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1
Departement d'Imagerie Medicale, Institut Gustave Roussy, Villejuif,
France.
2
Departement de Chirurgie, Institut Gustave Roussy, 94805 Villejuif Cedex,
France.
3
Departement de Medecine, Institut Gustave Roussy, 94805 Villejuif Cedex,
France.
Received March 29, 2000;
accepted after revision May 15, 2000.
Address correspondence to T. de Baere, Service de Radiologie
Interventionnelle, Institut Gustave Roussy, 94805 Villejuif Cedex, France.
Abstract
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SUBJECTS AND METHODS. Sixty-eight patients with 121 hepatic metastases (<5 metastases per patient) that were mainly colorectal in origin underwent 76 sessions of radiofrequency ablation with cooled-needle electrodes under sonographic guidance. Twenty-one patients with 33 metastases of 5-20 mm in diameter (mean ± SD,13 ± 7 mm) underwent intraoperative radiofrequency ablation. Forty-seven patients with 88 metastases of 10 to 42 mm in diameter (mean ± SD, 26 ± 9 mm) were treated with percutaneous radiofrequency ablation. Procedure efficacy was evaluated with dynamic enhanced CT and MR imaging performed 2, 4, and 6 months after treatment and then every 3 months.
RESULTS. Radiofrequency ablation allowed eradication of 91% of the 100 treated metastases that were followed up for 4-23 months (mean, 13.7 months). Tumor control was equivalent for percutaneous radiofrequency ablation (90%) and for intraoperative radiofrequency ablation (94%). Failure to achieve tumor control occurred mostly with the largest tumor nodules. One bilioperitoneum and two abscesses were the major complications encountered after treatment of 121 metastases with a follow-up of more than 2 months.
CONCLUSION. Radiofrequency ablation appears to be a promising therapeutic modality capable of extending the possibilities of partial hepatectomy and of efficiently treating small metastases percutaneously.
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We report our prospective evaluation of radiofrequency ablation of hepatic metastases in a series of patients with a mean follow-up of more than 1 year; this procedure was performed intra-operatively during partial hepatectomy to destroy unresectable tumors and percutaneously for the treatment of hepatic metastases in patients deemed ineligible for hepatic tumor resection.
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The inclusion criterion for intraoperative radiofrequency ablation was that the patient be a candidate for partial hepatectomy that would leave five or fewer metastases in the remnant liver. Inclusion criteria for percutaneous radiofrequency ablation was that the patient be deemed ineligible for surgery or had undergone previous partial hepatectomy and had five or fewer hepatic metastases accessible via direct puncture under imaging guidance. Both percutaneous and intraoperative radiofrequency procedures were performed with a curative intent and aimed at completely eradicating metastatic lesions in patients without detectable extrahepatic disease on pretreatment lung and abdominal CT scans. For both intraoperative and percutaneous radiofrequency ablation, metastases were not to be larger than 35 mm in diameter when only single needles were available and 45 mm in diameter when the cluster needle became available. Metastases in contact with the main portal bifurcation were a contraindication because biliary complications were feared. Normal prothrombin time values and a platelet count of more than 105/mm3 were required before percutaneous radiofrequency treatment. A second percutaneous radiofrequency procedure was performed for treatment of new hepatic metastases if three or fewer were present and if the new metastases were less than 35 mm in diameter.
Treatment
We used a 480-kHz CC1 generator (Radionics, Burlington, MA) that delivered
a maximum power of 200 W through 17-gauge monopolar cooled-needle electrodes.
We used either a single needle with an active 2- or 3-cm-long distal tip or a
triple cluster needle, which became available later during this study. This
triple cluster needle is composed of three single needles, each with a 2.5-cm
active distal part, that are 0.5 cm apart and arranged in a triangle.
Circuitry incorporated in the generator allows permanent monitoring of
impedance between the active part of the cooled-needle electrode and the
grounding pads placed on the patient's thighs. A thermocouple embedded in the
electrode ensured constant monitoring of the temperature at the tip of the
needle.
