M. Kashima

Complications After 1000 Lung Radiofrequency Ablation Sessions in 420 Patients: A Single Center’s Experiences

OBJECTIVE This study retrospectively evaluates complications after lung radiofrequency ablation (RFA). MATERIALS AND METHODS Complications were assessed for each RFA session in 420 consecutive patients with 1403 lung tumors who underwent 1000 RFA sessions with a cool-tip RFA system. A major complication was defined as a grade 3 or 4 adverse event. Risk factors affecting frequent major complications that occurred with an incidence of 1% or more were detected using multivariate analysis. RESULTS Four deaths (0.4% [4/1000]) related to RFA procedures occurred. Three patients died of interstitial pneumonia. The other patient died of hemothorax. The major complication rate was 9.8% (98/1000). Frequent major complications were aseptic pleuritis (2.3% [23/1000]), pneumonia (1.8% [18/1000]), lung abscess (1.6% [16/1000]), bleeding requiring blood transfusion (1.6% [16/1000]), pneumothorax requiring pleural sclerosis (1.6% [16/1000]), followed by bronchopleural fistula (0.4% [4/1000]), brachial nerve injury (0.3% [3/1000]), tumor seeding (0.1% [1/1000]), and diaphragm injury (0.1% [1/1000]). Puncture number (p < 0.02) and previous systemic chemotherapy (p < 0.05) were significant risk factors for aseptic pleuritis. Previous external beam radiotherapy (p < 0.001) and age (p < 0.02) were significant risk factors for pneumonia, as were emphysema (p < 0.02) for lung abscess, and serum platelet count (p < 0.002) and tumor size (p < 0.02) for bleeding. Emphysema (p < 0.02) was a significant risk factor for pneumothorax requiring pleural sclerosis. CONCLUSION Lung RFA is a relatively safe procedure, but it can be fatal. Risk factors found in this study will help to stratify high-risk patients.

Midterm results of radiofrequency ablation versus nephrectomy for T1a renal cell carcinoma.

PurposeThe aim of this study was to retrospectively evaluate midterm results of renal radiofrequency (RF) ablation compared to the results after nephrectomy in patients with T1a renal cell carcinoma (RCC).Materials and methodsA total of 115 patients with a single RCC measuring ≤4 cm (T1a) were included; 51 patients underwent RF ablation, 54 patients radical nephrectomy, and 10 patients partial nephrectomy. The survival and the percent decreases in glomerular filtration rate (GFR) were compared among the three treatments.ResultsAlthough overall survival after RF ablation (75.0% at 5 years) was lower than those after radical and partial nephrectomy, the RCC-related survival (100% at 5 years) was comparable to those following radical nephrectomy (100% at 5 years) and partial nephrectomy (100% at 3 years). The disease-free survival (DFS) after RF ablation (98.0% at 5 years) was also comparable to those after radical nephrectomy (95.0% at 5 years) (P = 0.72) and partial nephrectomy (75.0% at 3 years) (P = 0.13). The percent decrease in the GFR at last follow-up in the RF ablation group (median 7.9%) was significantly lower than that in the radical nephrectomy group (median 29.0%) (P < 0.001) and comparable to that in the partial nephrectomy group (median 11.5%) (P = 0.73).ConclusionRF ablation provides RCC-related and DFS comparable to that found after nephrectomy with little loss of renal function.

Radiofrequency Ablation for the Treatment of Bone Metastases From Hepatocellular Carcinoma

OBJECTIVE The objective of our study was to retrospectively evaluate the clinical utility of bone radiofrequency ablation in patients with bone metastases from hepatocellular carcinoma (HCC). MATERIALS AND METHODS At three institutions, 40 consecutive HCC patients with 54 bone metastases received radiofrequency ablation. The mean maximum diameter of the bone metastases was 4.8 +/- 2.3 (SD) cm (range, 1.0-12.0 cm). The feasibility and safety of the procedure and the pain relief achieved from the procedure were reviewed. Technical success was defined as correct placement of the radiofrequency electrode into the tumor target and completion of the planned ablation protocol. Survival and prognostic factors were evaluated. RESULTS Technical success was 100%. No major complication occurred aside from transient nerve injury in one patient (2.5%, 1/40). Pain relief was achieved in all patients with painful bone metastases except one (96.6%, 28/29). The respective 1-, 2-, and 3-year survival rates were 34.2% (95% CI, 19.2-49.1), 19.9% (95% CI, 7.0-32.8), and 10.0% (95% CI, 0-20.2), with a median survival time of 7.1 months. Complete ablation of bone metastases, a single bone lesion, negative alpha-fetoprotein levels, and the absence of viable intrahepatic lesions were significant factors for a better prognosis. The median survival time was, respectively, 12.5 months in 16 patients with negative alpha-fetoprotein levels, 16.8 months in 12 patients with complete tumor ablation, 16.8 months in 16 patients with a single bone metastasis, and 21.9 months in 17 patients with no viable intrahepatic HCCs. CONCLUSION Bone radiofrequency ablation is a safe, useful, and feasible therapeutic option for relieving pain in patients with HCC bone metastases. Prognostic factors reported herein can facilitate stratification of patients with HCC bone metastases.