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Actual role of radiofrequency ablation of liver metastases

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Abstract

The liver is, second only to lymph nodes, the most common site for metastatic disease irrespective of the primary tumour. More than 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality. Although the surgical resection leads to an improved survival in patients with colorectal metastases, only approximately 20% of patients are eligible for surgery. Thermal ablation and especially radiofrequency ablation emerge as an important additional therapy modality for the treatment of liver metastases. RF ablation shows a benefit in life expectancy and may lead in a selected patient group to cure. Percutaneous RF ablation appears safer (versus cryotherapy), easier (versus laser), and more effective (versus ethanol instillation and transarterial chemoembolisation) compared with other minimally invasive procedures. RF ablation can be performed by a percutaneous, laparoscopical or laparotomic approach, and may be potentially combined with chemotherapy and surgery. At present ideal candidates have tumours with a maximum diameter less than 3.5 cm. An untreatable primary tumour or a systemic disease represents contraindications for performing local therapies. Permanent technical improvements of thermal ablation devices and a better integration of thermal ablation in the overall patient care may lead to prognosis improvement in patients with liver metastases.

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References

  1. Greenlee RT, Hill-Harmon MB, Murray T et al (2001) Cancer statistics CA. Cancer J Clin 50:7–33

    Google Scholar 

  2. Landis SH, Murray T, Bolden S, Wingo PA (1999) Cancer statistics CA. Cancer J Clin 49:8–31

    CAS  Google Scholar 

  3. Baker ME, Pelley R (1995) Hepatic metastases: Basic principles and implications for radiologists. Radiology 197:329–337

    PubMed  CAS  Google Scholar 

  4. Miller CA, Ellison EC (1998) Therapeutic alternatives in metastatic neuroendocrine tumours. Surg Oncol Clin N Am 7:863–887

    CAS  Google Scholar 

  5. Lehnert T, Golling M (2001) Indications and results of the resection of liver metastases. Radiologe 41:40–48

    Article  PubMed  CAS  Google Scholar 

  6. Stangl R, Altendorf-Hofmann A, Charnley RM, Scheele J (1994) Factors influencing the natural history of colorectal liver metastases. Lancet 343:1405–1410

    Article  PubMed  CAS  Google Scholar 

  7. Saltz LB, Cox JV, Blanke C et al (2000) Irinotecan combined with fluorouracil and leucoverin for metastastic colorectal cancer: Irinotecan study group. N Engl J Med 343:905–914

    Article  PubMed  CAS  Google Scholar 

  8. Tournigand C, Andre T, Achille E et al (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: A randomized GERCOR study. J Clin Oncol 22:229–237

    Article  PubMed  CAS  Google Scholar 

  9. Kemeny N, Huang Y, Cohen AM et al (1999) Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. NEJM 341:2039–2048

    Article  PubMed  CAS  Google Scholar 

  10. Leonard GD, Brenner B, Kemeny NE (2005) Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma. J Clin Oncol 23:2038–2048

    Article  PubMed  CAS  Google Scholar 

  11. Meta-Analysis Group of Cancer (1996) Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst 88:252–258

    Article  Google Scholar 

  12. Zalcberg JR, Kemeny NE (2004) Systemic or regional chemotherapy for liver metastases from colorectal cancer: Has the wheel stopped spinning? Cancer J 10:271–279

    Article  PubMed  CAS  Google Scholar 

  13. Ellis LM, Chase J, Patt YZ et al (1998) Hepatic arterial infusion of chemotherapy for colorectal cancer metastasis to the liver. In: Curley SA (ed) Liver Cancer. Springer-Verlag, New York, NY, 150–172

    Google Scholar 

  14. Wang P, Chen Z, Huang WX, Liu LM (2005) Current preventive treatment for recurrence after curative hepatectomy for liver metastases of colorectal carcinoma: A literature review of randomized control trials. World J Gastroenterol 11(25):3817–3822