Intraoperative radiofrequency procedures were performed under exclusive
sonographic guidance and monitoring by a single operator experienced in the
technique using a 7.5-MHz probe (Ecco Cee Cx; Toshiba, Les Ulis, France).
Percutaneous radiofrequency ablation was performed by a single operator mostly
under sonographic guidance and monitoring of a 3.5- or 5-MHz probe (AU4-Idea;
Esaote-Biomedica, Le Perreux, France), except for five metastases not
visualized at sonographic examination that were treated under CT guidance.
With sonographic guidance, each metastasis was punctured in its median axis
and the needle was pushed through the lesion until its tip reached the
opposite side of the nodule with the active part of the needle embedded inside
the metastasis (Figs.
1A,1B,2A,2B,3A,3B,3C,4A,4B).
The length of the active needle tip was chosen according to the diameter of
the metastasis, and, as soon as it became available, a cluster electrode was
used for lesions 3 cm in diameter or larger. Treatment lasted between 15 and
20 min per electrode position, during which the maximum power delivered did
not allow impedance to rise 10 
above the baseline value. In practice,
the current intensity used was 0.5-1 A for a single needle and up to 1.8 A for
the cluster needle. A peristaltic pump (313FS/D variable speed pump;
Watson-Marlow, Paris, France) ensured cooling of the electrode with saline
solution (0°C) at a flow rate that was sufficient to maintain the
electrode temperature below 25°C. At the end of the radiofrequency
application, the current and the cooling circuit were interrupted
simultaneously, and the heated tissues were allowed to heat the electrode by
diffusion until the maximum temperature had been attained. The maximum tip
temperature was then recorded. If it was more than 65°C, treatment was
considered completed. If the final temperature was 65°C or less, treatment
was continued for an additional 3 min without cooling by maintaining the
temperature above 85°C at the tip of the needle. Treatment was considered
completed if the hyperechoic nodule induced by radiofrequency applications
totally covered the area harboring the metastasis (Fig.
1A,1B);
otherwise, a new needle position was chosen to achieve this goal.
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Intraoperative radiofrequency ablation was performed with the patient under general anesthesia in the operating theater during partial hepatectomy, with the Pringle maneuver (clamping of the hepatic vascular pedicle). Percutaneous radiofrequency procedures with single needles were performed for metastases that were not in close proximity to the capsule after administration of local anesthesia at the puncture site and IV sedation. General anesthesia was used for percutaneous radiofrequency procedures when lesions were close to the liver capsule, because experience has taught us that treatment of such metastases is often painful for the patient, or when the cluster needle was used. At the beginning of our experience, systematic prophylactic antibiotic therapy was not used for percutaneous radiofrequency ablation, but septic complications, which we will discuss, recently encountered after percutaneous radiofrequency ablation prompted us thenceforth to systematically inject 2 g of IV amoxycillin and clavulanate potassium (Augmentin; Beecham, Nanterre, France) as prophylactic antibiotherapy just before commencing the percutaneous radiofrequency procedure.
Assessment of Treatment Efficacy
Follow-up imaging was performed 2, 4, and 6 months after the procedure and
then every 3 months for 2 years. Each patient underwent CT and MR imaging on
the same day.
CT examinations were performed with a helical scanner (HiSpeed; General Electric Medical Systems, Milwaukee, WI). All patients received 100 mL of iobitridol (Xenetix 300; Guerbet, Aulnay-sous-Bois, France) administered IV at a rate of 3 mL/sec with a power injector. Dual-phase CT of the liver was performed during the hepatic arterial phase and the portal venous phase 30 and 70 sec, respectively, after initiating the injection of contrast material. Because a previous report pointed out that delayed-opacification images are useful for differentiating coagulation necrosis from hypoattenuating tumor [10], a late-phase image was also obtained 5 min after initiating the injection of contrast material. Scanning was performed at 120 kV and 270 mA. Contiguously reconstructed sections (pitch of 1:1) were obtained through the liver with a 7-mm collimation. Each helical acquisition through the liver was accomplished during a single breath-hold.
