eMedicine Specialties > Clinical Procedures > Radiology

Percutaneous Radiofrequency Ablation of Liver Tumors

Author: Badar Bin Bilal Shafi, MBBS, MRCP, Specialist Registrar in Radiology, University Hospital Aintree, Aintree NHS Foundation Trust, Liverpool, UK
Coauthor(s): Rana Haris Bin Bilal, MBBS, Senior House Officer, Department of Orthopedic Surgery, Nuffield Orthopedic Center, UK; Jonathan C Evans, MBChB, BSc, MRCP, DMRD, FRCR, Radiologist, Interventional Radiology and GI Imaging, Royal Liverpool University Hospital, UK
Contributor Information and Disclosures

Updated: Mar 12, 2009

Introduction

  • Percutaneous radio frequency ablation (RFA) is an exciting approach to destroying inoperable primary or metastasis tumors in the liver.1 In the treatment of hepatocellular carcinoma (HCC), less 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.2 RFA serves as a bridge for transplant candidates, especially in relation to small primary lesions.3
  • Percutaneous RFA is a minimally invasive, repeatable procedure with few complications. It is performed under radiological guidance. Randomized controlled trials have shown that RFA is superior to ethanol injection in the treatment of small HCC.4 RFA results in a higher rate of complete necrosis and requires fewer treatment sessions than percutaneous ethanol injection (PEI).5 Long-term survival rates are also better with RFA. A randomized clinical trial has shown that RFA results in significantly better 1-year complete response than does PEI.4 RFA in combination with transcatheter arterial chemoembolization (TACE) is also an effective treatment for inoperable hepatic tumors.6
  • Recent studies that have compared percutaneous RFA and percutaneous microwave coagulation therapy (PMCT) have shown better results with RFA in treatment of small tumors. RFA results in better survival rates, fewer complications, and significantly lower local recurrence rate.7,8
  • In RFA, a needle is inserted into the liver, usually under the guidance of ultrasonography or CT. Once placed within the tumor, a generator is used to deliver a rapidly alternating current (radiofrequency 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 and the United States. As noted by Shiina et al, 1500 institutes in Japan have introduced RFA in the treatment of liver tumors.9

Indications

In the treatment of hepatocellular carcinoma (HCC), the range of indications for percutaneous radiofrequency ablation (RFA) is becoming wider than that of surgery and intra-arterial therapies, and it includes the following main categories:4,1

  • Hepatocellular carcinoma at an early stage10,11
  • Primary treatment for small tumors12
    • A meta-analysis by Jansen et al has described local ablative techniques as the treatment of choice for small HCC.13  
    • The National Institute for Clinical Excellence (NICE) in the United Kingdom has also recommended RFA as the treatment of choice in small tumors.14
  • Inoperable primary liver tumor
  • Treatment of patients who cannot undergo general anesthesia or are not operative candidates because of comorbidity or advanced age
  • Liver metastasis, most commonly colorectal, especially if the patient is not an operative candidate15
  • Can be used for breast,16 thyroid,17 and neuroendocrine metastasis18
  • Treatment of patients who have a hepatoma or multiple small lesions and are waiting for liver transplantation3
  • Recurrent and progressive lesions19

Contraindications

  • Bile duct or major vessel invasion
  • Significant extrahepatic disease
  • Child class C cirrhosis or active infection
  • Decompensated liver disease
  • Lesions that are difficult to reach with electrodes or when electrode placement is impaired (In such cases, open rather than percutaneous approach should be used.20 )
  • Tumors that occupy >40% of the volume of the liver (Tumors of this size cannot be safely ablated because the liver reserve left after radiofrequency ablation [RFA] might not be sufficient to preserve hepatic function.)
  • Proximity to vital structures like vessels and adjacent organs21 (relative contraindication; open RFA is suggested by one study20 )
  • Lesions larger than 5 cm (relative contraindication)
    • RFA should be used cautiously for lesions larger than 5 cm.
    • One study suggests the use of open RFA for lesions larger than 5 cm.20
  • Patients with metastatic lesions larger than 3 cm (These lesions are not optimal for RFA, as the risk of recurrence is high.15 )
  • Large or numerous tumors (Multiple studies recommend RFA as a choice if fewer than 3 tumors are present, each lesion measuring less than 3 cm.22,23,24 )

More on Percutaneous Radiofrequency Ablation of Liver Tumors

Overview: Percutaneous Radiofrequency Ablation of Liver Tumors
Treatment & Medication: Percutaneous Radiofrequency Ablation of Liver Tumors
Multimedia: Percutaneous Radiofrequency Ablation of Liver Tumors
References
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References

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  2. Lencioni R, Cioni D, Crocetti L, et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology. Mar 2005;234(3):961-7. [Medline].

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Further Reading

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Keywords

radiofrequency ablation, radio frequency ablation, ablation, rf ablation, RF ablation, liver ablation, tumor ablation, RFA, hepatocellular carcinoma, HCC, HCC treatment, HCC ablation, lesion ablation, thermal ablation, liver cancer, liver carcinoma, liver cancer treatment, ethanol injection, multiple array electrode, electrodes, internally cooled electrodes, bipolar electrode, saline-enhanced RFA, saline infusion RFA

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Contributor Information and Disclosures

Author

Badar Bin Bilal Shafi, MBBS, MRCP, Specialist Registrar in Radiology, University Hospital Aintree, Aintree NHS Foundation Trust, Liverpool, UK
Badar Bin Bilal Shafi, MBBS, MRCP is a member of the following medical societies: Royal College of Radiologists
Disclosure: Nothing to disclose.

Coauthor(s)

Rana Haris Bin Bilal, MBBS, Senior House Officer, Department of Orthopedic Surgery, Nuffield Orthopedic Center, UK
Rana Haris Bin Bilal, MBBS is a member of the following medical societies: British Medical Association
Disclosure: Nothing to disclose.

Jonathan C Evans, MBChB, BSc, MRCP, DMRD, FRCR, Radiologist, Interventional Radiology and GI Imaging, Royal Liverpool University Hospital, UK
Jonathan C Evans, MBChB, BSc, MRCP, DMRD, FRCR is a member of the following medical societies: Royal College of Radiologists
Disclosure: Nothing to disclose.

Medical Editor

Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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