Combined radiofrequency and alcohol injection for percutaneous hepatic tumor ablation

Sridhar Shankar, Eric VanSonnenberg, Paul R. Morrison, Kemal Tuncali, Stuart G. Silverman

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. We sought to determine if alcohol potentiates radiofrequency energy by obtaining larger ablative volumes in 30 liver tumors in human patients. SUBJECTS AND METHODS. We compared two groups of patients: one group treated with radiofrequency ablation alone (radiofrequency-alone group), and a second group treated with radiofrequency ablation and immediate prior injection of alcohol (combined group). The radiofrequency-alone group comprised 20 ablations (mean diameter, 8.4 cm; colorectal cancer metastases [n = 15]; other metastases [n = 5]). The combined group consisted of 30 radio-frequency ablations (mean diameter, 8.8 cm; metastatic colorectal cancer [n = 17]; other metastases [n = 8]; and hepatocellular carcinoma [n = 5]) treated with alcohol injection immediately before radiofrequency ablation. The amount of alcohol injected was determined by the size and location of tumors. Preprocedural laboratory tests (complete blood cell count with differential, liver function tests, and coagulation parameters) were performed in all patients, along with pre- and postprocedural CT, MRI, and PET. Measurements of tissue necrosis were obtained on the postprocedural CT scans and MR images. Volumes of necrosis calculated in each group were corrected for the number of radiofrequency applications and were statistically compared using the Student's t test. In addition, tissue impedances obtained during the radiofrequency ablation procedure were compared between the two groups. RESULTS. The mean ablation volumes for the radiofrequency-alone group were 32.3 cm2 (median, 28.6 cm2; range, 14.4-61.8 cm2) and for the combined group, 84.6 cm2 (median, 78.3 cm2; range, 34.6-149 cm 2). The difference in the necrosis volumes was significantly larger (p < 0.0001) in the combined group. Overall, the combined treatment group underwent fewer radiofrequency applications per session. Tissue impedance during radiofrequency ablation was higher in the combined group (mean, 62.7 vs 57.3 Ω in the radiofrequency alone group; p = 0.0005) at comparable times during the ablations. No major complications were seen in either group. CONCLUSION. Percutaneous radiofrequency ablation appears to be potentiated by immediate prior alcohol injection into the tumor. Consistently larger lesions are obtainable in fewer sessions, without any increase of complications, using the combined method.

Original languageEnglish (US)
Pages (from-to)1425-1429
Number of pages5
JournalAmerican Journal of Roentgenology
Volume183
Issue number5
DOIs
StatePublished - Jan 1 2004

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Alcohols
Injections
Liver
Necrosis
Blood Cell Count
Neoplasms
Neoplasm Metastasis
Electric Impedance
Colorectal Neoplasms
Liver Function Tests
Radio
Hepatocellular Carcinoma
Students
Therapeutics

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Combined radiofrequency and alcohol injection for percutaneous hepatic tumor ablation. / Shankar, Sridhar; VanSonnenberg, Eric; Morrison, Paul R.; Tuncali, Kemal; Silverman, Stuart G.

In: American Journal of Roentgenology, Vol. 183, No. 5, 01.01.2004, p. 1425-1429.

