Download PDF
Semin intervent Radiol 2014; 31(02): 180-186
DOI: 10.1055/s-0034-1373792
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Image-Guided Percutaneous Ablation of Hepatic Malignancies

Gretchen Foltz
1   Division of Interventional Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2014 (online)

Also available at
    Permissions and Reprints

Abstract

The liver is a common site of primary and secondary malignancies, often resulting in significant morbidity and mortality. Evaluating these patients in a multidisciplinary setting allows for optimal utilization of all oncologic therapies including surgery, radiation, systemic chemotherapy, transarterial therapies, and ablation. While surgical intervention often provides the best outcomes when treating most hepatic tumors, many patients are not surgical candidates due to extensive tumor burden, underlying liver disease, or other comorbid conditions. The evolution of imaging and ablation devices has allowed for the increased utilization of percutaneous ablation as definitive and palliative treatment of primary and metastatic hepatic malignancies. Ablation induces tumor necrosis by injection of chemicals (chemical ablation) or temperature modification (thermal ablation). The goal of this review is to provide an overview of different ablation techniques commonly used for hepatic malignancies, discuss the oncologic outcomes of these interventions, and outline the current indications, contraindications, and reported complications of these therapies.

Keywords

percutaneous ablation - hepatocellular carcinoma - hepatic metastases - interventional radiology
 

