Treatment Strategy to Optimize Radiofrequency Ablation for Liver Malignancies

Chen, Min Hua; Yang, Wei; Yan, Kun; Gao, Wen; Dai, Ying; Huo, Ling; Yin, Shan Shan; Zhang, Hui; Poon, Ronnie T. P.

doi:10.1097/01.rvi.0000201985.61501.9e

Cited by 65 publications

(62 citation statements)

References 20 publications

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“…Lee et al [14] showed that when using three cooled-tip monopolar electrodes, the circularity (isometric ratio) of the ablation zone decreased with increasing interelectrode distance, and that interelectrode distances of larger than 3 cm could not create confluent coagulation necrosis. Multitined expandable electrodes may not be useful in our approach to position multiple electrodes very close to vessels, the diaphragm, and the liver capsule [4,10,16,26,30]. Multipolar electrodes are feasible but require strict parallelism of the electrode positions to ensure confluent necroses [31].…”

Section: Discussionmentioning

confidence: 98%

“…In the series of Seror et al [31] with US-guided multipolar RFA of HCC Livraghi et al [17,18,20], Solbiati et al [32], Seror et al [31], and Chen et al [4] each performed repeat sessions (up to 11) of conventional US-guided RFA, if possible, when residual tumor was identified on initial posttreatment CT. Thus, reported technique effectiveness often refers to secondary technique effectiveness [9].…”

Section: Discussionmentioning

confidence: 98%

“…Reasons for technical failure may be poor visibility of the lesion and/or lesions borders, imprecise electrode placement, insufficient ablation size, the heat sink effect due to vicinity to large vessels, and insufficient application of energy [15,18,28]. Lesion size and insufficient safety margin have been identified as the most important influential factors [4,11,22,[24][25][26]37]. The recent introduction of stereotactic radiofrequency ablation (SRFA) combines preinterventional 3D imaging, computerized 3D planning of electrode positions, and guided electrode placement at arbitrary angulations and orientations [1][2][3].…”

Section: Introductionmentioning

confidence: 98%

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Stereotactic Radiofrequency Ablation (SRFA) of Liver Lesions: Technique Effectiveness, Safety, and Interoperator Performance

Widmann

Schullian

Haidu

et al. 2011

Cardiovasc Intervent Radiol

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

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Stereotactic Radiofrequency Ablation (SRFA) of Liver Lesions: Technique Effectiveness, Safety, and Interoperator Performance

Widmann

Schullian

Haidu

et al. 2011

Cardiovasc Intervent Radiol

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“…For lesions larger than 5 cm, only one lesion was ablated in each session. The ablation area should cover the tumor and at least 0.5 cm of the surrounding tissue, and the margin should even be more than 1 cm when MLC border was unclear [12] . In lesions with feeding vessels shown on CEUS, "accumulative multiple ablations" were used at the vessel sites [13] To evaluate the tumor response to RFA therapy, contrast-enhanced CT was performed 1 month post-ablation and the early tumor necrosis was considered to be achieved if the scans revealed: (1) the ablation zone was beyond the tumor borders; (2) the margin of the ablation zone was well-defined and smooth; and (3) no contrast enhancement was detected within or around the tumor.…”

Section: Rfa Equipment and Methodsmentioning

confidence: 99%

Role of contrast enhanced ultrasound in radiofrequency ablation of metastatic liver carcinoma

Wu¹,

Chen

Yang

et al. 2012

Chin. J. Cancer Res.

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Objective: To investigate the application of contrast enhanced ultrasound (CEUS) in planning and guiding for radiofrequency ablation (RFA) for metastatic liver carcinoma (MLC).Methods: One hundred and thirty-five patients with clinically and pathologically diagnosed MLC (from gastrointestinal tumors) were included in the present study, and 104 of them had received CEUS prior to RFA to assess the number, size, shape, infiltration, location and enhancing features of the lesions. Among the 104 patients, 21 (20.1%) were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS. The remaining 83 patients with 147 lesions underwent RFA (group A). During the same period, other 31 patients with 102 lesions serving as control group were treated based on findings of conventional ultrasound without contrast (group B). The patients underwent follow-up enhanced CT at the 1st month, and then every 3-6 months after RFA. The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 1st month.Results: In group A, 72 of 147 MLC lesions (48.9%) showed increased sizes on CEUS. Among them, 48 lesions (66.6%) appeared enlarged in arterial phase, and 24 (33.3%) showed enlarged hypoechoic area in parenchymal phase. CEUS showed total 61 additional lesions in 35 patients (42.1%) (ranged from 8 to 15 mm) compared with conventional ultrasound (US), and 42 (68.8%) of them were visualized in parenchymal phase only. There were total 208 lesions in group A underwent RFA with CEUS planning, and the tumor necrosis rate was 94.2% (196/208). In this group, local recurrence was found in 16 lesions (7.7%) during 3-42 months' following up, and new metastases were seen in 30 cases (36.1%). For group B, the tumor necrosis rate was 86.3% (88/102), local recurrence in 17 lesions (16.7%), and new metastases in 13 cases (41.9%). Tumor early necrosis and recurrence rates were significantly different between the two groups (P=0.018, P=0.016, respectively).Conclusion: CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.

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“…However, there are technically difficult cases requiring multiple sessions for a variety of reasons, such as technical failure, which is patient related, or incomplete ablation even with a technically successful ablation [12][13][14]. Although the safety and therapeutic efficacy of RF ablation have been proven [6][7][8][9][10][11], no studies have assessed the technical aspects of patients who require more than one session of RF ablation during a single treatment period.…”

Section: Introductionmentioning

confidence: 98%

Percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of 80 patients treated with two consecutive sessions

et al. 2008

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This study investigated the reasons for some patients requiring two consecutive sessions of percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). We reviewed our database of 1,179 patients (1,624 treatments) with HCCs treated by percutaneous ultrasound (US)-guided RF ablation over 6 years. We retrospectively evaluated 80 patients who required a second session after the first session. The medical records and follow-up CTs were studied. We assessed the reasons for the second session and the patient outcomes. A second session was required in 80 (4.8%) out of 1,642 treatments of percutaneous RF ablation for HCC. The reason for the second session included technical failure related to the patient or the procedure (n=26), technical failure due to residual (n=40), newly detected (n=11) or missed (n=3) tumors found at the immediate follow-up CT. All patients were retreated with a second RFA session the next day. Seventy-five (93%) of 80 patients achieved complete ablation after the second session. The remaining five patients were treated by TACE (n=1), additional RFA (as second treatment at next admission) (n=3), or were lost to follow-up (n=1). After 1 month follow-up, 72 patients (96%) showed complete ablation after the second session. The interventional oncologist should understand the technical reasons for a patient requiring a second session of RF ablation when providing treatment for HCCs and perform careful pre-procedural planning to minimize the need for multi-session procedures.

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Treatment Strategy to Optimize Radiofrequency Ablation for Liver Malignancies

Cited by 65 publications

References 20 publications

Stereotactic Radiofrequency Ablation (SRFA) of Liver Lesions: Technique Effectiveness, Safety, and Interoperator Performance

Stereotactic Radiofrequency Ablation (SRFA) of Liver Lesions: Technique Effectiveness, Safety, and Interoperator Performance

Role of contrast enhanced ultrasound in radiofrequency ablation of metastatic liver carcinoma

Percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of 80 patients treated with two consecutive sessions

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