Rad-14. Percutaneous CT guided radiofrequency ablation of very large liver tumors.

We will discuss tumor evolution and complications encountered during treatment of very large (> 6 cm) hepatic tumors. Four patients with good performance status and very large secondary hepatic tumors as identified on diagnostic CT were treated with percutaneous CT guided radiofrequency ablation (RFA) under general endotracheal anesthesia. The ablation time was 3-8 hours, with a mean of 6 hours. Length of hospitalization was 3-6 days. The treatment was complex in one patient with breast carcinoma due to the presence of a cardiac pacemaker. The treatment of a second patient with renal cell carcinoma was augmented with pre-ablation arterial tumor embolization. The remaining two patients had primary colon adenocarcinoma. Seven tumors were treated. The mean tumor size was 10 centimeters (range 6-12cm). One patient developed a biliary to bronchial fistula that was successfully treated with an internal/external and subsequently an internal biliary drain. He survived for 15 months but eventually died from sepsis. The other three patients are alive with no evidence of viable tumor on follow-up CT Interventional Magnetic Resonance Imaging. One patient required a second RFA for residual tumor. Other complications included large right pleural effusions in all four patients. These were successfully drained under ultrasound guidance on post-op day 3 and did not recur. The mean post RFA survival is 9 months (5-15). Although patients with very large but limited hepatic metastatic disease and good performance status are rare, selection of those patients and aggressive targeted ablation is possible and carries an acceptable morbidity and mortality. Short-term survival can most likely be prolonged if all detectable disease is ablated, as illustrated in these four cases. Long-term survival is dependent upon the presence or absence of undetected metastatic disease.

Patrick E. Sewell, Jr, MD. University of Mississippi Medical School, Department of Radiology, Division of Image Guided Minimally Invasive Surgery, Jackson MS.