Saline-enhanced RFA lives up to expectations

Using saline perfusion to boost the radio-frequency ablation of liver tumors is feasible and safe, according to Italian researchers. They found caveats to its use, however.

For almost a decade, RFA with cooled-tip or multi-array expandable probes has earned a reputation as a safe treatment alternative for nonoperable liver lesions. Most potential complications observed in sizable trials have been properly documented, but the adverse effects of the saline-perfused RFA needles have not. Though rare, life-threatening complications such as acute liver failure persist.

Between 2000 and 2003, Dr. Antonio Giorgio and colleagues at the D. Cotugno Hospital of Naples enrolled 336 consecutive patients with liver cancer who underwent percutaneous, saline-enhanced RFA under sonographic guidance. Investigators prospectively logged complications and other adverse events related to the procedure.

Giorgio's team found the saline-perfused cannulated needle could treat liver cancers with fewer major complications than could internally cooled or expandable probes. A sudden worsening of functional liver reserve may occur, however, even when only a small nodule of hepatocellular carcinoma is treated, the researchers said. They published their results in the January issue of the American Journal of Roentgenology.

Of the 336 patients, 287 had hepatocellular carcinomas and 47 had liver metastases (38 from colon, six from breast, two from lung, and one from cutaneous melanoma). Three patients showed major complications:

• One patient died of worsening liver decompensation.

• One experienced liver abscess and infection, but was treated successfully with ultrasound-guided needle aspiration and antibiotics.

• One got mild post-treatment ascites.

One patient developed subcutaneous cellulites along the electrode-needle path that healed in two weeks. Fever lasting 24 to 72 hours and pain lasting 12 to 24 hours affected 141 and 211 patients, respectively.

The study validated previous reports suggesting that complications from liver abscesses may occur after RFA of tumors near the intestine, probably due to contamination of the RFA-induced necrosis by digestive tract pathogens. None of the patients in the study with tumors adjacent to the gallbladder experienced major complications described by other authors, however.

Saline-enhanced RFA of liver tumors can be considered safe. Though rare, a worsening liver decompensation that may lead to acute liver failure cannot be ruled out, the researchers said.

For more information from the Diagnostic Imaging archives:

Liver lesions respond to new treatment

Insurance companies line up to reimburse for liver RFA

RF tumor ablation breaks through in clinical practice

RF ablation tops nonsurgical tumor treatment options