Research output: Contribution to journalArticle

Shankar, Sridhar ; VanSonnenberg, Eric ; Morrison, Paul R. ; Tuncali, Kemal ; Silverman, Stuart G. / Combined radiofrequency and alcohol injection for percutaneous hepatic tumor ablation. In: American Journal of Roentgenology. 2004 ; Vol. 183, No. 5. pp. 1425-1429.
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abstract = "OBJECTIVE. We sought to determine if alcohol potentiates radiofrequency energy by obtaining larger ablative volumes in 30 liver tumors in human patients. SUBJECTS AND METHODS. We compared two groups of patients: one group treated with radiofrequency ablation alone (radiofrequency-alone group), and a second group treated with radiofrequency ablation and immediate prior injection of alcohol (combined group). The radiofrequency-alone group comprised 20 ablations (mean diameter, 8.4 cm; colorectal cancer metastases [n = 15]; other metastases [n = 5]). The combined group consisted of 30 radio-frequency ablations (mean diameter, 8.8 cm; metastatic colorectal cancer [n = 17]; other metastases [n = 8]; and hepatocellular carcinoma [n = 5]) treated with alcohol injection immediately before radiofrequency ablation. The amount of alcohol injected was determined by the size and location of tumors. Preprocedural laboratory tests (complete blood cell count with differential, liver function tests, and coagulation parameters) were performed in all patients, along with pre- and postprocedural CT, MRI, and PET. Measurements of tissue necrosis were obtained on the postprocedural CT scans and MR images. Volumes of necrosis calculated in each group were corrected for the number of radiofrequency applications and were statistically compared using the Student's t test. In addition, tissue impedances obtained during the radiofrequency ablation procedure were compared between the two groups. RESULTS. The mean ablation volumes for the radiofrequency-alone group were 32.3 cm2 (median, 28.6 cm2; range, 14.4-61.8 cm2) and for the combined group, 84.6 cm2 (median, 78.3 cm2; range, 34.6-149 cm 2). The difference in the necrosis volumes was significantly larger (p < 0.0001) in the combined group. Overall, the combined treatment group underwent fewer radiofrequency applications per session. Tissue impedance during radiofrequency ablation was higher in the combined group (mean, 62.7 vs 57.3 Ω in the radiofrequency alone group; p = 0.0005) at comparable times during the ablations. No major complications were seen in either group. CONCLUSION. Percutaneous radiofrequency ablation appears to be potentiated by immediate prior alcohol injection into the tumor. Consistently larger lesions are obtainable in fewer sessions, without any increase of complications, using the combined method.",
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AU - Morrison, Paul R.

AU - Tuncali, Kemal

AU - Silverman, Stuart G.

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N2 - OBJECTIVE. We sought to determine if alcohol potentiates radiofrequency energy by obtaining larger ablative volumes in 30 liver tumors in human patients. SUBJECTS AND METHODS. We compared two groups of patients: one group treated with radiofrequency ablation alone (radiofrequency-alone group), and a second group treated with radiofrequency ablation and immediate prior injection of alcohol (combined group). The radiofrequency-alone group comprised 20 ablations (mean diameter, 8.4 cm; colorectal cancer metastases [n = 15]; other metastases [n = 5]). The combined group consisted of 30 radio-frequency ablations (mean diameter, 8.8 cm; metastatic colorectal cancer [n = 17]; other metastases [n = 8]; and hepatocellular carcinoma [n = 5]) treated with alcohol injection immediately before radiofrequency ablation. The amount of alcohol injected was determined by the size and location of tumors. Preprocedural laboratory tests (complete blood cell count with differential, liver function tests, and coagulation parameters) were performed in all patients, along with pre- and postprocedural CT, MRI, and PET. Measurements of tissue necrosis were obtained on the postprocedural CT scans and MR images. Volumes of necrosis calculated in each group were corrected for the number of radiofrequency applications and were statistically compared using the Student's t test. In addition, tissue impedances obtained during the radiofrequency ablation procedure were compared between the two groups. RESULTS. The mean ablation volumes for the radiofrequency-alone group were 32.3 cm2 (median, 28.6 cm2; range, 14.4-61.8 cm2) and for the combined group, 84.6 cm2 (median, 78.3 cm2; range, 34.6-149 cm 2). The difference in the necrosis volumes was significantly larger (p < 0.0001) in the combined group. Overall, the combined treatment group underwent fewer radiofrequency applications per session. Tissue impedance during radiofrequency ablation was higher in the combined group (mean, 62.7 vs 57.3 Ω in the radiofrequency alone group; p = 0.0005) at comparable times during the ablations. No major complications were seen in either group. CONCLUSION. Percutaneous radiofrequency ablation appears to be potentiated by immediate prior alcohol injection into the tumor. Consistently larger lesions are obtainable in fewer sessions, without any increase of complications, using the combined method.

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