Radiofrequency ablation as locoregional therapy for unresectable hepatic malignancies: initial results in 24 patients with 5-years follow-up

Majerović, Mate and Augustin, Goran and Jelinčić, Željko and Buković, Damir and Kekez, Tihomir and Matošević, Petar and Smuđ, Dubravko and Kinda, Emil and Golem, Ante Zvonimir (2008) Radiofrequency ablation as locoregional therapy for unresectable hepatic malignancies: initial results in 24 patients with 5-years follow-up. Collegium Antropologicum, 32 (3). pp. 703-707. ISSN 0350-6134

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Abstract

Radiofrequency ablation (RFA) is one treatment modality for unresectable liver metastases. Patients with hepatic malignancies (n = 24) underwent elective RFA. All tumors were ablated with a curative intent, with a margin of 1 cm, in a single session of RFA. The median diameter of tumor was 3.1 cm (range 1.7-6.9 cm). Studied patients were not candidates for resection due to multifocal hepatic disease, extrahepatic disease, proximity to major vascular structures or presence of cirrhosis with functional hepatic reserve inadequate to tolerate major hepatic resection. Complete tumor necrosis was achieved in 87.5% and tumor recurred in 3 patients (12.5%) with lesions larger than 5 cm. Distant intrahepatic recurrence was diagnosed in another 4 (16.7%). Distant metastases were found in 7 (29.2%) patients. Four of these 7 patients had also distant intrahepatic recurrence of disease. Two and 5-years survival rates were 41.7% (10 patients) and 8.3% (2 patients) respectively. RFA is safe and effective option for patients with unresectable hepatic malignancies smaller than 5 cm without distant metastatic disease. RF ablation resulted in complete tumor necrosis in 87.5% with 2 and 5-years survival rates much higher than with chemotherapy alone or only supportive therapy, when survival is measured in weeks or months. If RFA is unavailable, percutaneous ethanol injection therapy can be done but with inferior survival rates.

Abstract in Croatian

Radiofrekvencijska ablacija (RFA) jedan je terapijski modalitet za liječenje neresektabilnih jetrenih metastaza. Bolesnici sa jetrenim metastazama (n=24) podvrgnuti su elektivnoj RFA. Ablacija svih jetrenih metastaza vršena je u svrhu izliječenja (kurativno) sa 1 cm zdravog ruba tijekom jedne (jedine) operacije. Srednji promjer tumora iznosio je 3,1 cm (rang 1,7–6,9 cm). Bolesnici podvrgnuti zahvatu nisu bili kandidati za resekcijski zahvat zbog: multifokalnih jetrenih metastaza, ekstrahepatalne proširenosti bolesti, blizine velikih krvnih žila ili prisutne ciroze sa nedovoljnom hepatalnom rezervom koja bi preostala nakon resekcije. Kompletna tumorska nekroza postignuta je u 87,5%, a rekurencija tumora pojavila se u 3 (12,5%) bolesnika i to kod metastatskih lezija većih od 5 cm. Udaljena intrahepatalna rekurencija dijagnosticirana je u 4 bolesnika (16,7%). Udaljene metastaze verificirane su u 7 (29,2%) bolesnika. Kod 4 od tih 7 bolesnika također je bila prisutna i udaljena intrahepatalna rekurencija bolesti. Dvogodišnje i 5-godišnje stope preživljenja iznosile su 41,7% (10 bolesnika) i 8,3% (2 bolesnika). Tijekom 24 mjeseca praćenja, preživljenje je iznosilo 41,7% (10 bolesnika). RFA je sigurna i efikasna metoda kod bolesnika sa neresektabilnim hepatalnim metastazama manjim od 5 cm bez udaljene metastatske bolesti. RFA je rezultirala sa kompletnom tumorskom nekrozom u 87,5% slučajeva sa 2- i 5-godišnjim stopama preživljenja znatno dužim u odnosu na primjenu isključivo kemoterapije ili suportivne terapije kada se preživljenje mjeri u tjednima ili mjesecima. Ako RFA nije dostupna također je moguće primijeniti perkutanu instlaciju etanola koja daje ipak lošije rezultate.

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