Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies - Results in 123 patients

Objective To describe the safety and efficacy of radiofrequency ablation (RFA) to tre at unresectable malignant hepatic tumors in 123 patients. Background The majority of patients with primary or metastatic malignancies confined t o the liver are not candidates for resection because of tumor size, locatio n, or multifocality or inadequate functional hepatic reserve. Local applica tion of heat is tumoricidal; therefore, the authors investigated a novel RF A system to treat patients with unresectable hepatic cancer. Patients and Methods Patients with hepatic malignancies were entered into a prospective, nonrand omized trial. The liver tumors were treated percutaneously or during surger y under ultrasound guidance using a novel LeVeen monopolar array needle ele ctrode and an RF 2000 generator. All patients were followed to assess compl ications, treatment response, and recurrence of malignant disease. Results RFA was used to treat 169 tumors (median diameter 3.4 cm, range 0.5 to 12 c m) in 123 patients. Primary liver cancer was treated in 48 patients (39.1%) , and metastatic liver tumors were treated in 75 patients (60.9%). Percutan eous and intraoperative RFA was performed in 31 patients (35.2%) and 92 pat ients (74.8%), respectively. There were no treatment-related deaths, and th e complication rate after RFA was 2.4%. All treated tumors were completely necrotic on imaging studies after completion of RFA treatments. With a medi an follow-up of 15 months, tumor has recurred in 3 of 169 treated lesions ( 1.8%), but metastatic disease has developed at other sites in 34 patients ( 27.6%). Conclusions RFA is a safe, well-tolerated, and effective treatment to achieve tumor des truction in patients with unresectable hepatic malignancies. Because patien ts are at risk for the development of new metastatic disease after RFA, mul timodality treatment approaches that include RFA should be investigated.