MR imaging was performed with a 1.5-T whole-body imager (Signa LX; General Electric Medical Systems). All MR images were obtained in the axial plane with a phased array multicoil for the body. Sections were 7 mm thick with a 2-mm intersection gap for all pulse sequences. The MR imaging protocol included the following: fat-suppressed T2-weighted imaging with respiratory-triggered fast spin-echo sequences (TR/TE, 5454/ 102; an echo train length of 16; 4 signals acquired; 10-msec interecho spacing; 256 x 256 matrix; 31.25 kHz of received bandwidth; 40-cm field of view); dynamic contrast-enhanced imaging at three consecutive 30-sec intervals and 5 min after bolus injection of 0.1 mmol/kg of gadoterate meglumine (Dotarem; Guerbet) at a rate of 3 mL/sec; and T1-weighted imaging with fast multiplanar spoiled gradient-recalled echo sequences (125/1.6, 60° flip angle, 1 signal acquired, 512 x 256 matrix, 62.5 kHz of received bandwidth, 40-cm field of view, 25-sec acquisition time) with 17 images obtained during a single breath-hold. Saturation bands were used with all MR sequences that were larger and smaller than the imaging volume to obviate flow-related artifacts.
The interpretation of radiologic studies was based on the consensus of two radiologists. Radiofrequency treatment was considered incomplete and active tumor still present when hyperintense foci were seen on T2-weighted MR images, when the radiofrequency-treated area had enlarged after the first 2 months of follow-up imaging, or when foci of contrast material uptake were depicted in the treated area on enhanced CT or MR imaging. Foci of enhancement that were considered active disease were nodules or thickening exceeding 2 mm. On the contrary, a thin regular peripheral rim of enhancement of 2 mm or thinner around the treated area, previously described by others [11] and known to be an inflammatory reaction that can persist for several months [12], was not considered as active tumor. Radiofrequency treatment was defined as successful when a hypoattenuating area was seen on CT scans or a hypointense area was seen on T2-weighted MR images that did not enhance after administration of contrast material with either technique. When findings from CT and MR imaging studies were at variance, no treatment was undertaken, but further follow-up imaging was performed 2 months later.
Data Analysis
An efficacy analysis is provided for patients with at least 4 months of
follow-up since the last radiofrequency procedure, including 54 patients with
100 treated metastases. Technical data and information concerning the
tolerance and complications are provided for all patients who were followed up
for at least 2 months because most of the severe complications occurred in
recently treated patients.
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Intraoperative radiofrequency ablation was performed in addition to 21 primary hepatectomies to destroy 33 hepatic metastases (mean, 1.6 metastases per patient) measuring 5-20 mm in diameter (mean ± SD, 13 ± 7 mm), except for one 35-mm lesion. The percutaneous radiofrequency ablation group included 38 patients who had undergone partial hepatectomy 3-42 months earlier (mean, 11 months), five patients with centrally located minute lesions not amenable to surgery, and four patients who refused surgery or had contraindications to general anesthesia. During the first percutaneous radiofrequency procedure, 76 metastases measuring 10-42 mm in diameter (mean ± SD, 26 ± 9 mm) were treated in 47 patients (mean, 1.6 metastases per patient), amounting to 47 initial radiofrequency procedures because all metastases present were treated during a single radiofrequency session. Eight patients required a second radiofrequency procedure for nine new metastases in five patients, three new metastases and two local regrowths in two patients, and a local regrowth in one patient. Consequently, a total of 55 percutaneous radiofrequency procedures treating 88 metastases were performed in the 47 percutaneous radiofrequency ablation patients.
One intraoperative radiofrequency ablation patient was treated with percutaneous radiofrequency ablation 6 months after surgery for a new liver metastasis, and one of the eight patients retreated with percutaneous radiofrequency ablation developed a new metastasis that was removed surgically because it was inaccessible to percutaneous radiofrequency.
