Radiofrequency thermal ablation of hepatic metastases of adrenocortical cancer–a case report and review of the literature
Abstract
AIM: Radiofrequency thermal ablation (RFA) has shown promise as a technique for treating solid tumors. This method has been suggested as an alternative to surgery in patients with adrenocortical carcinoma (ACC). MATERIALS AND METHODS: We reviewed the literature, and report the case of a patient with stage 4 ACC who received intraoperative and percutaneous RFA of two liver metastasis according to a standard ablation protocol. RESULTS: Post-interventional imaging in our patient demonstrated that after both interventions, a stellar-like structure of vital tumor tissue had remained within the coagulation necrosis. This was the starting point of a fast and progressive tumor recurrence. We suspect heat-sink effects of blood vessels in the highly vascularized metastasis to cause the tumor recurrence. In literature, there are only a few reports of RFA in ACC patients. In addition, there is no large randomized trial investigating the efficacy of RFA against surgery in those patients. CONCLUSIONS: Presently, RFA in ACC should be restricted to patients in whom surgery is contraindicated. It is necessary that strongly vascularized ACC metastases deserve a modified ablation protocol due to perfusion related cooling effects and to increase the efficacy of RFA.
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General limitations for RFA include highly vascularized metastasis or proximity to large vessels, because both function as a heat sink preventing the full destructive effect of RFA.
“There are general limitations for RFA, such as in cases of highly vascularized metastasis or proximity to large vessels, because both function as a heat sink preventing the full destructive effect of RFA (353).”
From Adrenocortical carcinoma (2014) · cites this paper as [353]
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“Radiofrequency ablation is an alternative for selected metastases”
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on behalf of the German Adrenocortical Carcinoma Study Group, Baur, J., Büntemeyer, T.-O., Megerle, F., Deutschbein, T., Spitzweg, C., Quinkler, M. O., Nawroth, P. P., Kroiß, M., Germer, C., et al. (2017) · BMC Cancer · doi:10.1186/s12885-017-3506-z · Cited by 38 · see citing works
“Another case report and review of the literature about thermoablation for ACC LM suggested that RFA should be considered as therapy alternative only for patients in whom resection is contraindicated, due to the increased risk of local recurrence in highly vascularized ACC metastases after ablation [16].”
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“23 Bauditz et al 24 also reported a high local recurrence rate after RFA for liver metastases of ACC.”
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Kienitz, T., Rayes, N., & Quinkler, M. O. (2015) · best practice onkologie · doi:10.1007/s11654-014-0520-3
“Dabei ist die Radiofrequenztherapie jedoch in ihrer Wirksamkeit durch die hohe Vaskularisierung des Tumors häu g eingeschränkt [2].”
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Polanía, D., Linares, J. G., Linares, C. G., Ruiz, P. C., & Rivera, O. M. M. (2011) · Revista Med · doi:10.18359/rmed.1281
Outcome of multidisciplinary management of adrenocortical carcinoma: a retrospective studyPreprint
Zhu, J., Zheng, Z., Shen, J., Lian, X., Miao, Z., Shen, J., & Zhang, F. (2020) · doi:10.21203/rs.2.22981/v1
“RFA may provide short-term local control for small liver metastases with a 5-year OS rate of 29% [32, 33].”
Background
- Authors
- Bauditz, J., Quinkler, M., & Wermke, W.
- Affiliations
- Charité – Universitätsmedizin Berlin (DE)
- ORCID
- Quinkler, M.
- Venue
- Experimental and Clinical Endocrinology & Diabetes
- Publisher
- Georg Thieme Verlag KG
- Published
- 2008-12-03
- Volume
- 117
- Issue
- 07
- Pages
- 316-319
- ISSN
- 0947-7349 (ISSN-L)
- 1439-3646
- OpenAlex
- W1964953687
- Cited by
- 15
- References
- 0
- Citations by year
- 2023: 1 · 2022: 1 · 2020: 1 · 2018: 2 · 2017: 1 · 2015: 1 · 2013: 2 · 2012: 1
- FWCI
- 1.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Experimental and Clinical Endocrinology & Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
- Keywords
- radiofrequency ablation, adrenocortical carcinoma, liver metastasis, intraoperative ablation, percutaneous ablation, tumor recurrence, heat sink effect, coagulative necrosis, alternative to surgery
- MeSH terms
- Adrenal Cortex Neoplasms, Adult, Carcinoma, Female, Humans, Liver Neoplasms, Ultrasonography, Monitoring, Intraoperative, Treatment Outcome, Catheter Ablation, Disease Progression
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