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AJR 2004; 182:1597
© American Roentgen Ray Society

Cryotherapy and Percutaneous Ablation

Robert S. Shapiro

Mount Sinai School of Medicine New York, NY 10029

The concept of using locally destructive techniques to provide symptomatic relief of neuroendocrine symptoms is attractive. In the October 2003 issue of AJR, Henn et al. [1] describe their experience using percutaneous radiofrequency ablation for treatment of hepatic metastases from carcinoid tumors and insulinomas. In 1998, we achieved similar results using cryotherapy to treat patients with metastatic carcinoid tumors [2]. Dissemination of this information is important because locally destructive techniques are simultaneously becoming less invasive and more effective. These techniques are likely to play an increasingly important role in the treatment of a variety of tumors.

References

  1. Henn AR, Levine EA, McNulty W, Zagoria RJ. Percutaneous radiofrequency ablation of hepatic metastases for symptomatic relief of neuroendocrine syndromes. AJR2003; 181:1005 –1010[Abstract/Free Full Text]
  2. Shapiro RS, Shafir M, Sung M, Warner R, Glajchen N. Cryotherapy of metastatic carcinoid tumors. Abdom Imaging1998; 23:314 –317[Medline]

Reply

Ronald J. Zagoria, Edward A. Levine and Adam R. Henn

Wake Forest University Winston-Salem, NC 27157

We thank Dr. Shapiro for his interest in our article [1] on percutaneous radiofrequency ablation for the treatment of liver metastases from primary neuroendocrine tumors. He noted that he achieved similar results with cryoablation. In our article, we acknowledged this option and referenced an article that reported experience with cryoablation for this purpose. Ablative therapies clearly have a role in the palliation of the paraneoplastic syndromes, which are the hallmark of metastatic neuroendocrine tumors.

Several alternatives are now available for minimally invasive treatment of liver metastases, with radiofrequency and cryoablation being two of the more commonly used techniques. Few studies have compared different techniques for liver tumor ablation. Our institutional experience with cryotherapy for hepatic metastases has been gained via an open technique. We have no experience with percutaneous cryoablation, but the oncologic surgeons at our institution have abandoned it in favor of radiofrequency ablation. This change was prompted because radiofrequency ablation has lower rates of serious complications and local recurrence than cryoablation. This perception is supported by others [2, 3]. Coagulopathy, cryoshock, and cardiorespiratory complications are known morbidities that not infrequently occur after cryotherapy for ablation of liver tumors [2–4]. In our experience from treating more than 200 patients with radiofrequency ablation, the rate and severity of complications are lower.

References

  1. Henn AR, Levine EA, McNulty W, Zagoria RJ. Percutaneous radiofrequency ablation of hepatic metastases for symptomatic relief of neuroendocrine syndromes. AJR2003; 181:1005 –1010
  2. Adam R, Hagopian EJ, Linhares M, et al. A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies. Arch Surg2002; 137:1332 –1339[Abstract/Free Full Text]
  3. Helling TS. Realistic expectations for cryoablation of liver tumors. J Hepatobiliary Pancreat Surg2000; 7:510 –515[Medline]
  4. Sheen AJ, Poston GJ, Sherlock DJ. Cryotherapeutic ablation of liver tumours. Br J Surg 2002;89 :1396 –1401[Medline]

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This Article
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Right arrow Articles by Shapiro, R. S.
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Right arrow Articles by Shapiro, R. S.
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