Procedures
During radiofrequency ablation it was sometimes necessary to achieve
several needle positions for treatment of larger lesions as a result of
inadequate coverage of the metastases by the first hyperechoic
radiofrequency-induced lesion, especially at the beginning of the study when
the cluster needle was not available. To date, 134 electrode positions have
been required for percutaneous radiofrequency ablation of 88 metastases (1-4
positions per metastasis); intraoperative radiofrequency treatment of the 33
metastases required 40 needle positions. The cluster needle was used in 34
percutaneous radiofrequency-treated metastases and in one intraoperatively
treated metastasis. The mean value of the final temperature was 83.1°C
(±SD, ±6.3°C). The final temperature was more than 65°C
in 153 of the 174 electrode positions. In the remaining 21 positions
concerning exclusively the single needle, additional treatment without cooling
was performed.
Efficacy and Patient Follow-Up
Fifty-four patients for whom 100 metastases were treated with
radiofrequency ablation were followed up for at least 4 months, with a mean
duration of 13.7 months (range, 4-23 months)
(Table 1). Local regrowth of
nine (9%) of the 100 metastases occurred after a median time of 79 days
(range, 60-122 days) after treatment, including two regrowths that reappeared
after intraoperative radiofrequency ablation (6%) and seven regrowths after
percutaneous radiofrequency ablation (10%). The second radiofrequency
procedure failed to eradicate regrowth in two of the three patients for whom
it was attempted, and progressive disease remained.
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Among the 54 patients followed up, no viable tumor was depicted in the liver in 27 patients (50%), and 27 patients had viable liver tumors. Seventeen of the 27 patients free of hepatic disease still remain totally tumorfree, but 10 developed distant brain (n = 2), lung (n = 5), and lymph node (n = 3) metastases. Among the 27 patients with active liver tumors, five had local regrowth of a radiofrequency-treated lesion, four had new metastases remote from the radiofrequency-induced lesions and local regrowth, and 18 had new metastases. Eight patients died after a median of 262 days (range, 82-686 days) as a result of cerebral or pulmonary metastases (n = 3), hepatic disease (n = 3), and causes unrelated to cancer (n = 2).
Postprocedure Care and Complications
Intraoperative radiofrequency ablation never prolonged hospitalization
associated with partial hepatectomy. In 17 of the 29 procedures performed with
the patient under local anesthesia and IV sedation, the patient was discharged
from the hospital 4 hr after treatment; the 12 other patients each spent 1
night in the hospital. Twenty-six percutaneous radiofrequency procedures were
performed with the patient under general anesthesia: 23 patients needed to
stay a single night in the hospital, two patients required 2 days in the
hospital for pain sedation, and one patient stayed 6 days in the hospital
because of a complication, which we will discuss.
A liver abscess was depicted at the site of percutaneous radiofrequency—treated metastases on the follow-up imaging study at 2 months in two patients. These abscesses induced moderate hyperthermia after treatment and were clinically well tolerated, insofar as patients were not referred to the hospital before the planned follow-up imaging study at 2 months. Both abscesses were punctured under sonographic guidance and drained over 3 days before tube removal. Cultures were positive for Escherichia coli and Streptococcus organisms. Treatment with amoxycillin and clavulanate potassium (Augmentin) was initiated (2 g/day) before draining the abscess and was continued for 15 days; the patients recovered uneventfully. One patient developed severe abdominal pain 2 hr after percutaneous radiofrequency ablation and underwent laparotomy. Traces of bile were found in the peritoneum, and a bile leak was present at one of the five puncture sites used to treat the five metastases in this patient. The patient recovered uneventfully after 2 days of peritoneal drainage and was discharged from the hospital 6 days after percutaneous radiofrequency ablation. Two patients had segmental biliary tract dilatation upstream from a radiofrequency-treated lesion discovered on the 2-month follow-up imaging study. These patients did not present with any clinical symptoms or with elevation of serum bilirubin level after 7 and 9 months of follow-up, respectively. At the beginning of our experience, two minor skin burns occurred at the grounding pad sites. This complication ceased to occur once the size and the number of grounding pads were increased.
