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Published in: CardioVascular and Interventional Radiology 6/2012

01-12-2012 | Clinical Investigation

Combined Therapies for the Treatment of Technically Unresectable Liver Malignancies: Bland Embolization and Radiofrequency Thermal Ablation within the Same Session

Authors: Guido Bonomo, Paolo Della Vigna, Lorenzo Monfardini, Gianluigi Orgera, Antonio Chiappa, Paolo Pietro Bianchi, Maria Giulia Zampino, Franco Orsi

Published in: CardioVascular and Interventional Radiology | Issue 6/2012

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Abstract

Purpose

This retrospective study evaluated the feasibility, efficacy, and safety of combining transcatheter arterial embolization (TAE) with radiofrequency thermal ablation (RFA) in a single session for the treatment of technically unresectable liver-only malignancies.

Methods

From May 2006 to January 2011, a total of 30 patients affected by liver metastases with single or multiple unresectable liver-only lesions underwent a combined treatment with TAE followed by RFA in the same session, for a total of 36 treated lesions. Patients were extrapolated from a cohort of patients discussed within the weekly institutional tumor board. TAE was performed by using 100 μm microspheres; RFA was performed immediately after TAE by positioning the electrode needle via ultrasound and/or computed tomographic guidance. Local tumor responses and procedure-related complications were evaluated.

Results

Completion of both procedures was obtained in all patients for all 36 lesions. Liver lesions had a maximum axial diameter ranging 16–59 mm. Postintervention unenhanced ablated areas ranged 28–104 mm in maximum axial diameter. Safety margins ranged 1–30.5 mm. Complete response, defined as complete devascularization at computed tomography, was obtained in all treated lesions for a maximum period of 12 months. Tumor relapse was observed in one patient at 12 months. Sixteen patients developed new liver lesions or progressive systemic disease during follow-up. Nine patients were still disease-free. Seven patients died as a result of systemic progressive disease. One major treatment-related complication was observed.

