Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?

Introduction  The role of ablation for hepatic colorectal metastases (HCM) continues to evolve as ablation technology changes and systemic chemotherapy improves. Our aim was to evaluate the therapeutic efficacy of radiofrequency ablation (RFA) of HCM compared to surgical resection. Methods  A retrospective review of our 1,105 patient prospective hepatic database from August 1995 to July 2007 identified 192 patients with only hepatic resection or only ablation for HCM. Results  Patients who underwent RFA were similar to resection patients based on a similar Fong score (1.8 vs. 2.1 p = 0.28), presence of extrahepatic disease (15% vs. 9% p = 0.19), mean number of hepatic lesions (2.8 vs. 2.1 p = 0.14), and prior chemotherapy (67% vs. 60% p = 0.33). Median time to recurrence was shorter with ablation than resection (12.2 vs. 31.1 months; p < 0.001). Recurrence at the ablation–resection site was more common with ablation than resection occurring 17% vs. 2% (p ≤ 0.001) of the time, respectively. Distant recurrence in the liver was also more common with ablation occurring in 33% of patients vs. 14% for resection (p = 0.002). Conclusions  Surgical resection is associated with a lower chance of recurrence and a longer disease-free interval than RFA and should remain the treatment of choice in resectable HCM.     

Radiofrequency Ablation Versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

Background Surgical resection is the gold standard in the treatment of resectable colorectal liver metastases (CRLM). In several centers, resection is being replaced by radiofrequency ablation (RFA), even though there is no evidence yet from randomized trials to support this. The aim of this study was to critically review the oncological evidence for and against the use of RFA for resectable CRLM. Methods An exhaustive review of RFA of colorectal metastases was carried out. Results Five-year survival data after RFA for resectable CRLM are not available. Percutaneous RFA is associated with worse local control, worse staging, and a small risk of electrode track seeding when compared with resection (level V evidence). For tumors ≤3 cm, local control after surgical RFA is equivalent to resection, especially if applied by experienced physicians to nonperivascular tumors (level V evidence). There is indirect evidence for profoundly different biological effects of RFA and resection. Conclusions A subgroup of patients has been identified for whom local control after RFA might be equivalent to resection. Whether this is true, and whether this translates into equivalent survival, remains to be proven. The time has come for a randomized trial.     

Percutaneous Imaging–Guided Radiofrequency Ablation in Patients With Colorectal Pulmonary Metastases: 1-Year Follow-Up

Background: We assessed the safety and evidence of efficacy of radiofrequency ablation (RFA) for colorectal lung metastases with follow-up to 1 year.Methods: Twenty-three patients had percutaneous RFA for 52 colorectal pulmonary metastases under fluoro-computed tomography (CT). Patients received intravenous conscious sedation and local analgesia with routine hospitalization and monitoring for 24 hours after RFA. Patients had CT scanning at 1 month and then every 3 months, with serum carcinoembryonic antigen assessment monthly and every 3 months.Results: All ablations were technically successful. Tumor diameter ranged from .3 to 4.2 cm. Pneumothorax occurred in 43% (10 of 23) of patients. Six patients required intercostal chest drain placement. Six patients had a second RFA, four for new lesions and two for re-treatment of a previously treated lesion. The median admission was 2.0 days (range, 1–9 days). The median follow-up was 428 days (range, 173–829 days); data are reported to 1 year in this article. Five patients died at 5, 6, 8, 8, and 12 months after RFA from extrapulmonary (n = 1) or widespread (n = 4) disease. One patient developed a malignant pleural effusion at 6 months after RFA. Cavitation was seen in nine treated lesions (17%); all resolved with scar tissue contraction by 12 months. Eighteen patients with CT scan follow-up at 1 year have 40 lesions classified as disappeared (n = 17), decreased (n = 5), stable/same size (n = 4), or increased (n = 14).Conclusions: Percutaneous imaging–guided RFA of multiple colorectal pulmonary metastases is a minimally invasive treatment option with modest morbidity. A significant proportion of patients show good evidence of successful local control at 1 year.     

Author’s Reply: Radiofrequency Ablation for Benign Thyroid Nodules: 1-Year Follow-Up in 184 Patients

World Journal of Surgery -     

Radiofrequency Ablation Versus Surgical Resection for Hepatocellular Carcinoma in Childs A Cirrhotics—a Retrospective Study of 1,061 Cases

Introduction  

The long-term outcomes of radiofrequency ablation (RFA) vs. surgical resection in cirrhotic patients with hepatocellular carcinoma (HCC) remain controversial. One thousand sixty-one cirrhotic HCC patients were included into a retrospective study. Four hundred thirteen received RFA and 648 received surgical resection.     

Combined Thermal–Surgical Ablation of Locally Advanced Abdominopelvic Malignancies

Background

Treatment options for patients with inoperable primary or recurrent/metastatic abdominopelvic malignancies are limited, and these patients have short lifespan. The purpose of our study is to examine outcomes of combined open radiofrequency ablation (RFA) and surgical debulking of otherwise unresectable tumors.

Methods

Consecutive 50 patients were identified from an Institutional Review Board (IRB)-approved database undergoing ablation for unresectable abdominopelvic malignancies via conventional surgical methods in a single institution between 07/2003 and 09/2009. Patients were selected for debulking if they had a dominant mass that caused significant symptoms.

