Radiofrequency ablation in the management of primary hepatic and biliary tumors

Table 1 Utilization of radiofrequency ablation for cholangiocarcinoma

Technique	Ref.	Number of Patients	Location	Stent type	Mean number of sessions	Patency of stent (d, median)	Stent occlusion	Survival	Adverse events
	Mizandari et al[78], 2013	39	CCA (17); Bismuth I (5); II (1); IIIa (4); IV (7)-Panc CA (11), GB CA (4), HCC (1), Ampullary CA (1), Metastatic CA (5)	SEMS (all)	1	84.5	1	3 mo (median)	Abdominal pain (15)
	Wu et al[32], 2017	71[RFA and stenting = 35, stenting alone = 36]	Extra-hepatic distal CCA	Covered SEMS (7); uncovered SEMS (28)	1	Uncovered SEMS (241); covered SEMS (212)	-	Uncovered SEMS (245 d, median); covered SEMS (278 d, median)	Abdominal pain (27)
Percutaneous	Li et al[29], 2015	26[RFA and stenting = 12, stenting alone = 14]	Hilar (2), middle and distal CBD(7), Panc CA (2), ampullary CA (1)	SEMS (all)	1	RFA group (0), control group (3)	RFA group 100%; control group 85% at 90 d	-	Cholangitis (3)
	Wu et al[31], 2015	47	Hilar (7), distal CBD (16);ampullary CA (8); Panc CA (6); GB CA (4); HCC(2); Metastatic disease( 4)	SEMS	1.38	149	11	6 mo	Abdominal pain (21), intra-abdominal hemorrhage (1)
	Wang et al[28], 2016	9	Bismuth IIIa (1); IIIb (1); IV (7)	SEMS	1 (only 1 patient had 2 sessions)	100	-	5.3 mo	Abdominal pain (3); Cholangitis (4)
	Wang et al[39], 2016	12	Bismuth I (5); IIIa (1); IV (3); Gastric CA (1); HCC(1); Congenital Choledochal cyst (1)	Plastic (7); SEMs (4)	1	125	-	7.7 mo (median)	Fever (2), pancreatitis (1)
	Laquière et al[81], 2016	12	Bismuth I (4); II (3); III (2); IV (3)	Plastic and Metallic (does not quantify)	1.63	-	4	12.3 mo	Sepsis (1), early stent migration (1), late stent migration(1), cholangitis (1)
Endoscopic	Sharaiha et al[86], 2015	69	Hilar (23); proximal CBD (7); distal CBD (7); Bismuth I (4); Bismuth III (2); Bismuth IV (5); Panc CA (19); GB CA (2); Gastric CA (1), Metastasis disease (3)	Metallic (49); Plastic (20)	1.3	95% at 30 d	3	17.7 ± 15.4 mo	Pancreatitis (1); Cholecystitis( 2); Haemobilia (1); abdominal pain (3)
	Strand et al[87], 2014	16	Intrahepatic/proximal (1); Hilar (13); Extrahepatic/distal (2)	Plastic (3); fully covered SEMS (3); uncovered SEMS (11)	1.19	-	0.06	9.6 mo	Stent migration (0.02); cholangitis (0.13); hepatic abscess (0.02); need for percutaneous drainage (0.01); severe abdominal pain (0.02) (occurrence per month)
	Sharaiha et al[30], 2014	64	CCA (18); Panc CA (8)	Covered SEMS (8); uncovered SEMS (7); Plastic (11)	1	100% at 90 d	0	5.9 mo	Abdominal pain(3); Pancreatitis (1); Cholecystitis (1)
	Alis et al[88], 2013	10	Bismuth I (4); Distal CBD (6)	SEMS (all)	1	270	0	-	Pancreatitis (2)
	Figueroa Barojas et al[49], 2013	20	CCA (11); Panc CA (7); Gastric Ca (1), IPMN with high grade dysplasia (1)	Plastic (6); covered SEMS (13); uncovered SEMS ( 1)	1.25	100% at 30 d	0	-	Abdominal pain (5); Pancreatitis (1); Cholecystitis (1)
	Steel et al [19], 2011	21	CCA (6); Panc CA (16)	Uncovered SEMS (all)	2	114 (median stent patency at 9- d)	4	-	Pancreatitis (1); cholecystitis (2), obstructive jaundice/death (1)
Percutaneous and endoscopic	Dolak et al[27], 2014	58	Bismuth I (5); II (1); III (6); IV (33); distal CBD (5);Panc CA (4), central HCC,mCRC(3)	Plastic (19); SEMS (35); no stent (4)	1.44	170 (Metallic stent = 218, Plastic stent = 115)	-	10.9 mo (median)	Cholangitis (5); hemobilia (2); sepsis (2); hepatic coma (1); hepatic infarction (1)

CBD: Common bile duct; CCA: Cholangiocarcinoma; GA Ca: Gallbladder cancer; Panc CA: Pancreatic cancer; mCRC: Metastatic colorectal cancer; SEMS: Self-expanding metallic stent.