    PubMed  Google Scholar 

  15. Leonard GD, Brenner B, Kemeny NE (2005) Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma. J Clin Oncol 23:2038–2048

    Article  PubMed  CAS  Google Scholar 

  16. Hao CY, Ji JF (2006) Surgical treatment of liver metastases of colorectal cancer: Strategies and controversies in 2006. Eur J Surg Oncol 32:473–483

    Article  PubMed  CAS  Google Scholar 

  17. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: Analysis of 1001 consecutive cases. Ann Surg 230:309–318

    Article  PubMed  CAS  Google Scholar 

  18. Büchler P, Pfannschmidt J, Rudek B, Dienemann H, Lehnert T (2002) Surgical treatment of hepatic and pulmonary metastases from non-colorectal and non-neuroendocrine carcinoma. Scan J Surg 91:147–154

    Google Scholar 

  19. Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: A model to predict long-term survival. Ann Surg 240:644–658

    Article  PubMed  Google Scholar 

  20. Topham C, Adam R (2002) Oncosurgery: A new reality in metastatic colorectal carcinoma. Semin Oncol 29(15):3–10

    Article  PubMed  Google Scholar 

  21. Gillams AR, Lees WR (2004) Radiofrequency ablation of colorectal liver metastases in 167 patients. Eur Radiol 14:2261–2267

    Article  PubMed  CAS  Google Scholar 

  22. Solbiati L, Livraghi T, Goldberg SN et al (2001) Percutaneous radiofrequency ablation of hepatic metastases from colorectal cancer: Long-term results in 117 patients. Radiology 221:159–166

    Article  PubMed  CAS  Google Scholar 

  23. Miller CA, Ellison EC (1998) Therapeutic alternatives in metastatic neuroendocrine tumours. Surg Oncol Clin N Am 7:863–879

    PubMed  CAS  Google Scholar 

  24. Buscarini E, Savola A, Brambilla G et al (2005) Radiofrequency thermal ablation of liver tumours. Eur Radiol 15:84–894

    Article  Google Scholar 

  25. D’Arsonval MA (1891) Physiological effect of alternative currents. CR Soc Biol 43:283–286

    Google Scholar 

  26. Clark WL (1911) Oscillatory dessication in the treatment of accessible malignant growths and minor surgical conditions. J Adv Ther 29:169–183

    Google Scholar 

  27. Cushing H, Bovie WT (1928) Electro-surgery as an aid to the removal of intracranial tumors. Surg Gynecol Obstet 47:751–784

    Google Scholar 

  28. McGahan JP, Browning PD, Brock JM, Tesluk H (1990) Hepatic ablation using radiofrequency electrocautery. Invest Radiol 25:267–270

    Article  PubMed  CAS  Google Scholar 

  29. Rossi S, Fornari F, Pathies C, Buscarini L (1990) Thermal lesions induced by 480 KHz localized current field in guinea pig and pig liver. Tumori 76:54–57

    PubMed  CAS  Google Scholar 

  30. Goldberg SN, Gazelle GS, Compton CC, Mueller PR, Tanabe KK (2000) Treatment of intrahepatic malignancies with radiofrequency ablation: Radiologic-pathologic correlation. Cancer 88:2452–2453

    Article  PubMed  CAS  Google Scholar 

  31. Pennes HH (1948) Analysis of tissue and arterial blood temperatures in the resting human forearm. J Appl Physiol 1:93–122

    Google Scholar 

  32. Nikfarjam M, Muralidharan V, Christophi C (2004) Mechanisms of focal heat destruction of liver tumors. J Surg Res 127:208–223

    Article  Google Scholar 

  33. Solbiati L, Ierace T, Goldberg SN et al (1997) Percutaneous US-guided radio-frequency tissue ablation of liver metastases: Treatment and follow-up in 16 patients. Radiology 202:195–203

