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June 1, 2006

Long-term Survival After Radiofrequency Ablation of Complex Unresectable Liver Tumors

Author Affiliations

Author Affiliations: John Wayne Cancer Institute, Saint John's Health Center, Santa Monica (Drs Amersi, McElrath-Garza, Ahmad, Zogakis, and Bilchik), and Resolution Imaging Medical Group, Los Angeles (Drs Allegra and Krasne), Calif.

Arch Surg. 2006;141(6):581-588. doi:10.1001/archsurg.141.6.581

Hypothesis  Radiofrequency ablation (RFA) may improve survival of high-risk patients with unresectable and refractory tumors.

Design  Retrospective analysis of a prospective database.

Setting  A tertiary referral cancer center.

Patients and Methods  Between November 1, 1997, and January 31, 2005, we performed 219 RFA procedures to ablate 521 hepatic tumors in 181 patients.

Results  Of the 181 patients, 52% were male and 48% were female, and the mean age was 61.3 years (age range, 27-91 years). Radiofrequency ablation was performed via celiotomy (n = 135), via laparoscopy (n = 48), or percutaneously (n = 36). In 106 patients (79%), RFA was used in combination with surgical resection. The most common tumors included colorectal cancer (40.9%), hepatocellular carcinoma (14.9%), carcinoid tumor (13.8%), melanoma (9.4%), and breast cancer (5.0%). The average number of tumors per patient was 3.3 tumors. The average number of RFA-treated lesions per procedure was 2.38 lesions; the mean lesion size was 3.56 cm (lesion size range, 0.8-9.0 cm). At a mean follow-up of 33.2 months (follow-up range, 12-91 months), overall survival was 48.3 months for carcinoid tumors, 25.2 months for hepatocellular carcinoma, 18.5 months for melanoma, 29.7 months for colorectal cancer, and 30.1 months for breast cancer. Seventy-eight patients (43%) developed recurrences. Of 521 tumors that were treated, 125 (24%) recurred; the incidence of local recurrence was 28% for tumors larger than 3 cm vs 18% for tumors 3 cm or smaller (P = .04). Twenty-nine patients underwent serial ablations. Seventy-one patients (39%) were disease free at last follow-up.

Conclusion  A significant number of patients whose hepatic malignancies are unresectable or refractory to chemotherapy may be considered for RFA as part of a multimodality therapeutic regimen. In these patients, RFA is safe and may prolong survival.