Conclusions

In patients with technically unresectable liver-only malignancies, single-session combined TAE-RFA is an effective and safe treatment.
Literature
1.
2.
3.
go back to reference Biasco G, Derenzini E, Grazi G et al (2006) Treatment of hepatic metastases from colorectal cancer: many doubts, some certainties. Cancer Treat Rev 32:214–228PubMedCrossRef Biasco G, Derenzini E, Grazi G et al (2006) Treatment of hepatic metastases from colorectal cancer: many doubts, some certainties. Cancer Treat Rev 32:214–228PubMedCrossRef
4.
5.
go back to reference Goldberg SN, Gazelle GS (2001) Radiofrequency tissue ablation: physical principles and techniques for increasing coagulation necrosis. Hepatogastroenterology 48:359–367PubMed Goldberg SN, Gazelle GS (2001) Radiofrequency tissue ablation: physical principles and techniques for increasing coagulation necrosis. Hepatogastroenterology 48:359–367PubMed
6.
go back to reference Goldberg SN, Hahn PF, Tanabe KK et al (1998) Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol 9:101–111PubMedCrossRef Goldberg SN, Hahn PF, Tanabe KK et al (1998) Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol 9:101–111PubMedCrossRef
7.
go back to reference Nakai M, Sato M, Sahara S et al (2007) Radiofrequency ablation in a porcine liver model: effects of transcatheter arterial embolization with iodized oil on ablation time, maximum output, and coagulation diameter as well as angiographic characteristics. World J Gastroenterol 13:2841–2845PubMed Nakai M, Sato M, Sahara S et al (2007) Radiofrequency ablation in a porcine liver model: effects of transcatheter arterial embolization with iodized oil on ablation time, maximum output, and coagulation diameter as well as angiographic characteristics. World J Gastroenterol 13:2841–2845PubMed
8.
go back to reference Mostafa EM, Ganguli S, Faintuch S et al (2008) Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors. J Vasc Interv Radiol 19:1740–1748PubMedCrossRef Mostafa EM, Ganguli S, Faintuch S et al (2008) Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors. J Vasc Interv Radiol 19:1740–1748PubMedCrossRef
9.
go back to reference Cheng BQ, Jia CQ, Liu CT et al (2008) Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm. JAMA 299:1669–1677PubMedCrossRef Cheng BQ, Jia CQ, Liu CT et al (2008) Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm. JAMA 299:1669–1677PubMedCrossRef
10.
go back to reference Takaki H, Yamakado K, Uraki J et al (2009) Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinomas larger than 5 cm. J Vasc Interv Radiol 20:217–224PubMedCrossRef Takaki H, Yamakado K, Uraki J et al (2009) Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinomas larger than 5 cm. J Vasc Interv Radiol 20:217–224PubMedCrossRef
11.
go back to reference Liu CH, Arellano RS, Uppot RN et al (2010) Radiofrequency ablation of hepatic tumours: effect of post-ablation margin on local tumour progression. Eur Radiol 20:877–885PubMedCrossRef Liu CH, Arellano RS, Uppot RN et al (2010) Radiofrequency ablation of hepatic tumours: effect of post-ablation margin on local tumour progression. Eur Radiol 20:877–885PubMedCrossRef
12.
go back to reference Brown DB, Cardella JF, Sacks D et al (2006) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization and chemiotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 17:225–232PubMedCrossRef Brown DB, Cardella JF, Sacks D et al (2006) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization and chemiotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 17:225–232PubMedCrossRef
13.
go back to reference Goldberg SN, Grassi CJ, Cardella JF et al (2009) Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 20:s377–s390PubMedCrossRef Goldberg SN, Grassi CJ, Cardella JF et al (2009) Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 20:s377–s390PubMedCrossRef
14.
go back to reference Curley SA, Izzo F, Ellis LM et al (2000) Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg 232:381–391PubMedCrossRef Curley SA, Izzo F, Ellis LM et al (2000) Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg 232:381–391PubMedCrossRef
15.
go back to reference Solbiati L, Livraghi T, Goldberg SN et al (2001) Percutaneous radiofrequency ablation of hepatic metastases from colorectal cancer: long-term results in 111 patients. Radiology 221:159–166PubMedCrossRef Solbiati L, Livraghi T, Goldberg SN et al (2001) Percutaneous radiofrequency ablation of hepatic metastases from colorectal cancer: long-term results in 111 patients. Radiology 221:159–166PubMedCrossRef
16.
go back to reference Lin SM, Lin CJ, Lin CC et al (2005) Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 54:1151–1156PubMedCrossRef Lin SM, Lin CJ, Lin CC et al (2005) Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 54:1151–1156PubMedCrossRef
17.
go back to reference Primrose JN (2002) Treatment of colorectal metastases: surgery, cryotherapy, or radiofrequency ablation. Gut 50:1–5PubMedCrossRef Primrose JN (2002) Treatment of colorectal metastases: surgery, cryotherapy, or radiofrequency ablation. Gut 50:1–5PubMedCrossRef
18.
go back to reference O’Rourke AP, Haemmerich D, Prakash P et al (2007) Current status of liver tumor ablation devices. Expert Rev Med Devices 4:523–537PubMedCrossRef O’Rourke AP, Haemmerich D, Prakash P et al (2007) Current status of liver tumor ablation devices. Expert Rev Med Devices 4:523–537PubMedCrossRef
19.
go back to reference Flanders VL, Gervais DA (2010) Ablation of liver metastases: current status. J Vasc Interv Radiol 21:S214–S222PubMedCrossRef Flanders VL, Gervais DA (2010) Ablation of liver metastases: current status. J Vasc Interv Radiol 21:S214–S222PubMedCrossRef
20.
go back to reference Nesbitt C, Glendinning RJ, Byrne C et al (2007) Factors that influence treatment strategies in advanced colorectal cancer. Eur J Surg Oncol 33:s88–s94PubMedCrossRef Nesbitt C, Glendinning RJ, Byrne C et al (2007) Factors that influence treatment strategies in advanced colorectal cancer. Eur J Surg Oncol 33:s88–s94PubMedCrossRef
