Results of radiofrequency ablation treatment in primary and metastatic liver cancer

ABSTRACT Results of radiofrequency ablation treatment in primary and metastatic liver cancer The aim of this present study was to retrospectively evaluate the efficiency of radiofrequency ablation (RFA) treatment in patients with primary and metastatic liver cancer. Hepatocellular carcinoma (HCC) is currently the fifth most common malignant tumor in the world. Nevertheless, the liver is the most frequent organ for metastases of gastrointestinal origin via the hematogenous route because of its rich blood supply. In the liver, metastatic tumors are encountered at a rate of 20/1 when compared to primary liver tumors. Surgical resection is the accepted choice of treatment in liver cancers. However, the number and distribution of tumoral lesions, the significant disturbance of liver functions, and associating other systemic problems decrease the chance of surgical resection more often than not. RFA treatment is used as an alternative in patients who can not be treated surgically. A total of 35 patients who had undergone RFA in the present Clinic was included and evaluated retrospectively. Demographic data like gender, age, and duration of follow-up and survival were recorded. Results of clinical and radiological evaluation, such as the number and magnitude of lesions, localization, primary or metastatic features, and etiologic reason were also recorded. After treatment, the presence of residual lesions, local tumor progression and new lesion development were followed. All RFA procedures were performed by the doctors of the present Interventional Radiology Unit, in accordance with rules of routine surgical sterilization, with the appropriate technique, and under the sedation performed by the doctors of the Anesthesia and Reanimation Clinic. Patients were grouped according to their ages as Group I being 65 years old or younger and Group II being over 65 years old. Patients with lesions 25 mm or smaller were further categorized as Group A, lesions between 26 mm and 40 mm as Group B, and lesions 41 mm or larger as Group C. Also, lesions were evaluated as metastatic or primary, along with the classification of patients with single or multiple lesions. Local tumor progression, new lesion development, and factors that could affect duration of survival were evaluated. A total of 51 lesions of 35 patients were performed RFA treatment for primary or metastatic liver cancer. The mean age of patients was 69.6 ± 12.09 (range: 42-87) years old. The duration of follow-up was between 4 and 48 months and the mean duration of follow-up was 16.2 ± 9.9 months. Of these 51 lesions, 19 (37.3%) was primary and 32 (62.7%) was metastatic. The mean magnitude of these 51 lesions encountered in 35 patients was found as 23.7 ± 13.9 (5-72) mm. During the follow-up after RFA treatment, the residual tumor was determined in the treatment area in only one (1.9%) lesion. At the dates the present study was performed, 13 (37.1%) patients had died. The survival rates of patients at the 12th and 24th months were 78.1%and 46.8%, respectively. The negative effects of advanced age (p<0.05), local tumor progression (p<0.05), and new lesion development (p<0.01) were established on survival. During follow-up, local tumor progression was encountered in 9 lesions out of 51 (17.6%). Mean duration of local tumor progression was 9.67 ± 6.42 months. Evaluations of local tumor progression showed that only the magnitude of lesions affected this parameter (p=0.056). During follow-up, development of a new lesion at a separate liver region was seen in 22 (62.8%) patients. In these patients with new lesions, mean duration of new lesion development was 11.0 ± 2.9 months. Factors affecting new lesion development were determined as advanced age (p<0.01) and the Child-Pugh grade B in the primary lesion (p<0.05). Following RFA, one patient had cholecystitis while intraperitoneal minimal hemorrhage was encountered in two patients. As RFA treatment protects intact liver tissues, directly targets the tumor, and the mortality and morbidity rates are lower when compared to other treatments, it is currently considered safe for the treatment of liver tumors. Keywords: radiofrequency ablation-interventional radiology-liver cancer