Table 2 Utilization of Radiofrequency ablation for hepatocellular carcinoma

Ref.	Type	N	Technique	Survival	Recurrence	Adverse Events	Outcome
Zhang et al[89], 2013	Retrospective	155	RFA (78- 93 sessions) and MWA (77-91 sessions)	1-, 3-, and 5-year overall survival rates: RFA: 91.0%, 64.1% and 41.3%; MWA: 92.2%, 51.7%, and 38.5%	RFA: 11/93 (11.8%) and MWA: 11/105 (10.5%)	RFA group: persistent jaundice (n = 1) and biliary fistula (n = 1). MWA group: hemothorax and intrahepatic hematoma (n = 1) and peritoneal hemorrhage (n = 1)	No significant differences LTP, DR, and overall survival
Karla et al[90], 2017	Prospective	50	RFA alone (25) and RFA + alcohol ablation (25)	RFA alone 84%; RFA + alcohol (80%) (at 6 month)	Local recurrence (11); Distant intrahepatic tumor recurrence (4)	Hemoperitoneum (1)	Combined use of RFA and alcohol did not improve the local tumor control and survival
Abdelaziz et al[91], 2017	Retrospective	67	TACE-RFA (22) and TACE-MWA (45)	Survival at 1, 2 and 3 years: TACE-MWA: 83.3%, 64.7%, 64.7%; TACE-RFA: 73.1%, 40.6% and 16.2% (P = 0.08)	TACE-RFA: 4 (18.2%); TACE-MWA: 8 (17.8%)	TACE-RFA: bone metastases 1 (4.5%), Ascites 3 (13.6%), variceal bleeding 5 (22.7%); TACE-MWA: portal vein thrombosis: 1 (2.2%), ascites 6 (13.3%), variceal bleeding: 4 (8.9%)	No significant difference in overall survival was observed
Gyori et al[92], 2017	Retrospective	150	54% (n = 81) received TACE-based LRT, 26% (n = 39) PEI/RFA regimen, and 17% (n = 26) had no treatment while on the waiting list	No difference in overall survival after liver transplantation when comparing TACE- and RFA-based regimens.			TACE- and RFA-based regimens showed equal outcomes in terms of transplantation rate, tumor response, and post-transplant survival. Lower survival in recipients of Multimodality LRT.
Hao et al[93], 2017	Retrospective	237	50 pathologically early HCCs, 187 typical HCCs		LTP observed in 1 Early HCC (2%); 46 Typical HCC (24.6%)	Fever, abdominal pain and elevated liver enzyme levels.	Rate of LTP for early HCCs after RFA was significantly lower than typical HCCs.
Liao et al[63], 2017	Prospective randomized	96	48 patients wide margin (WM) ablation (≥ 10 mm) and 48 normal margin (NM) ablation (≥ 5 mm but < 10 mm )	The 1-, 2-, and 3-year survival rates: WM: 95.8%, 91.6%, and 74.6%; NM: 95.8%, 78.4%, and 60.2%	3-year LTP: WM: 14.9%; NM: 30.2% Intrahepatic recurrence (IHR): WM: 15.0% NM: 32.7%	Perihepatic bile collection (1); intrahepatic hemorrhage(1); fever(1); liver infarction (1); thermal skin injury (1); pleural effusion (1)	WM-RFA may reduce the incidence of tumor recurrence among cirrhotic patients with small HCCs
Rajyaguru et al[64], 2018	Observational	3980	RFA (3,684) and SBRT (296)	5 yr overall survival: RFA: 29.8% (95%CI: 24.5-35.3%); SBRT: 19.3% (95%CI: 13.5-25.9%)			Treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC
Parick et al[65], 2018	Retrospective cohort	440	RFA (408) and SBRT (32)	RFA patients had better overall survival (P < 0.001)			SBRT (HR 1.80; 95%CI: 1.15-2.82) associated with worse survival
Santambrogio et al[94], 2018	Prospective controlled	264	Laparoscopic hepatic resection (LHR = 59) vs laparoscopic ablation therapy (LAT = 205)	Survival rates LHR at 1, 3, and 5 years were 93, 82, and 56%. In LAT = 91%, 62%, and 40%	LHR = 24/59 (41%); LAT = 135/205 (66%)		LAT found to be adequate alternative

OLT: Orthotopic liver transplantation; LRT: Locoregional treatment; LTP: Local Tumor Progression; TACE: Transarterial chemoembolization; PEI: Percutaneous ethanol injection; SBRT: Stereotactic body radiotherapy; MWA: Microwave ablation; DR: Distant recurrence.