Stereotactic radiofrequency ablation of subcardiac hepatocellular carcinoma: a case-control study

Purpose To evaluate safety, local oncological control, long-term outcome and potential prognostic factors of stereotactic RFA (SRFA) for the treatment of BCLMs. Methods Between July 2003 and December 2019, 42 consecutive female patients with median age 54.0 years were treated with SRFA at our institution for 110 BCLMs in 48 ablation sessions. Median tumor size was 3.0 cm (0.8–9.0). Eighteen (42.9%) patients had extrahepatic metastasis at initial SRFA. Results Technical success rate was 100%, i.e., all coaxial needles were inserted with appropriate accuracy within 10 mm off plan and 107/110 (92.3%) BCLMs were successfully ablated at initial SRFA. Four Grade 1 (8.3%, 4/48) and one Grade 2 (2.1%, 1/48) complications occurred. No perioperative deaths occurred. Local recurrence developed in 8 of 110 tumors (7.3%). Overall survival (OS) rates of all patients at 1, 3, and 5 years from the date of the first SRFA were 84.1%, 49.3%, and 20.8% with a median OS of 32.3 months. Univariable cox regression analyses revealed age > 60 years and extrahepatic disease (without bone only metastases) as significant predictors of worse OS (p = 0.013 and 0.025, respectively). Size and number of metastases, hormone receptor status and time onset did not significantly affect OS after initial SRFA. Conclusions SRFA is a safe, minimally invasive treatment option in the management of BCLMs, especially in younger patients without advanced extrahepatic metastasis, including those with large liver tumors.

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“…The method of SRFA has been reported in detail previously [16][17][18]. An example SRFA for BCLM is shown in Fig.…”

Section: Srfa Proceduresmentioning

confidence: 99%

Stereotactic Radiofrequency Ablation of Breast Cancer Liver Metastases: Short- and Long-Term Results with Predicting Factors for Survival

Schullian

Johnston

Laimer

et al. 2021

Cardiovasc Intervent Radiol

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Four propensity score matched analyses compared stereotactic thermal ablation for different subtypes of patients or lesions. Stereotactic RFA yielded similar safety and treatment e cacy outcomes when comparing CT 'invisible' tumours ablated with MR image fusion to CT visible tumours (30), octogenarians to a younger study population (36), lesions in a subphrenic location to non-dome locations (39) and HCC in a subcardiac position to a non-subcardiac location (40).…”

Section: Comparative Studiesmentioning

confidence: 90%

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

Tinguely

Paolucci

Ruiter

et al. 2020

Preprint

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Background: Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumours. We qualitatively reviewed and quantitatively summarised the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumours.Methods: A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency and treatment efficacy outcomes. Meta-analysis including subgroup analyses were performed.Results: Thirty-four studies (2 randomised controlled trials, 3 prospective cohort studies, 29 case series) were qualitatively analysed and 22 studies included for meta-analysis. Weighted average lateral targeting error was 3.7mm (CI 3.2,4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1) and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1 – 6 weeks and 90% (87, 93) if assessed at 6 – 12 weeks post ablation, with significant remaining between-study heterogeneity. Pooled odds ratio of primary technique efficacy for stereotactic versus free-hand targeting was 1.9 (1.2, 3.2)(n = 6 studies).Conclusions: Advances in stereotactic navigation technologies allow highly precise and safe tumour targeting, potentially leading to enhanced early treatment efficacy. The use of varying definitions and terminology limit comparability of safety and efficacy among studies, highlighting the crucial need for further standardization of follow-up definitions.

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“…The method of SRFA has previously been reported in detail [20][21][22] . In brief, the whole treatment is performed under general anesthesia with muscle paralysis.…”

Section: Methodsmentioning

confidence: 99%

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

Schullian

Johnston

Putzer

et al. 2020

Sci Rep

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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.

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Stereotactic radiofrequency ablation of subcardiac hepatocellular carcinoma: a case-control study

Cited by 23 publications

References 32 publications

Stereotactic Radiofrequency Ablation of Breast Cancer Liver Metastases: Short- and Long-Term Results with Predicting Factors for Survival

Stereotactic Radiofrequency Ablation of Breast Cancer Liver Metastases: Short- and Long-Term Results with Predicting Factors for Survival

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

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

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