21.
go back to reference Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48:S20–S37PubMedCrossRef Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48:S20–S37PubMedCrossRef
22.
go back to reference Livraghi T, Meloni F, Goldberg SN et al (2000) Hepatocellular carcinoma: radiofrequency ablation of medium and large lesions. Radiology 214:761–768PubMed Livraghi T, Meloni F, Goldberg SN et al (2000) Hepatocellular carcinoma: radiofrequency ablation of medium and large lesions. Radiology 214:761–768PubMed
23.
go back to reference Liapi E, Geschwind JFH (2007) Transcatheter and ablative therapeutic approaches for solid malignancies. J Clin Oncol 25:978–986PubMedCrossRef Liapi E, Geschwind JFH (2007) Transcatheter and ablative therapeutic approaches for solid malignancies. J Clin Oncol 25:978–986PubMedCrossRef
24.
go back to reference Takaki H, Yamakado K, Uraki J et al (2009) Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinoma larger than 5 cm. J Vasc Interv Radiol 20:217–224PubMedCrossRef Takaki H, Yamakado K, Uraki J et al (2009) Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinoma larger than 5 cm. J Vasc Interv Radiol 20:217–224PubMedCrossRef
25.
go back to reference Liao GS, Yu CY, Chan DC et al (2009) Radiofrequency ablation after transarterial embolization as therapy for patients with unresectable hepatocellular carcinoma. Eur J Surg Oncol 34:61–66CrossRef Liao GS, Yu CY, Chan DC et al (2009) Radiofrequency ablation after transarterial embolization as therapy for patients with unresectable hepatocellular carcinoma. Eur J Surg Oncol 34:61–66CrossRef
26.
go back to reference Veltri A, Moretto P, Doriguzzi A et al (2006) Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol 16:661–669PubMedCrossRef Veltri A, Moretto P, Doriguzzi A et al (2006) Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol 16:661–669PubMedCrossRef
27.
go back to reference Vogl TJ, Mack MG, Balzer JO et al (2003) Liver metastases: neoadjuvant downsizing with trans-arterial chemoembolization before laser-induced thermotherapy. Radiology 229:457–464PubMedCrossRef Vogl TJ, Mack MG, Balzer JO et al (2003) Liver metastases: neoadjuvant downsizing with trans-arterial chemoembolization before laser-induced thermotherapy. Radiology 229:457–464PubMedCrossRef
28.
go back to reference Nakai M, Sato M, Sahara S et al (2007) Radiofrequency ablation in a porcine liver model: effects on transcatheter arterial embolization with iodized oil on ablation time, maximum output, and coagulation diameter as well as angiographic characteristics. World J Gastreoenterol 13:2841–2845 Nakai M, Sato M, Sahara S et al (2007) Radiofrequency ablation in a porcine liver model: effects on transcatheter arterial embolization with iodized oil on ablation time, maximum output, and coagulation diameter as well as angiographic characteristics. World J Gastreoenterol 13:2841–2845
29.
go back to reference Cady B, Jenkins R, Steele GD et al (1998) Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant outcome. Ann Surg 227:566–571PubMedCrossRef Cady B, Jenkins R, Steele GD et al (1998) Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant outcome. Ann Surg 227:566–571PubMedCrossRef
30.
31.
go back to reference Ekberg H, Tranberg KG, Andersson R et al (1986) Determinants of survival in liver resection for colorectal secondaries. Br J Surg 73:727–731PubMedCrossRef Ekberg H, Tranberg KG, Andersson R et al (1986) Determinants of survival in liver resection for colorectal secondaries. Br J Surg 73:727–731PubMedCrossRef
32.
go back to reference Scheele J, Stang R, Altendorf-Hofmann A et al (1995) Resection of colorectal liver metastases. World J Surg 19:59–71PubMedCrossRef Scheele J, Stang R, Altendorf-Hofmann A et al (1995) Resection of colorectal liver metastases. World J Surg 19:59–71PubMedCrossRef
33.
go back to reference Kokudo N, Miki Y, Sugai S et al (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 137:833–840PubMedCrossRef Kokudo N, Miki Y, Sugai S et al (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 137:833–840PubMedCrossRef
34.
go back to reference Cheng BQ, Jia CQ, Liu CT et al (2008) Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm. A randomized controlled trial. JAMA 299:1669–1677PubMedCrossRef Cheng BQ, Jia CQ, Liu CT et al (2008) Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm. A randomized controlled trial. JAMA 299:1669–1677PubMedCrossRef
35.
go back to reference Kang SG, Yoon CJ, Jeong SH et al (2009) Single-session combined therapy with chemoembolization and radiofrequency ablation in hepatocellular carcinoma less than or equal to 5 cm: a preliminary study. J Vasc Interv Radiol 20:1570–1577PubMedCrossRef Kang SG, Yoon CJ, Jeong SH et al (2009) Single-session combined therapy with chemoembolization and radiofrequency ablation in hepatocellular carcinoma less than or equal to 5 cm: a preliminary study. J Vasc Interv Radiol 20:1570–1577PubMedCrossRef
36.
go back to reference Simmonds PC, Primrose JN, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: systematic review of published studies. Br J Cancer 94:982–999PubMedCrossRef Simmonds PC, Primrose JN, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: systematic review of published studies. Br J Cancer 94:982–999PubMedCrossRef
Metadata
Title
Combined Therapies for the Treatment of Technically Unresectable Liver Malignancies: Bland Embolization and Radiofrequency Thermal Ablation within the Same Session
Authors
Guido Bonomo
Paolo Della Vigna
Lorenzo Monfardini
Gianluigi Orgera
Antonio Chiappa
Paolo Pietro Bianchi
Maria Giulia Zampino
Franco Orsi
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
CardioVascular and Interventional Radiology / Issue 6/2012
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-012-0341-0

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