Predictors of Local Recurrence after Radiofrequency Ablation of Liver Tumors.

Rajarathinam, G (2008) Predictors of Local Recurrence after Radiofrequency Ablation of Liver Tumors. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Radiofrequency (RF) energy has become a popular means of tumor ablation in recent years. Radiofrequency ablation (RFA) has been used to destroy malignant lesions of the lung, kidney, bone, adrenal glands, spleen, breast, lymph nodes, pelvis, prostate, neural tissue, and liver. The concept of tumor ablation has been used for more than 100 years. Many ablation modalities have been used, including cryoablation, alcohol ablation, laser, and microwave energy.9 Most recently, the use of RF energy for tumor ablation is becoming commonplace, most likely owing to its ease of use and availability, the multiple approaches of probe delivery, the wide range of applications, and the effectiveness of treatment. Hepatic resection offers the greatest potential for cure in patients with primary and metastatic liver tumors. Unfortunately, advanced stage, inadequate functional liver reserve, extrahepatic disease, or medical comorbidities render most patients with hepatic malignancy inoperable. Although complete surgical resection of HCC offers the best chance of long-term survival, cirrhosis may limit the amount of parenchymal resection that will be tolerated and increases the risk of postoperative liver failure and death. In most patients with cirrhosis and HCC confined to the liver, resection is not safe, and local tumor-ablation therapies are considered as alternative treatment options.Liver-directed therapies encompass a broad range of modalities from transarterial chemotherapy to intratumoral chemical injection and thermal destruction. AIM : The aim of this study was to identify and analyze the factors that may influence local recurrence to determine treatment efficacy, safety, local tumor control, and patterns of failure, treatment-related complications and outcome and overall survival in patients treated with Radiofrequency ablation for primary and metastatic liver tumors. METHODS : Between June 2005 and June 2007, 23 patients with 55 hepatic tumors underwent RFA at the Department of Surgical gastroenterology,Govt Stanley medical college hospital ,Chennai. Among these, 18 were male and 5 were female. Mean age of patients was 67 years (range 36–82). All patients were diagnosed by biopsy at least on one lesion. Twelve were hepatic cellular carcinoma (HCC) patients (25 tumors), with mean diameter of 3.3 cm (range, 2-7 cm). Of these 12 HCC patients, 8 were cirrhotic. Eleven patients (17 tumors) had metastatic liver carcinomas (MLCs) with mean diameter of 2.5 cm (range, 1.5- 4 cm). The primary tumors were from colorectal tract (n=6), neuroendocrine (n= 2),gastrointestinal stromal tumors(n = 3)respectively. CONCLUSION : In our experience, local recurrences were evident at a median follow-up time of 6 months and were associated with ablation of larger and multiple tumors. Additionally, based on our limited experience, repeat RFA seems to be well tolerated. However, recurrence in the liver is frequently accompanied by extrahepatic disease, and careful preoperative staging is essential to select patients who could potentially benefit from repeat RFA. Resection or ablation of liver tumors will not cure most patients with primary or metastatic malignant disease, although long-term disease-free survival rates of 20 % to 40 % For patients with resectable CRLM whom are appropriate candidates to undergo resection (medical condition and comorbidities) resection remains the gold standard. Complete ablation with superior local control by RFA is achievable for lesions up to 3 cm in size. Treatment with multimodality strategy is superior to single modality treatment for unresectable patients. Overall morbidity is related to patient selection and underlying co morbidities. We are very encouraged by our initial experience with RFA as a treatment for malignant liver tumors because it is safe, well tolerated, associated with few complications, and usually effective in controlling grossly or ultrasonographically evident in liver tumors. RFA for liver tumors should not be viewed as a simple technique but rather a specialized treatment modality that should be undertaken only by clinicians with adequate knowledge and experience in interventional therapies for liver tumors. When initiating the treatment, a team approach with close collaboration between surgeons and interventional radiologists may shorten the learning curve. Currently, many centers are reporting their initial experience with RFA for liver tumors. With adequate experience, RFA can be used to ablate liver tumors with low morbidity, low mortality, and a high complete ablation rate. .

Item Type: Thesis (Masters)
Uncontrolled Keywords: Predictors ; Local Recurrence ; Radiofrequency Ablation ; Liver Tumors.
Subjects: MEDICAL > Surgical Gastroenterology and Proctology
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 02:53
Last Modified: 28 Jul 2017 02:53

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