    PubMed  CAS  Google Scholar 

  34. Hansen PD, Pogers S, Corless CL, Swanstrom LL, Siperstein AE (1999) Radiofrequency ablation lesions in a pig liver model. J Surg Res 87:114–121

    Article  PubMed  CAS  Google Scholar 

  35. Morimoto M, Sugimori K, Shirato K et al (2002) Treatment of hepatocellular carcinoma with radiofrequency ablation: Radiologic-histologic correlation during follow-up periods. Hepatology 35:1467–1475

    Article  PubMed  Google Scholar 

  36. Itoh, Orba Y, Takei H et al (2002) Immunohistochemical detection of hepatocellular carcinoma in the setting of ongoing necrosis after radiofrequency ablation. Mol Pathol 15(2):110–115

    Article  Google Scholar 

  37. Organ LW (1976) Electrophysiologic principles of radiofrequency lesion making. Appl Neurophysiol 39:69–76

    Article  PubMed  Google Scholar 

  38. Pereira PL, Trübenbach J, Schenk M et al (2004) Radiofrequency ablation: In vivo comparison of four commercially available devices in pig livers. Radiology 232(2):482–490

    Article  PubMed  Google Scholar 

  39. Goldberg SN, Charbonneau JW, Dodd GD III et al (2003) Image-guided tumor ablation: Proposal for standardization of terms and reporting criteria. Radiology 228:335–345

    Article  PubMed  Google Scholar 

  40. Mulier S, Miao Y, Mulier P et al (2005) Electrodes and multiple electrode systems for radiofrequency ablation: A proposal for updated terminology. Eur Radiol 15(4):798–808

    Article  PubMed  Google Scholar 

  41. Burdio F, Navarro A, Sousa R et al (2006) Evolving technology in bipolar perfused radiofrequency ablation: Assessment of efficacy, predictability and safety in a pig liver model. Eur Radiol 16(8):1826–1834

    Article  PubMed  Google Scholar 

  42. Clasen S, Schmidt D, Boss A, Dietz K, Kröber SM, Claussen CD, Pereira PL (2006) Multipolar radiofrequency ablation with internally cooled electrodes: Experimental study in ex vivo bovine liver with mathematic modeling. Radiology 238(3):881–890

    Article  PubMed  Google Scholar 

  43. Livraghi T, Goldberg SN, Monti F et al (1997) Saline-enhanced Radiofrequency tissue ablation in the treatment of liver metastases. Radiology 202:205–210

    PubMed  CAS  Google Scholar 

  44. Schmidt D, Brieger J, Schenk M et al (2003) Automated saline-enhanced radiofrequency ablation: Initial results in ex-vivo bovine livers. Am J Roentgenol 180:163–165

    Google Scholar 

  45. Leyendecker JR, Dodd GD III, Halff GA et al (2002) Sonographically observed echogenic response during intraoperative radiofrequency ablation of cirrhotic livers: Pathologic correlation. Am J Roentgenol 178:1147–1151

    Google Scholar 

  46. Lewin JS, Connell CF, Duerk JL et al (1998) Interactive MRI-guided radiofrequency interstitial thermal ablation of abdominal tumors: Clinical trial for evaluation of safety and feasibility. J Magn Reson Imaging 8(1):40–47

    Article  PubMed  CAS  Google Scholar 

  47. Mahnken AH, Buecker A, Spuentrup E, Krombach GA, Henzler D, Gunther RW, Tacke J (2004) MR-guided radiofrequency ablation of hepatic malignancies at 1.5 T: Initial results. J Mag Reson Imaging 19:342–348

    Article  Google Scholar 

  48. Clasen S, Boss A, Schmidt D, Fritz J, Schraml C, Claussen CD, Pereira PL (2006) Magnetic resonance imaging for hepatic radiofrequency ablation. Eur J Radiol 59:140–148

