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Percutaneous Saline-Enhanced Radiofrequency Ablation of Unresectable Hepatic Tumors: Initial Experience in 26 Patients

¹ Department of Diagnostic Radiology, Division of Angiography and Interventional Radiology, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
² Department of Internal Medicine I, Division of Oncology, University of Vienna Medical School, A-1090 Vienna, Austria.
³ Statistical Analyses Methodical Consulting, Treustr. 15/11, A-1200 Vienna, Austria.
⁴ Department of Anesthesiology and Intensive Care (B), University of Vienna Medical School, A-1090 Vienna, Austria.
⁵ Department of Radiotherapy, University of Vienna Medical School, A-1090 Vienna, Austria.
⁶ Wilhelminenspital, Montlearstr. 37, A-1160 Vienna, Austria.
⁷ University Department Biomedical Engineering, Fachhochschule Furtwangen, Jakob-Kienzle-Str. 17, D-78054 Villingen-Schwenningen, Germany.
⁸ Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd., Boston, MA 02215.

OBJECTIVE. The purpose of our study was to evaluate the safety and efficacy of percutaneous saline-enhanced radiofrequency ablation for unresectable primary or metastatic hepatic tumors.

SUBJECTS AND METHODS. Twenty-six patients with 15 hepatocellular carcinomas and 33 hepatic metastases (maximum diameter 8.6 cm) were treated; of these, seven tumors in five patients were treated twice. Thus, 44 radiofrequency treatments were performed. Saline-enhanced and impedance-controlled radiofrequency ablation (0.5–1.1 mL/min of saline, 15-mm conductive portion of the electrode tip, 25–60 W, 5–43 min) was performed using MR imaging guidance. Coagulation necrosis, volume indexes, morbidity, and complications were assessed.

RESULTS. The volume of coagulation necrosis 1–7 days after radiofrequency ablation was 1.6–126.6 cm³ (median, 18.9 cm³), corresponding to coagulation diameters of 1.5–6.2 cm (median, 3.2 cm). The coagulation volume was significantly larger if there were more than four radiofrequency applications (p = 0.006). Tumors of 3 cm or less in diameter were eight times as likely to be successfully completely ablated (p = 0.01) and volume indexes of lesions treated with the patient under general anesthesia were significantly larger than those treated with the patient under conscious sedation (p < 0.001). Major complications occurred in four patients (15%). Incomplete ablation in 19 (35%) of 54 radiofrequency lesions was due to cooling by a large vessel nearby (n = 2) or to low power applied in painful (n = 11) or critical (n = 6) locations. Residual tumor was observed in 14 (58%) of 24 tumors evaluated 6–8 months after radiofrequency ablation.

CONCLUSION. Percutaneous saline-enhanced and impedance-controlled radiofrequency ablation can be effective in the treatment of unresectable hepatic tumors and minimizes potential carbonization. A greater number of radiofrequency applications, general anesthesia, and increasing experience provide significantly better results.

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