Malign Karaciğer Lezyonlarında Radyofrekans Ablasyon Uygulanması
Özet
Karaciğer tümörlerinde tek küratif tedavi cerrahi rezeksiyon olsa da hastaların yalnızca %5-15'i bu işleme uygun bulunmakta, bu durum unrezektabl lezyonlar için termal ablasyon yöntemlerini öne çıkarmaktadır. Bu modaliteler arasında en sık kullanılanı, elektrik enerjisini ısı enerjisine dönüştürerek tümör dokusunda homojen koagülasyon nekrozu oluşturan radyofrekans ablasyon (RFA) yöntemidir. Görüntüleme eşliğinde yerleştirilen elektrotlar ve kapalı devre elektrik sistemiyle çalışan RFA, özellikle hepatosellüler karsinom (HCC) ve kolorektal kanser metastazlarında güvenle uygulanmaktadır. Teknolojik gelişmeler sayesinde geliştirilen soğutulmuş uçlu, bipolar ve genişletilebilir iğne elektrotlar, doku direncini azaltıp ısı emici büyük damarların olumsuz etkilerini baskılayarak koagülasyon alanını büyütmüş ve lokal nüks oranlarını düşürmüştür. İşlem sonrasında düşük ateş, ağrı ve halsizlik gibi geçici post-ablasyon sendromu semptomları sık görülmekle birlikte; majör komplikasyon ve mortalite oranları %5'in altındadır. RFA, cerrahiye uygun olmayan malign karaciğer lezyonlarında sağkalımı uzatan, düşük morbiditeye sahip, etkin ve güvenilir bir tedavi seçeneğidir.
Although surgical resection remains the only curative treatment for liver tumors, only 5-15% of patients are eligible for it, which makes thermal ablation methods essential for unresectable lesions. Among these modalities, radiofrequency ablation (RFA) is the most frequently utilized technique, functioning by converting electrical energy into thermal energy to induce homogeneous coagulation necrosis in tumor tissues. Guided by imaging, RFA utilizes specialized electrodes within a closed-loop electrical circuit and is safely implemented primarily for hepatocellular carcinoma (HCC) and colorectal cancer metastases. Recent technological advancements—such as cooled-tip, bipolar, and expandable needle electrodes—have minimized tissue impedance and counteracted the cooling effects of large blood vessels, thereby expanding the coagulation zone and decreasing local recurrence rates. While temporary post-ablation syndrome symptoms like low-grade fever, pain, and fatigue are common, major complication and mortality rates remain below 5%. Consequently, RFA stands out as an effective, reliable, and low-morbidity treatment alternative that significantly prolongs survival in patients with unresectable malignant liver lesions.
Referanslar
Highleyman L, Franciscus A. An introduction to the liver (HCSP FACT SHEET). 2010;[last accessed 7 September 2012].
O’Rourke AP, Haemmerich D, Prakash P, et al. Current state of liver tumor ablation devices. Expert Review of Medical Devices. 2007;4:523–37.
Siegel RL, Miller KD, Fuchs HD, et al. Cancer Statistics 2021. https://doi.org/10.3322/caac.21654
Poon R, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: A prospective study of 377 patients over 10 years. Annals of Surgery. 2001;234: 63–70.
McGahan JP, Dodd III GD. Radiofrequency Ablation of the liver: Current status. American Journal of Roentgenology. 2001;176:3–16.
Wood BJ, Ramkaransingh JR, Fojo T, et al. Percutaneous tumor ablation with radiofrequency. Cancer. 2002;94:443-51.
Seror O, N'Kontchou G, Tin-Tin-Htar M, et al. Radiofrequency ablation with internally cooled versus perfused electrodesfor the treatment of small hepatocellular carcinoma in patients with cirrhosis.. J Vasc Interv Radiol. 2008;19:718-24.