  • References

  • 1 Clark WL, Morgan D, Asnis EJ. Electrothermic methods in treatment of neoplasms and other lesions with clinical and histological observations. Radiology 1924; 2: 233-246
    CrossrefPubMedGoogle Scholar
  • 2 Livraghi T, Festi D, Monti F, Salmi A, Vettori C. US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology 1986; 161 (2) 309-312
    CrossrefPubMedGoogle Scholar
  • 3 Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012; 379 (9822) 1245-1255
    CrossrefPubMedGoogle Scholar
  • 4 Alazawi W, Cunningham M, Dearden J, Foster GR. Systematic review: outcome of compensated cirrhosis due to chronic hepatitis C infection. Aliment Pharmacol Ther 2010; 32 (3) 344-355
    CrossrefPubMedGoogle Scholar
  • 5 Lencioni R, Crocetti L, Cioni D, Della Pina C, Bartolozzi C. Percutaneous radiofrequency ablation of hepatic colorectal metastases: technique, indications, results, and new promises. Invest Radiol 2004; 39 (11) 689-697
    CrossrefPubMedGoogle Scholar
  • 6 Bruix J, Sherman M ; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005; 42 (5) 1208-1236
    CrossrefPubMedGoogle Scholar
  • 7 Bruix J, Sherman M ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (3) 1020-1022
    CrossrefPubMedGoogle Scholar
  • 8 de Lope CR, Tremosini S, Forner A, Reig M, Bruix J. Management of HCC. J Hepatol 2012; 56 (Suppl. 01) S75-S87
    PubMedGoogle Scholar
  • 9 Mazzaferro V, Regalia E, Doci R , et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334 (11) 693-699
    CrossrefPubMedGoogle Scholar
  • 10 Wiesner R, Edwards E, Freeman R , et al; United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124 (1) 91-96
    CrossrefPubMedGoogle Scholar
  • 11 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 2005; 234 (3) 961-967
    CrossrefPubMedGoogle Scholar
  • 12 Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Intervent Radiol 2010; 33 (1) 11-17
    CrossrefPubMedGoogle Scholar
  • 13 Ahmed M, Brace CL, Lee Jr FT, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology 2011; 258 (2) 351-369
    CrossrefPubMedGoogle Scholar
  • 14 Livraghi T, Giorgio A, Marin G , et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology 1995; 197 (1) 101-108
    CrossrefPubMedGoogle Scholar
  • 15 Shiina S, Tagawa K, Unuma T , et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study. Cancer 1991; 68 (7) 1524-1530
    CrossrefPubMedGoogle Scholar
  • 16 Knab LM, Salem R, Mahvi DM. Minimally invasive therapies for hepatic malignancy. Curr Probl Surg 2013; 50 (4) 146-179
    CrossrefPubMedGoogle Scholar
  • 17 Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. 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 2005; 54 (8) 1151-1156
    CrossrefPubMedGoogle Scholar
  • 18 Livraghi T, Vettori C, Lazzaroni S. Liver metastases: results of percutaneous ethanol injection in 14 patients. Radiology 1991; 179 (3) 709-712
    CrossrefPubMedGoogle Scholar
  • 19 Lencioni R, Bartolozzi C, Caramella D , et al. Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients. Cancer 1995; 76 (10) 1737-1746
    CrossrefPubMedGoogle Scholar
  • 20 Livraghi T, Bolondi L, Buscarini L , et al; Italian Cooperative HCC Study Group. No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. J Hepatol 1995; 22 (5) 522-526
    CrossrefPubMedGoogle Scholar
  • 21 Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology 1998; 37 (3) 171-186
    CrossrefPubMedGoogle Scholar
  • 22 Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000; 174 (2) 323-331
    CrossrefPubMedGoogle Scholar
  • 23 Livraghi T, Goldberg SN, Lazzaroni S , et al. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 2000; 214 (3) 761-768
    CrossrefPubMedGoogle Scholar
  • 24 Goldberg SN, Hahn PF, Tanabe KK , et al. Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis?. J Vasc Interv Radiol 1998; 9 (1 Pt 1) 101-111
    CrossrefPubMedGoogle Scholar
  • 25 Choi D, Lim HK, Rhim H , et al. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol 2007; 17 (3) 684-692
    CrossrefPubMedGoogle Scholar
  • 26 Mahnken AH, Pereira PL, de Baère T. Interventional oncologic approaches to liver metastases. Radiology 2013; 266 (2) 407-430
    CrossrefPubMedGoogle Scholar
  • 27 Stang A, Fischbach R, Teichmann W, Bokemeyer C, Braumann D. A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases. Eur J Cancer 2009; 45 (10) 1748-1756
    CrossrefPubMedGoogle Scholar
  • 28 Tzeng CW, Aloia TA. Colorectal liver metastases. J Gastrointest Surg 2013; 17 (1) 195-201 , quiz 201–202
    CrossrefPubMedGoogle Scholar
  • 29 Hur H, Ko YT, Min BS , et al. Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg 2009; 197 (6) 728-736
    CrossrefPubMedGoogle Scholar
  • 30 Lu DS, Raman SS, Limanond P , et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003; 14 (10) 1267-1274