    Article  PubMed  CAS  Google Scholar 

  49. Seror O, Lepetit-Coiffe M, Quesson B, Trillaud H, Moonen CT (2006) Quantitative magnetic resonance temperature mapping for real-time monitoring of radiofrequency ablation of the liver: An ex-vivo study. Eur Radiol 16:2265–2274

    Article  PubMed  Google Scholar 

  50. Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal metastases. Ann Surg 239(6):818–825

    Article  PubMed  Google Scholar 

  51. Fioole B, Jansen MC, van Duijnhoven FH, van Hillegersberg R, van Gulik TM, Borel Rinkes IH (2006) Combining partial liver resection and local ablation of liver tumors: A preliminary Dutch experience. World J Surg Oncol 17(4):46

    Article  Google Scholar 

  52. Dodd GD III, Frank MS, Aribandi M, Chopra S, Chintapalli KN (2001) Radiofrequency thermal ablation: Computer analysis of the size of the thermal injury created by overlapping ablations. Am J Roentgenol 177:177–182

    Google Scholar 

  53. Pawlik TM, Abdalla EK, Ellis LM, Vauthey JN, Curley SA (2006) Debulking dogma: Surgery for four or more colorectal metastases is justified. J Gastrointest Surg 10(2):240–248

    Article  PubMed  Google Scholar 

  54. Poon RT, Ng KK, Lam CM, Ai V, Yuen J, Fan ST, Wong J (2004) Learning curve for radiofrequency ablation of liver tumors: Prospective analysis of initial 100 patients in a tertiary institution. Ann Surg 239:441–449

    Article  PubMed  Google Scholar 

  55. Berber E, Pelley R, Siperstein AE (2005) Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: A prospective study. J Clin Oncol 23:1358–1364

    Article  PubMed  Google Scholar 

  56. DeBaere T, Elias D, Dromain C et al (2000) Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. Am J Rontgenol 175:1619–1625

    CAS  Google Scholar 

  57. Wood TF, Rose DM, Chung M et al (2000) Radiofrequency ablation of 231 unresectable hepatic tumours: Indications, limitations, and complications. Ann Surg Oncol 7:593–600

    PubMed  CAS  Google Scholar 

  58. Bleicher RJ, Allegra DP, Nora DT, Wood TF, Foshag LJ, Bilchik LJ (2003) Radiofrequency ablation in 447 complex unresectable liver tumours: Lessons learned. Ann Surg Oncol 10:52–58

    Article  PubMed  Google Scholar 

  59. van Duijnhoven FH, Jansen MC, Junggeburt JM et al (2006) Factors influencing the local failure rate of radiofrequency ablation of colorectal liver metastasis. Ann Surg Oncol 13:651–658

    Article  PubMed  Google Scholar 

  60. Aloia TA, Vauthey JN, Loyer EM et al (2006) Solitary colorectal liver metastasis: Resection determines outcome. Arch Surg 141:460–466

    Article  PubMed  Google Scholar 

  61. Amersi FF, Mc Elrath-Garza A, Ahmad A, Zogakis T, Allegra DP, Krasne R, Bilchik AJ (2006) Long-term survival after radiofrequency ablation of complex unresectable liver tumors. Arch Surg 141:581–587

    Article  PubMed  Google Scholar 

  62. Livraghi T, Solbiati L, Meloni F, Ierace T, Goldberg SN, Gazelle GS (2003) Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection. Cancer 97:3027–3035

    Article  PubMed  Google Scholar 

  63. Rossi S, Di Stasi M, Buscarini E et al (1996) Percutaneous RF interstitial thermoablation in the treatment of hepatic cancer. Am J Rontgenol 167:759–768

    CAS  Google Scholar 

  64. Solbiati L, Goldberg SN, Ierace T et al (1997) Hepatic metastases: Percutaneous radiofrequency ablation with cooled-tip electrodes. Radiology 205:367–373

