PERCUTANEOUS RF INTERSTITIAL THERMAL ABLATION IN THE TREATMENT OF HEPATIC CANCER

OBJECTIVE. The aim of this study was to evaluate the usefulness of RF interstitial thermal ablation for treating hepatic cancer. SUBJECTS AN D METHODS. Fifty patients, 39 who had 41 hepatocellular carcinoma nodu les and ii who had 13 hepatic metastatic nodules, underwent RF interst itial thermal ablation. In all but one, a thermal necrosis volume grea ter than the tumoral nodule volume was created to obtain total tumor d estruction. One large tumor was treated for debulking purposes. RESULT S. Hepatocellular carcinoma nodule destruction was achieved in a mean of 3.3 sessions of RF interstitial thermal ablation. During a mean fol low-up of 22.6 months (range, 3-66 months), 16 (41%) of 39 patients ha d recurrences; two (5%) of these patients showed local recurrences and the remaining 14 (36%) had new lesions. Nine of these 16 patients und erwent further RF interstitial thermal ablation that proved effective. RF interstitial thermal ablation was also successfully repeated in fo ur patients who had a second recurrence. With RF interstitial thermal ablation, we treated 54 hepatocellular carcinoma nodules in 39 patient s. Eleven (28%) of the 39 patients died: five from hepatic failure due to advanced cancer and six from causes other than cancer. Autopsy was performed on three patients who died from causes other than cancer, o ne had had two new courses of RF interstitial thermal ablation for two new lesions. Gross examination failed to detect two treated tumor nod ules; histologic examination of three other treated tumor nodules show ed total necrosis in two nodules and a 3-mm focus of viable cancer cel ls in the other nodule. Cumulative survival curves showed the median s urvival time to be 44 months. The survival rate fdr the first year was 0.94, 0.86 for the second year, 0.68 for the third year, and 0.40 for the fourth and fifth years. In the patients treated for metastatic no dules, posttreatment imaging studies showed necrosis that varied from 80% to 100% in all cases. Pathologic studies performed on two patients who underwent surgery after RF interstitial thermal ablation showed 1 00% necrosis in one case and 80% necrosis in the other. CONCLUSION. RF interstitial thermal ablation is a useful percutaneous treatment for hepatic cancer.