Haemmerich D, Chachati L, Wright AS, et al. Hepatic bipolar radiofrequency ablation with internally cooled probes: Effect of coolant tempera-ture on lesion size. IEEE Transaction on Biomedical Engineering. 2003;50:493–500.
Organ LW. Electrophysiologic principles of radiofrequency lesion making. Applied Neurophysiology. 1976;39:69–76.
Lencioni R, Goletti O, Armillotta N, et al. Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: Results of a pilot clinical trial. European Radiology. 1998; 8:1205–11.
Livraghi T, Goldberg SN, Lazzaroni S, et al. Hepatocellular carcinoma: Radio-frequency ablation of medium and large lesions. Radiology. 2000;214:761–8.
Chang IA, Nguyen UD. Thermal modeling of lesion growth with radio frequency ablation devices. Biomedical Engineering 2004; Online: 3-19 pp.
McGahan JP, Brock JM, Tesluk H, et al. Hepatic ablation with use of radio-frequency electrocautery in the animal model. Journal of Vascular and Interventional Radiology. 1992;3:291–7.
Haemmerich D, Lee FT, SchuttD.J,et al. Large-Volume radio-frequency ablation of ex vivo bovine liver with multiple cooled cluster electrodes. Radiology. 2005;234:563–8.
Rossi S, Buscarini E, Garbagnati F, et al. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. American Journal of Roentgenology. 1998;170:1015–22.
Goldberg SN, Grassi CJ, Cardella JF, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria. Radiology 2005;235:728-39.
Park MH, Rhim H, Kim YS, et al. Spectrum of CT findings after radiofrequency ablation of hepatic tumors. Radiographics. 2008;28:379-90.
Lu MD, Yu XL, Li AH, et al. Comparison of contrast enhanced ultrasound and contrast enhanced CT or MRI in monitoring percutaneous thermal ablation procedure in patients with hepatocellular carcinoma: A multi-center study in China. Ultrasound Med Biol 2007;33:1736-49.
Geyik S, Akhan O, Abbasoglu O, et al. Radiofrequency ablation of unresectable hepatic tumors. Diagn Interv Radiol. 2006;12:195-200.
Sartori S, Tombesi P, Macario F, et al. Subcapsular liver tumors treated with percutaneous radiofrequency ablation: a prospective comparison with nonsubcapsular liver tumors for safety and effectiveness. Radiology. 2008;248:670-9
Bleicher RJ, Allegra DP, Nora DT, et al. Radiofrequency ablation in 447 complex unresectable liver tumors: Lessons learned. Annals of Surgical Oncology. 2003;10:52–8.
Osaki Y, Ikeda K, Izumi N, et al. Clinical effectiveness of bipolar radio-frequency ablation for small liver cancers. Journal of Gastroenterology. 2013;48(7):874-83.
Yu J, Liang P, Yu X, et al. A comparison of microwave ablation and bipolar radiofrequency ablation both with an internally cooled probe: Results in ex vivo and in vivo porcine livers. European Journal of Radiology. 2011;79:124–30.
Schramm W, Yang D, Wood BJ, et al. Contribution of direct heating, thermal conduction and perfusion during radiofrequency and microwave ablation. The Open Biomedical Engineering Journal. 2007;1:47–52.
Zhang B, Moser M, Zhang E, et al. Radiofrequency ablation technique in the treatment of liver tumours: review and future issues. J Med Eng Technol, 2013; 37(2): 150–159
Vogl T, Farshid P, Naguib N, et al. Thermal ablation of liver metastases from colorectal cancer: radiofrequency, microwave and laser ablation therapies. Radiol Med. 2014;119(7):451-61.
Bao H, Chen T, Zhu J, et al. CEUS-Based Radiomics Can Show Changes in Protein Levels in Liver Metastases After Incomplete Thermal Ablation. Front Oncol. 2021;11:694102
Granata V, Fusco R, Salati S, et al. A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response. Int J Environ Res Public Health. 2021;18(11):5592.
