![]() ![]() At present, there is no study to our knowledge on the safety limit of large-volume hepatic RFA. A previous animal study 9 demonstrated that RFA of 30% to 35% of the liver volume caused significant systemic inflammatory responses. Therefore, large-volume hepatic RFA carried a significant morbidity that should not be underestimated. In one study, 7 RFA was shown to be effective for advanced hepatocellular carcinoma with a maximal size up to 18 cm in diameter.Ĭlinical studies 3, 8 have shown that large tumor size and the number of RFA sessions were risk factors for major complications after RFA. 5, 6 The modern designs of radiofrequency electrodes (saline-enhanced, expandable, and cooled-tip electrodes) and the use of the hepatic inflow occlusion technique have rendered RFA feasible in treating large liver tumors (>5 cm). With the advance in modern technology, the volume of ablation by RFA has increased much compared with that of the initial prototype of the radiofrequency electrode. 1 - 4 It uses high-frequency alternating current (350-500 kHz) to cause thermal destruction of the target lesion by electronic vibration within the lesion. Radiofrequency ablation (RFA) has been used to treat patients with unresectable malignant liver tumors with low morbidity (2.2%-12.7%) and mortality (0.0%-1.4%) rates. Beyond that limit, RFA would cause significant systemic inflammatory responses and poor survival. Similar systemic inflammatory responses and poor survival rates were observed among the cirrhotic liver groups when 30% and 40% of the liver volume were ablated.Ĭonclusions The normal rats can tolerate RFA of 40% of the liver volume with minimal morbidity and no mortality whereas the cirrhotic rats can only tolerate 20% of the ablated liver volume. The 4-week survival rates were 100%, 60%, and 0% when 40%, 50%, and 60%, respectively, of the liver volume were ablated. Thrombocytopenia, prolonged clotting time, and interstitial pneumonitis occurred when 50% and 60% of the liver volume were ablated. The concentrations of TNF-α and IL-6 in other groups remained similar to those in the control group. Results In the normal liver groups, the concentrations of TNF-α and IL-6 were significantly elevated in the early postoperative period when 50% (mean ± SD TNF-α concentration, 130.3 ± 15.6 pg/mL mean ± SD IL-6 concentration, 163.2 ± 12.2 pg/mL) and 60% (mean ± SD TNF-α concentration, 145.7 ± 13.0 pg/mL mean ± SD IL-6 concentration, 180.8 ± 11.0 pg/mL) of the liver volume were ablated compared with the control group (mean ± SD TNF-α concentration, 30.4 ± 9.9 pg/mL, P<.001 mean ± SD IL-6 concentration, 28.4 ± 6.7 pg/mL, P<.001). Main Outcome Measures Changes in concentrations of serum inflammatory markers (tumor necrosis factor α and interleukin 6), functions of various end organs, and survival rates were assessed. Intervention Using the Cool-tip RF System (Radionics, Burlington, Mass), RFA was performed for different percentages of the liver volume by weight in normal and cirrhotic Sprague-Dawley rats. Hypothesis Large-volume hepatic RFA causes a significant systemic inflammatory reaction. This study aimed to investigate the possible systemic responses of large-volume hepatic RFA and to estimate its safety limit in normal and cirrhotic rats. Shared Decision Making and Communicationīackground Large-volume hepatic radiofrequency ablation (RFA) has been used to treat large liver tumors, but its safety limit is unknown.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment. ![]()
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