What is percutaneous radiofrequency ablation (RFA) of liver tumors?

Updated: Mar 30, 2021
  • Author: Badar Bin Bilal Shafi, MBBS, MRCP, FRCR, CCT, EBIR; Chief Editor: Kurt E Roberts, MD  more...
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In percutaneous radiofrequency (RF) ablation (RFA) of liver tumors, a needle is inserted into the liver, usually under the guidance of ultrasonography (US) or computed tomography (CT). [1] Once the needle is placed within the tumor, a generator is used to deliver a rapidly alternating current (RF energy). This needle may be bipolar or unipolar; the latter requires grounding pads placed on the patient's thighs. Heat is generated at the site of the lesion through frictional heat produced by rapid agitation of adjacent cells and produces destruction (liquefactive necrosis) of the tumor. This technology is used widely in Europe, the United States, and Japan. [2]

Percutaneous RFA is an exciting approach to destroying inoperable primary tumors or metastases in the liver. [3, 4] In the treatment of hepatocellular carcinoma (HCC), fewer than 40% of patients are candidates for surgery, and the rate of recurrence after curative surgery is high. Percutaneous techniques like RFA are, therefore, very important. RFA is widely used for metastatic and small primary tumors. [5] It serves as a bridge for transplant candidates, especially in relation to small primary lesions. [6]

Percutaneous RFA is a minimally invasive, repeatable procedure with few complications.Randomized controlled trials showed that RFA is superior to ethanol injection in the treatment of small HCCs. [7] RFA results in a higher rate of complete necrosis and requires fewer treatment sessions than percutaneous ethanol injection (PEI). [8, 9, 10]  Long-term survival rates are also better with RFA. A randomized clinical trial showed that RFA yields a significantly better 1-year complete response rate than does PEI. [7]

RFA in combination with transcatheter arterial chemoembolization (TACE) is also an effective treatment for inoperable hepatic tumors. [11, 12]  RFA combined with TACE also appears to be safe and effective in the treatment of breast cancer with liver metastasis. [13]

Some studies comparing percutaneous RFA and percutaneous microwave coagulation therapy (PMCT) showed better results with RFA in treatment of small tumors; RFA was associated with better survival rates, fewer complications, and significantly lower local recurrence rates. [14, 15]  However, a systematic review and meta-analysis by Glassberg et al, aimed at comparing microwave ablation (MWA) with RFA for treatment of liver cancer, found that MWA was at least as safe and effective as RFA in this setting, with significantly lower rates of local tumor progression. [16]

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