Radiofrequency Ablation of Hepatic Lesions: A Review

Venkataramu N. Krishnamurthy, MD; V. Javier Casillas, MD; Lina Latorre, MD

Disclosures

Appl Radiol. 2003;32(10) 

In This Article

Outcome Analysis

Radiofrequency ablation is being increasingly performed worldwide. Currently, it is predominantly performed for treatment of hepatic tumors that are not amenable to resection. The most common tumors treated by RF ablation are HCC and colorectal metastases. Results of long-term survival rates from some of the larger studies have become available recently.[25,26,54,55,56] These studies show that the most important determinant for achieving complete ablation is the size of the tumor. In general, technically successful complete ablation is possible in 90% of tumors <2.5 cm in diameter, in approximately 70% to 90% of tumors with 2.5- to 3.5-cm diameter, in 50% to 70% of tumors with 3.5 to 5.0 cm in diameter, and <50% of tumors >5.0 cm in diameter.[25,29,56,57,58,59] Tumor type is also shown to affect the outcome with better success reported in treating HCC and breast metastases compared with colorectal metastases.[25,57,60] Studies have also shown that tumor histology directly affects the success rate with well-differentiated HCC having better results of ablation than infiltrating lesions.

Radiofrequency ablation of HCC has been documented to provide survival benefits, particularly for smaller lesions (<3.5 cm).[14,26,27] Disease-free survival on long-term follow-up, as reported by larger studies are as follows: 64% at 23-month and 71% at 12-month mean follow-up, according to Rossie et al[14,27]; 67% at 15-month mean follow-up, according to Francica et al[33]; and 92% at 1-year and 60% at 3-year follow-up, according to Iannitti et al.[54]

Radiofrequency ablation for liver metastases is promising but is less effective than it is for HCC.[57,58,61] Colorectal metastasis is the most common metastasis treated by RF ablation. Disease-free survival has generally been reported to be lower than that reported for HCC. However, two recent studies show comparable results with disease-free survival of 87% to 93% at follow-up at 12 months, 62% to 77% at 24 months, and 41% to 50% at 36 months.[54,61]

Although hepatic resection is the standard of care for hepatic malignancy, major hepatic resection is associated with significant morbidity and mortality (2% to 10%).[62] Radiofrequency ablation, in comparison, is a minimally invasive and safe procedure with lower morbidity and mortality (<2%).[53,54]

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