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Radiofrequency Ablation of Hepatic Tumors: Increased Tumor Destruction with Adjuvant Liposomal Doxorubicin Therapy

S. Nahum Goldberg1, Ihab R. Kamel1,2, Jonathan B. Kruskal1, Kevin Reynolds1, Wayne L. Monsky1, Keith E. Stuart3, Muneeb Ahmed1 and Vassilos Raptopoulos1

1 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215.
2 Present address: Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD 21287.
3 Department of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215.



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  		Fig. 1A. —46-year-old woman with intrahepatic breast metastases. Patient was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained during hepatic arterial phase shows focus of ablation with high-density center (white arrow). This zone was slightly larger than initial tumor. Faint rim of hyperthermia (black arrows) is visible on anterior surface.

 


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  		Fig. 1B. —46-year-old woman with intrahepatic breast metastases. Patient was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained during portal venous phase of contrast enhancement shows resolution of hypervascular rim and more pronounced visualization of partly enhancing zone of normal liver adjacent to main focus of ablation (arrow).

 


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  		Fig. 1C. —46-year-old woman with intrahepatic breast metastases. Patient was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained during equilibrium phase shows that this region (arrow) progressively enhances and hence has not undergone definitive coagulation.

 


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  		Fig. 1D. —46-year-old woman with intrahepatic breast metastases. Patient was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained during portal venous phase 2 weeks after therapy shows markedly larger coagulation zone (arrow) that has expanded to include region of delayed enhancement.

 


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  		Fig. 2A. —82-year-old man with 8.2-cm vascular hepatoma who was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained immediately after radiofrequency ablation shows persistent regions of residual untreated tumor (black arrows). Small amount of gas can be seen in anterior portion of tumor (white arrow).

 


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  		Fig. 2B. —82-year-old man with 8.2-cm vascular hepatoma who was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained 2 weeks after therapy shows interval increase in coagulation: inferior region of residual tumor and medial portion of anterior tumor (black arrows) no longer enhance. However, persistent nodule of viable tumor (white arrow) can be seen and appears to have grown during 2-week interval between A and B.

 


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  		Fig. 2C. —82-year-old man with 8.2-cm vascular hepatoma who was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained immediately after repeated therapy (2 weeks after initial ablation) shows total coagulation of region (arrow).

 


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  		Fig. 2D. —82-year-old man with 8.2-cm vascular hepatoma who was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained immediately after repeated radiofrequency ablation shows persistence of large vessel (arrows) coursing through nonenhancing coagulated lesion.

 


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  		Fig. 2E. —82-year-old man with 8.2-cm vascular hepatoma who was treated with combined Doxil (ALZA Pharmaceuticals, Mountainview, CA) and radiofrequency ablation therapy. CT image obtained 2 weeks after therapy shows lack of enhancement throughout region; no vessel was seen on images obtained during any of three phases of contrast enhancement.

 

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