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Keywords:
Interventional non-vascular, Liver, Oncology, CT, Ablation procedures, Cancer, Metastases, Outcomes
Authors:
S. A. Forbes, C. J. Zagorski, P. E. Jennings, R. Soomal, S. L. Smith; Ipswich/UK
DOI:
10.1594/ecr2014/C-1151
Conclusion
Accessible liver metastases,
<30mm in diameter and distant from hepatic vasculature and biliary structures could be considered for initial RFA treatment rather than surgery,
minimising morbidity and loss of liver volume.
Pre-RFA chemotherapy can improve survival in selected patients.
3-year survival of 65% compares favourably with liver resection alone (4) (6) (9) (10),
suggesting that RFA is equivalent to resection in patients with resectable disease.
The initial number of lesions treated and total number of lesions ablated did not produce a statistically significant difference in survival.
RFA could be considered as a viable treatment option when faced with a larger number of hepatic lesions,
in order to prevent the significant rise in morbidity and poor 5 year survival associated with the surgical resection of large numbers of lesion as at a single attempt.
Additional advantages of RFA are that it is minimally invasive,
requiring shorter hospital stays and recovery time,
with fewer complications.
This is supported in a recent paper (11) that demonstrated a median hospital stay of 13 days following hepatic resection compared to only 2 days after RFA.
Furthermore,
complications occurred in 7 and 30 patient following RFA and surgery respectively.
Ideally a randomised control trial designed to compare outcomes of aggressive liver resection against RFA is needed.
In reality such a study is very unlikely to take place given the fact that liver resection is so well established as the primary treatment modality.
However there is growing evidence from observational studies,
that RFA is a low cost,
safe and well tolerated technique that potentially carries equal benefit in carefully selected patients,