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In our experience, radiofrequency ablation efficiently treated liver metastases with a 94% and 90% control rate at 1 year for intraoperative and percutaneous radiofrequency treatment, respectively. Although the difference between the diameter of percutaneous (mean ± SD, 13 ± 7 mm) and intraoperative (mean ± SD, 26 ± 9 mm) radiofrequency-treated metastases was statistically significant (p = 0.0001), no statistically significant difference was found between the two techniques in terms of the tumor control rate, probably because the size of metastases was carefully selected within acceptable thresholds for radiofrequency ablation. Failures occurred exclusively with the largest lesions. Indeed, two of the three regrowths after cluster treatment were among the largest (40 and 42 mm) metastases treated. Three of the six regrowths after single-needle radiofrequency ablation occurred among the seven tumors treated with a single needle that were larger than 30 mm. On the contrary, regrowth did not occur after radiofrequency ablation with the single needle when lesions were 25 mm in diameter or smaller.
Thus, it is probably advisable to use a cluster needle when metastases are larger than 25 mm. Triple-cluster needle electrodes are capable of treating larger lesions [17], although the maximum lesion size has yet to be clearly defined. The mean diameter of tissue destruction obtained with one cluster needle position in healthy pig liver in vivo was reported to be 31 ± 2 mm [17], and we have obtained a mean diameter of 37.2 mm (±SD, ±4 mm) with a minimal axis of 34.1 mm (±SD, ±4 mm) (de Baere et al., unpublished data). Goldberg et al. [17] also described a mean diameter of radiofrequency destruction of 53 mm (±SD, ±6 mm), with a minimum short-axis diameter of 42 mm when treating colorectal metastases. Thus, our inclusion criterion of a maximum diameter of 45 mm appears at the superior threshold for a single cluster needle position.
Although it is theoretically possible to use multiple needle positions to treat larger lesions, this option is difficult to achieve for two reasons. The first one is the intense hyperechoic pattern induced by radiofrequency, which induces a blind area under sonographic guidance and requires 5-10 min after the end of the radiofrequency current to decrease enough to allow new needle positioning. The second reason is the difficulty in combining spheres of radiofrequency destruction (radiofrequency-induced lesions are usually spherical) to completely cover a larger sphere of tumor (metastases are usually spherical too). Indeed, on the basis of a 3-cm thermal injury per radiofrequency application, a tumor less than 2 cm can be treated in one radiofrequency application, a tumor of 2-3 cm requires six overlapping ablations, and a tumor larger than 3 cm requires at least 12 overlapping ablations [18]. Multiplying needle positions and the technical prowess involved in placing them accurately are therefore formidable challenges in clinical practice.
When the first radiofrequency treatment of tumor was not efficient, eradication of residual foci was impossible during another radiofrequency session in two of the three patients, emphasizing how difficult it is to differentiate active tumors from coagulation necrosis under sonographic guidance and, therefore, how difficult it is to target residual tumor foci. In such cases, alternative imaging guidance, such as sonography with a contrast agent, contrast-enhanced CT, or MR imaging (when MR-compatible needles become available) may prove interesting.
Biliary tract dilatation occurred upstream of a treated metastasis in two patients, probably as a result of radiofrequency-induced stenosis of the bile duct, thus confirming that treating tumors in contact with the main portal bifurcation may risk significant bile duct obstruction. These complications depicted on imaging never provoked clinical or biologic symptoms after 6 and 9 months of follow-up. The rate of biliary complications remained low probably because of the cooling effect of vessels running alongside the biliary tract. We observed biliary tract stenosis in an experimental animal study only when hepatic arterial embolization, portal vein clamping, and radiofrequency ablation were combined, but no complications occurred when portal or arterial flow was interrupted separately (de Baere et al., unpublished data).
