for a growing number of patients with primary and metastatic liver cancer.

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumours - A Systematic Review and Meta-Analysis

“…Due to the increasing expertise in specialized centres, treatment indications for stereotactic thermal ablation are increasingly expanded. The present summary shows the encouraging results in all reported outcomes including for patients with tumours in di cult intrahepatic locations (centrally, liver dome (39), segment 1(37)), very large tumours (33) and "vanishing" or CT invisible tumours using image fusion (72). In practice, minimally invasive stereotactic ablation approaches are bene cial especially in these situations, where they allow a curative intended treatment when conventional image guidance techniques preclude an e cient and safe targeting.…”

“…All of the 34 included works were single-centre studies, of which 26 were retrospective studies (29,30,(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)31,(49)(50)(51)(52)(53)(54)(32)(33)(34)(35)(36)(37)(38), 3 prospective case series(55-57), 3 prospective cohort studies(58-60) and 2 randomised controlled trials (61,62). Two studies reported results using a laparoscopic treatment access (44,55), the other 32 reporting on thermal ablations using a percutaneous approach.…”

“…The overall complication rate ranged between 0 and 57.9%, the pooled estimate being 11.4% (CI 6.7, 16.1; I 2 87.9%, p < 0.01) in 16 studies included for meta-analysis. Major complications ranged between 0 and 20.5%, the 20.5% rate being reported in a study of patients undergoing stereotactic radiofrequency ablation for very large (≥ 8 cm) tumours (33). The overall pooled estimate for major complication rate was 2.4% (CI 1.4, 3.6; I 2 20.7%, p = 0.198), which was lower in the subgroup applying the Clavien-Dindo classi cation (2.0%, CI 0.7, 4.0) versus the subgroup applying the SIR classi cation (4.0%, CI 1.0, 8.8) ( Figure 4).…”

Advanced Techniques in the Percutaneous Ablation of Liver Tumours

“…The main limitations of RFA are tissue charring, causing an increase in impedance and peripheral tissue cooling, caused by the dissipation of heat by both large blood vessels as well as capillary level micro-perfusion [ 30 ]. Although effective against small (<2 cm) HCCs, achieving adequate margins for larger tumours requires multiple electrodes [ 22 , 31 ]. Due to this limitation, RFA suffers from a relatively high rate of LTP ranging from 10.0 to 39.1% at five years [ 16 , 22 ].…”

Currently available treatment options for neuroendocrine liver metastases

“…Furthermore, RFA mandates a high level of operator experience in the use of conventional ultrasound- and CT-navigation in order to achieve precise 3D alignment of probes and subsequently create adequately overlapping ablation areas. In that setting, stereotactic RFA as an emerging alternative approach allows for optimal 3D ablation planning and achievement of optimal configuration of the RFA probes, thus creating multiple overlapping coagulation volumes, especially in larger tumors (>5 cm) [ 86 ].…”