    CrossrefPubMedGoogle Scholar
  • 31 Illing R, Gillams A. Radiofrequency ablation in the treatment of breast cancer liver metastases. Clin Oncol (R Coll Radiol) 2010; 22 (9) 781-784
    CrossrefPubMedGoogle Scholar
  • 32 Bergenfeldt M, Jensen BV, Skjoldbye B, Nielsen D. Liver resection and local ablation of breast cancer liver metastases—a systematic review. Eur J Surg Oncol 2011; 37 (7) 549-557
    CrossrefPubMedGoogle Scholar
  • 33 Adam R, Aloia T, Krissat J , et al. Is liver resection justified for patients with hepatic metastases from breast cancer?. Ann Surg 2006; 244 (6) 897-907 , discussion 907–908
    CrossrefPubMedGoogle Scholar
  • 34 Brace CL. Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences?. Curr Probl Diagn Radiol 2009; 38 (3) 135-143
    CrossrefPubMedGoogle Scholar
  • 35 Lubner MG, Brace CL, Hinshaw JL, Lee Jr FT. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21 (8, Suppl): S192-S203
    CrossrefPubMedGoogle Scholar
  • 36 Liang P, Dong B, Yu X , et al. Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation. Radiology 2005; 235 (1) 299-307
    CrossrefPubMedGoogle Scholar
  • 37 Dong B, Liang P, Yu X , et al. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: results in 234 patients. AJR Am J Roentgenol 2003; 180 (6) 1547-1555
    CrossrefPubMedGoogle Scholar
  • 38 Shibata T, Iimuro Y, Yamamoto Y , et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 2002; 223 (2) 331-337
    CrossrefPubMedGoogle Scholar
  • 39 Mala T. Cryoablation of liver tumours—a review of mechanisms, techniques and clinical outcome. Minim Invasive Ther Allied Technol 2006; 15 (1) 9-17
    CrossrefPubMedGoogle Scholar
  • 40 Hinshaw JL, Lee Jr FT. Cryoablation for liver cancer. Tech Vasc Interv Radiol 2007; 10 (1) 47-57
    CrossrefPubMedGoogle Scholar
  • 41 Littrup PJ, Ahmed A, Aoun HD , et al. CT-guided percutaneous cryotherapy of renal masses. J Vasc Interv Radiol 2007; 18 (3) 383-392
    CrossrefPubMedGoogle Scholar
  • 42 Shimizu T, Sakuhara Y, Abo D , et al. Outcome of MR-guided percutaneous cryoablation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 2009; 16 (6) 816-823
    CrossrefPubMedGoogle Scholar
  • 43 Adam R, Hagopian EJ, Linhares M , et al. A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies. Arch Surg 2002; 137 (12) 1332-1339 , discussion 1340
    CrossrefPubMedGoogle Scholar
  • 44 Zhang YJ, Liang HH, Chen MS , et al. Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: a prospective randomized trial. Radiology 2007; 244 (2) 599-607
    CrossrefPubMedGoogle Scholar
  • 45 Ni JY, Liu SS, Xu LF, Sun HL, Chen YT. Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol 2013; 19 (24) 3872-3882
    CrossrefPubMedGoogle Scholar
  • 46 Levit E, Bruners P, Günther RW, Mahnken AH. Bile aspiration and hydrodissection to prevent complications in hepatic RFA close to the gallbladder. Acta Radiol 2012; 53 (9) 1045-1048
    CrossrefPubMedGoogle Scholar
  • 47 Rhim H, Lim HK. Radiofrequency ablation for hepatocellular carcinoma abutting the diaphragm: the value of artificial ascites. Abdom Imaging 2009; 34 (3) 371-380
    CrossrefPubMedGoogle Scholar
  • 48 Kondo Y, Yoshida H, Tateishi R, Shiina S, Kawabe T, Omata M. Percutaneous radiofrequency ablation of liver cancer in the hepatic dome using the intrapleural fluid infusion technique. Br J Surg 2008; 95 (8) 996-1004
    CrossrefPubMedGoogle Scholar
  • 49 Nishigaki Y, Tomita E, Hayashi H , et al. Efficacy and safety of radiofrequency ablation for hepatocellular carcinoma in the caudate lobe of the liver. Hepatol Res 2013; 43 (5) 467-474
    CrossrefPubMedGoogle Scholar
  • 50 Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226 (2) 441-451
    CrossrefPubMedGoogle Scholar
  • 51 Dodd III GD, Napier D, Schoolfield JD, Hubbard L. Percutaneous radiofrequency ablation of hepatic tumors: postablation syndrome. AJR Am J Roentgenol 2005; 185 (1) 51-57
    CrossrefPubMedGoogle Scholar
  • 52 Kerkar S, Carlin AM, Sohn RL , et al. Long-term follow up and prognostic factors for cryotherapy of malignant liver tumors. Surgery 2004; 136 (4) 770-779
    CrossrefPubMedGoogle Scholar
  • 53 Jaskolka JD, Asch MR, Kachura JR , et al. Needle tract seeding after radiofrequency ablation of hepatic tumors. J Vasc Interv Radiol 2005; 16 (4) 485-491
    CrossrefPubMedGoogle Scholar
  • 54 Sainani NI, Gervais DA, Mueller PR, Arellano RS. Imaging after percutaneous radiofrequency ablation of hepatic tumors: Part 1, Normal findings. AJR Am J Roentgenol 2013; 200 (1) 184-193
    CrossrefPubMedGoogle Scholar
  • 55 Belghiti J, Panis Y, Farges O, Benhamou JP, Fekete F. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 1991; 214 (2) 114-117
    CrossrefPubMedGoogle Scholar