To our knowledge, we report the first abscess formation after radiofrequency ablation. The most plausible explanation for the formation of this abscess is contamination of an area of radiofrequency-induced necrosis by pathogens originating from the digestive tract through altered peripheral bile ducts. Indeed, if large bile ducts are potentially protected by neighboring large vessels, then this is not the case for small bile ducts that are altered by necrosis induced by radiofrequency. Systematic prophylactic antibiotic therapy has been instituted since this finding. No further septic complications have occurred, although recently we treated two patients with bilioenteric anastomoses. Bilioenteric anastomoses are known to increase the risks of septic complications after local treatment of liver tumors [19] as a result of retrograde enteric bacterial contamination of the biliary tract in up to 90% of patients [20].
Two cases of hemorrhage have been reported during treatment of subcapsular tumors [21]. This complication did not occur in our series, even though eight of the nodules treated had reached the capsule. Furthermore, when experimental animal studies were performed, radiofrequency-induced subcapsular lesions never bled during open surgery. Some authors have recommended coagulating the tract at the puncture site by delivering additional current during liver ablation with radiofrequency [22].
During imaging follow-up, nine local regrowths were depicted. Five were depicted on both CT and MR imaging performed on the same day; however, MR imaging revealed regrowth in four lesions that were initially inconspicuous on CT but were visible 2 months later. MR imaging therefore seems to have an advantage over CT for early depiction of local regrowth, even if the difference between the techniques was not statistically significant because of the small number of recurrences. Two of the regrowths were located adjacent to large vessels and could probably be explained by the cooling effect of the vessels that prevents destruction of the tumor cells adjacent to large vessels, as reported by other authors [21, 23]. Undoubtedly, a tumor located close to large vessels would be a good indication of interruption of hepatic blood flow during radiofrequency delivery, as has been reported by others during microwave coagulation therapy [24].
The results achieved with intraoperative radiofrequency ablation as an adjuvant to hepatic surgery are encouraging in that these findings extend the possibilities of partial hepatectomy. However, surgery remains more or less a "one-shot" technique. On the other hand, one of the major advantages of percutaneous radiofrequency ablation is its iterative use to treat new metastases as soon as they occur and, in so doing, to maintain the liver tumor-free. Iterative percutaneous radiofrequency treatment allowed us to maintain five patients free of liver tumor in our series.
The good preliminary results of percutaneous radiofrequency ablation suggest percutaneous radiofrequency ablation as an alternative to surgery for a subset of patients. This subset of patients is difficult to define at this time because of the rapid evolution of the technique and the limited duration of follow-up data on patients treated with radiofrequency applications.
Acknowledgments
We thank Lorna Saint Ange for the linguistic revision of this
manuscript.
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J. M. Lee, J. K. Han, S. H. Choi, S. H. Kim, J. Y. Lee, K. S. Shin, C. J. Han, and B. I. Choi Comparison of Renal Ablation with Monopolar Radiofrequency and Hypertonic-Saline-Augmented Bipolar Radiofrequency: In Vitro and In Vivo Experimental Studies Am. J. Roentgenol., March 1, 2005; 184(3): 897 - 905. [Abstract] [Full Text] [PDF]