Results

Sixteen patients had primary tumors, and 34 presented with a recurrent/metastatic malignancy. The primary tumors were abdominopelvic sarcomas (eight patients), large desmoids (two), colorectal cancer (CRC) (two), and gastric cancer, mucinous cystic pancreatic neoplasm, gastrointestinal stromal tumor (GIST), and carcinoid (one each). The recurrent/metastatic tumors were CRCs (16 patients), abdominopelvic sarcomas (12), and GIST, prostate cancer, bladder cancer, melanoma, adrenal cancer, and pseudomyxoma peritonei recurrences (1 each). Twenty-two patients were alive and 28 died as of September 2009. Median survival for patients who died was 9.5 months and for patients who were alive was 22 months. Patients with primary tumors had 5-year survival of 18% compared with no survivors at 5 years in the recurrent/metastatic group (P = 0.002).

Conclusions

Thermosurgical ablation of otherwise unresectable primary tumors and recurrent/metastatic abdominopelvic malignancies is feasible in selected cases. Patients with ablated primary tumors have a survival advantage over patients who have ablation for recurrent/metastatic disease.     

Radiofrequency ablation for osteoid osteoma – Recurrence rates and predictive factors

Background and purpose

Osteoid osteoma is an infrequent but debilitating benign bone lesion which can be successfully managed by percutaneous radiofrequency ablation (RFA). There are few studies investigating the efficacy and follow-up of this treatment. An arbitrary upper limit of 15 mm has been used to differentiate between osteoid osteoma and osteoblastoma with surgery used for lesions above this limit.We aimed to analyse the cases identified from our prospectively maintained database over a ten year period since adoption of this technique in our unit. The primary objectives were to investigate factors which influenced recurrence and the time period at which patients are at risk of this.

Radiofrequency ablation: emerging therapy for the small pulmonary nodule?

Traditional approaches to small pulmonary nodules have ranged from serial radiographic surveillance to transthoracic needle aspiration to surgical resection for diagnosis. Once the diagnosis of non-small-cell lung cancer is secured, lobectomy remains the gold standard treatment. Nevertheless, advances in image-guided technology and radiofrequency thermal ablation techniques have allowed for diagnostic sampling of lesions with concomitant therapeutic thermal ablation. The role these techniques will play in the treatment of patients with primary lung cancer remains undefined. This review (1) examines the basic technology of radiofrequency ablation; (2) provides an update on current clinical experience with this technique; and (3) explores the role of radiofrequency ablation in the treatment scheme of patients with non-small-cell lung cancer.     

Is Percutaneous Radiofrequency Coblation for Treatment of Achilles Tendinosis Safe and Effective?

Insertional Achilles tendinosis results in isolated pain at the Achilles tendon insertion site due to intratendinous degeneration. When conservative measures fail, surgical treatment may be necessary. Radiofrequency coblation has been suggested to be an effective procedure for treatment of tendon pathologies. Percutaneous execution of this procedure is very simple as well as minimally invasive, and thus if effective, would be an excellent alternative to an open treatment of insertional Achilles tendinopathy. A review of 47 cases with this percutaneous technique was conducted. In our relatively short-term follow-up (mean = 8.6 months, SD = 9.71, range 1 to 40), the incidence of reoperation was 14.9% (7/47). Rupture of the Achilles tendon was identified in 3 (6.4%) patients. Our cohort had a relatively high body mass index (mean = 37.1, SD = 6.96, range 24.3 to 52.8). We recommend surgeons to be cautious about selecting this procedure in similar, high body mass index patient cohorts for treatment of Achilles tendinosis.     

Radiofrequency ablation for Barrett’s-associated intramucosal carcinoma: a multi-center follow-up study

Background

Radiofrequency ablation (RFA), with or without endoscopic mucosal resection (EMR), has been validated as a safe, effective and durable treatment option for dysplastic Barrett’s esophagus. Its durability in eradicating Barrett’s-associated intramucosal carcinoma (IMC), however, is unclear. We set out to assess the long-term safety and efficacy of RFA for IMC.

Methods

Retrospective review of two tertiary care facility records for patients undergoing RFA, with or without EMR, for biopsy-proven IMC. Our primary outcome of interest was to quantify the rate of durable complete eradication for intestinal metaplasia and for IMC and associated dysplasia. A multi-variate regression analysis was performed to identify features which correlate with durable eradication of IMC/dysplasia. Our secondary outcome of interest was treatment-related complications.

Results

36 patients (26 male; mean age 64 ± 12 years), with a mean Barrett’s length of 3.5 ± 2.5 cm, underwent RFA for biopsy-proven IMC. EMR was performed in 31 (86 %) prior to or during RFA. Complete eradication of IMC/dysplasia was achieved in 32/36 (89 %) and patients required a mean of 1 ± 1 EMR and 2 ± 1 RFA sessions to achieve eradication. During a mean follow-up period of 24 ± 19 months, durable complete eradication of IMC/dysplasia was achieved in 29/36 (81 %) patients. On multi-variate regression analysis, undergoing an EMR prior to RFA was associated with an increased likelihood of maintaining durable eradication of IMC/dysplasia (p = 0.03). Treatment-related complications included: bleeding (3 %) and stricture formation (19 %).

Conclusion

RFA is an effective and durable treatment option for Barrett’s-associated IMC. Greater than 80 % of patients will achieve and maintain complete eradication of IMC at a mean of 2 years follow-up.