    PubMed  CAS  Google Scholar 

  65. Pawlik TM, Izzo F, Cohen DS, Morris JS, Curley SA (2003) Combined resection and radiofrequency ablation for advanced hepatic malignancies: Results in 172 patients. Ann Surg Oncol 10:1059–1069

    Article  PubMed  Google Scholar 

  66. Oshowo A, Gillams A, Harrison E, Lees WR, Taylor I (2003) Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases. Brit J Surg 90:1240–1243

    Article  PubMed  CAS  Google Scholar 

  67. Lencioni R, Crocetti L, Cioni D, Della Pina C, Bartolozzi C (2004) Percutaneous radiofrequency ablation of hepatic colorectal metastases: technique, indications, results, and new promises. Invest Radiol 39(11):689–697

    Article  PubMed  Google Scholar 

  68. Gillams AR, Lees WR (2000) Survival after percutaneous, image-guided, thermal ablation of hepatic metastases from colorectal cancer. Dis Colon Rectum 43:556–561

    Article  Google Scholar 

  69. Jakobs TF, Hoffmann RT, Trumm C, Reiser MF, Helmberger TK (2006) Radiofrequency ablation of colorectal metastases: Mid term results in 68 patients. Anticancer Res 26:671–680

    PubMed  Google Scholar 

  70. Pereira PL, Clasen S, Burkart C, Hartmann JT, Teichmann R, Claussen CD (2005) Combination of MR-guided radiofrequency (RF) ablation and neoadjuvant-adjuvant chemotherapy for colorectal liver metastases: A prospective phase II study. Radiology (Suppl.) 237:70

    Google Scholar 

  71. Kainuma O, Asano T, Aoyama H (1999) Combined therapy with radiofrequency thermal ablation and intra-arterial infusion chemotherapy for hepatic metastases from colorectal cancer. Hepatogastroenterology 46:1071–1077

    PubMed  CAS  Google Scholar 

  72. Livraghi T, Goldberg SN, Solbiati L, Meloni F, Ierace T, Gazelle GS (2001) Percutaneous radiofrequency ablation of liver metastases from breast cancer: Initial experience in 24 patients. Radiology 220:145–149

    PubMed  CAS  Google Scholar 

  73. Siperstein AE, Berber E (2001) Cryotherapy, percutaneous alcohol injection, and radiofrequency ablation for treatment of neuroendocrine liver metastases. World J Surg 25:693–696

    Article  PubMed  CAS  Google Scholar 

  74. Berber E, Flesher N, Siperstein AE (2002) Laparoscopic radiofrequency ablation of neuroendocrine liver metastases. World J Surg 26:985–990

    Article  PubMed  Google Scholar 

  75. Henn AR, Levine EA, McNulty W, Zagoria RJ (2003) Percutaneous radiofrequency ablation of hepatic metastases for symptomatic relief of neuroendocrine syndromes. Am J Rontgenol 181:1005–1010

    Google Scholar 

  76. Gillams A, Cassoni A, Conway G, Lees W (2005) Radiofrequency ablation of neuroendocrine liver metastases: The Middlesex experience. Abdom Imaging 30:435–441

    Article  PubMed  CAS  Google Scholar 

  77. Mejl V, Zuetenbrhorst JM, van Hillegersberg R, Kroger R, Prevoo W, van Coeverden F, Taal BG (2005) Local treatment in unresectable hepatic metastases of carcinoid tumors: Experiences with hepatic artery embolization and radiofrequency ablation. World J Surg Oncol 3(1):75

    Article  Google Scholar 

  78. Van Cutsem E, Nordlinger B, Adam R et al (2006) Towards a pan-european consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer 42:2212–2221

    Article  PubMed  Google Scholar 

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  1. Department of Diagnostic Radiology, Eberhard-Karls-University of Tübingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany

    Philippe L. Pereira

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Pereira, P.L. Actual role of radiofrequency ablation of liver metastases. Eur Radiol 17, 2062–2070 (2007). https://doi.org/10.1007/s00330-007-0587-0

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