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A. Giorgio, L. Tarantino, G. de Stefano, C. Coppola, and G. Ferraioli Complications After Percutaneous Saline-Enhanced Radiofrequency Ablation of Liver Tumors: 3-Year Experience with 336 Patients at a Single Center Am. J. Roentgenol., January 1, 2005; 184(1): 207 - 211. [Abstract] [Full Text] [PDF]
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S. H. Kim, H. K. Lim, D. Choi, W. J. Lee, S. H. Kim, M. J. Kim, S. J. Lee, and J. H. Lim Changes in Bile Ducts after Radiofrequency Ablation of Hepatocellular Carcinoma: Frequency and Clinical Significance Am. J. Roentgenol., December 1, 2004; 183(6): 1611 - 1617. [Abstract] [Full Text] [PDF]
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C. Gadaleta, V. Mattioli, G. Colucci, A. Cramarossa, V. Lorusso, E. Canniello, A. Timurian, G. Ranieri, G. Fiorentini, M. De Lena, et al. Radiofrequency Ablation of 40 Lung Neoplasms: Preliminary Results Am. J. Roentgenol., August 1, 2004; 183(2): 361 - 368. [Abstract] [Full Text] [PDF]
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 M. P. Goetz, M. R. Callstrom, J. W. Charboneau, M. A. Farrell, T. P. Maus, T. J. Welch, G. Y. Wong, J. A. Sloan, P. J. Novotny, I. A. Petersen, et al. Percutaneous Image-Guided Radiofrequency Ablation of Painful Metastases Involving Bone: A Multicenter Study J. Clin. Oncol., January 15, 2004; 22(2): 300 - 306. [Abstract] [Full Text] [PDF]
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M. Kitamoto, M. Imagawa, H. Yamada, C. Watanabe, M. Sumioka, O. Satoh, M. Shimamoto, M. Kodama, S. Kimura, K. Kishimoto, et al. Radiofrequency Ablation in the Treatment of Small Hepatocellular Carcinomas: Comparison of the Radiofrequency Effect With and Without Chemoembolization Am. J. Roentgenol., October 1, 2003; 181(4): 997 - 1003. [Abstract] [Full Text] [PDF]
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A. R. Henn, E. A. Levine, W. McNulty, and R. J. Zagoria Percutaneous Radiofrequency Ablation of Hepatic Metastases for Symptomatic Relief of Neuroendocrine Syndromes Am. J. Roentgenol., October 1, 2003; 181(4): 1005 - 1010. [Abstract] [Full Text] [PDF]
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T. de Baere, O. Risse, V. Kuoch, C. Dromain, C. Sengel, T. Smayra, M. G. E. Din, C. Letoublon, and D. Elias Adverse Events During Radiofrequency Treatment of 582 Hepatic Tumors Am. J. Roentgenol., September 1, 2003; 181(3): 695 - 700. [Abstract] [Full Text] [PDF]
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G. D'Ippolito, M. Ahmed, G. D. Girnun, K. E. Stuart, J. B. Kruskal, E. F. Halpern, and S. N. Goldberg Percutaneous Tumor Ablation: Reduced Tumor Growth with Combined Radio-frequency Ablation and Liposomal Doxorubicin in a Rat Breast Tumor Model Radiology, July 1, 2003; 228(1): 112 - 118. [Abstract] [Full Text] [PDF]
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R. L. Titton, P. C. Gryzenia, D. A. Gervais, R. S. Arellano, G. W. Boland, and P. R. Mueller Continuous High-Output Drainage of Hepatic Abscess 3 Months After Radiofrequency Ablation of Hepatocellular Carcinoma Am. J. Roentgenol., April 1, 2003; 180(4): 1079 - 1084. [Full Text] [PDF]
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T. Livraghi, L. Solbiati, M. F. Meloni, G. S. Gazelle, E. F. Halpern, and S. N. Goldberg Treatment of Focal Liver Tumors with Percutaneous Radio-frequency Ablation: Complications Encountered in a Multicenter Study Radiology, February 1, 2003; 226(2): 441 - 451. [Abstract] [Full Text] [PDF]
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T. J. Vogl, R. Straub, K. Eichler, D. Woitaschek, and M. G. Mack Malignant Liver Tumors Treated with MR Imaging-guided Laser-induced Thermotherapy: Experience with Complications in 899 Patients (2,520 lesions) Radiology, November 1, 2002; 225(2): 367 - 377. [Abstract] [Full Text] [PDF]
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W. L. Monsky, J. B. Kruskal, A. N. Lukyanov, G. D. Girnun, M. Ahmed, G. S. Gazelle, J. C. Huertas, K. E. Stuart, V. P. Torchilin, and S. N. Goldberg Radio-frequency Ablation Increases Intratumoral Liposomal Doxorubicin Accumulation in a Rat Breast Tumor Model Radiology, September 1, 2002; 224(3): 823 - 829. [Abstract] [Full Text] [PDF]
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S. N. Goldberg, I. R. Kamel, J. B. Kruskal, K. Reynolds, W. L. Monsky, K. E. Stuart, M. Ahmed, and V. Raptopoulos Radiofrequency Ablation of Hepatic Tumors: Increased Tumor Destruction with Adjuvant Liposomal Doxorubicin Therapy Am. J. Roentgenol., July 1, 2002; 179(1): 93 - 101. [Abstract] [Full Text] [PDF]
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A. Marangio, U. Prati, O. Luinetti, E. Brunetti, and C. Filice Radiofrequency Ablation of Colorectal Splenic Metastasis Am. J. Roentgenol., June 1, 2002; 178(6): 1481 - 1482. [Full Text] [PDF]
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S. N. Goldberg Comparison of Techniques for Image-guided Ablation of Focal Liver Tumors Radiology, May 1, 2002; 223(2): 304 - 307. [Full Text] [PDF]
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J. R. Leyendecker, G. D. Dodd III, G. A. Halff, V. A. McCoy, D. H. Napier, L. G. Hubbard, K. N. Chintapalli, S. Chopra, W. K. Washburn, R. M. Esterl, et al. Sonographically Observed Echogenic Response During Intraoperative Radiofrequency Ablation of Cirrhotic Livers: Pathologic Correlation Am. J. Roentgenol., May 1, 2002; 178(5): 1147 - 1151. [Abstract] [Full Text] [PDF]
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D. A. Iannitti, D. E. Dupuy, W. W. Mayo-Smith, and B. Murphy Hepatic Radiofrequency Ablation Arch Surg, April 1, 2002; 137(4): 422 - 427. [Abstract] [Full Text] [PDF]
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T. de Baere, B. Bessoud, C. Dromain, M. Ducreux, V. Boige, N. Lassau, T. Smayra, B. V. Girish, A. Roche, and D. Elias Percutaneous Radiofrequency Ablation of Hepatic Tumors During Temporary Venous Occlusion Am. J. Roentgenol., January 1, 2002; 178(1): 53 - 59. [Abstract] [Full Text] [PDF]
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H. Choi, E. M. Loyer, R. A. DuBrow, H. Kaur, C. L. David, S. Huang, S. Curley, and C. Charnsangavej Radio-frequency Ablation of Liver Tumors: Assessment of Therapeutic Response and Complications RadioGraphics, October 1, 2001; 21(90001): S41 - 54. [Abstract] [Full Text] [PDF]
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T. Boehm, A. Malich, S. N. Goldberg, J. R. Reichenbach, I. Hilger, P. Hauff, M. Reinhardt, M. Fleck, and W. A. Kaiser Radio-frequency Tumor Ablation: Internally Cooled Electrode versus Saline-enhanced Technique in an Aggressive Rabbit Tumor Model Radiology, March 1, 2002; 222(3): 805 - 813. [Abstract] [Full Text] [PDF]
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S. N. Goldberg, G. D. Girnan, A. N. Lukyanov, M. Ahmed, W. L. Monsky, G. S. Gazelle, J. C. Huertas, K. E. Stuart, T. Jacobs, V. P. Torchillin, et al. Percutaneous Tumor Ablation: Increased Necrosis with Combined Radio-frequency Ablation and Intravenous Liposomal Doxorubicin in a Rat Breast Tumor Model Radiology, March 1, 2002; 222(3): 797 - 804. [Abstract] [Full Text] [PDF]
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C. Dromain, T. de Baere, D. Elias, V. Kuoch, M. Ducreux, V. Boige, P. Petrow, A. Roche, and R. Sigal Hepatic Tumors Treated with Percutaneous Radio-frequency Ablation: CT and MR Imaging Follow-up Radiology, April 1, 2002; 223(1): 255 - 262. [Abstract] [Full Text] [PDF]
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