Doctors are touting the benefits of an alternative treatment approach for people with inoperable liver cancer that they claim can be an effective option in these cases. The latest study to test the efficacy of radiofrequency ablation, or RFA, was released at a meeting of the Society of American Gastrointestinal and Endoscopic Surgeons this past spring.¹

Increased RFA Scrutiny
There have been many studies testing the effectiveness of RFA. But this research went one step further, to determine if the procedure could effectively treat liver tumors from cancers that originated elsewhere in the body. While there has been "increasing experience" with RFA for treating patients with liver tumors that originated from colorectal and neuroendocrine cancer; "little is known about the outcome of patients with other tumor types," wrote Alan Siperstein, MD, in the department of General Surgery at the Cleveland Clinic Foundation, and his colleagues.

Radiofrequency ablation is primarily advised for patients who cannot have their liver cancer removed through surgery, either because the tumor is larger, involves more than one lobe of the liver, or has grown into blood vessels or other vital structures. It's a relatively new procedure aimed at destroying the tumor using electro currents passed through a small needle inserted into the tumor.²

There are two types of needles that are used commonly in RFA; one needle with an active tip is water-cooled to avoid charring or overcooking, and a second coaxial needle system houses hot hooks that are released once the needle enters the tumor.³

RFA doesn't rule out other treatment options, and in fact, it can be used before or after surgery or radiation therapy, as well as with systemic treatments like chemotherapy. It’s used in combination because certain sections of tumors can’t always be heated effectively using RFA alone.³

No long-term randomized, controlled clinical trials have been conducted to evaluate the benefits of the procedure, but preliminary research has been positive.⁴ While RFA is not considered a cure for liver cancer, studies have suggested it can prolong and improve a patient's quality of life.⁵

Effective for Various Liver Metastases?
In their study, Siperstein and his team prospectively followed 517 patients who underwent RFA using laparoscopy (a form of minimally invasive surgery in which slender, telescope-like instruments are inserted through small incisions) between 1996 and 2005. Of those patients, 53 had lesions related to sarcoma, breast cancer, esophageal cancer, lung cancer, melanoma, ovarian cancer, pancreatic cancer, cholangiocarcinoma, rectal squamous cell carcinoma, kidney cancer, and hemangioendothelioma.

All patients had evidence of exclusive liver disease and had failed chemotherapy. Each underwent RFA, with eight requiring repeat treatment. The average hospital stay for all the patients in the study was one day with no deaths within 30 days after the procedure, Siperstein's group found. Postoperative complications included one hemorrhage, one liver abscess, and one wound infection.

RFA Outcomes Were Positive
After two years of follow-up, the research team found about one-fifth of the tumors recurred. The overall, median length of survival was 33 months, with 51 months for those diagnosed with breast cancer and 25 months for patients with sarcoma.

The rates of recurrence and disease following RFA were similar to those seen in patients who underwent the procedure for other tumor types, explained study investigator Eren Berber, MD, chief surgical resident at the Cleveland Clinic Foundation. And that was the case in these patients who had presented with more non-conventional tumor types, Berber said.

"Laparoscopic RFA is able to safely and effectively treat hepatic metastasis in these unusual tumor types," the researchers wrote. ”We feel that this heterogeneous group of patients, selected for their unusual presentation of liver exclusive disease, may benefit from [reduction] of their tumor by laparoscopic RFA when other treatment methods have failed."

1. Berber E, Ari E, Herceg N, Siperstein A. Laparoscopic radiofrequency thermal ablation for unusual hepatic tumors: operative indications and outcome. The Society of American Gastrointestinal and Endoscopic Surgeons 2005 Annual Meeting. 2005 April 13-16. Fort Lauderdale, Florida.
2. American Liver Foundation. Liver Tumors. Available at:  http://www.liverfoundation.org/db/articles/1040.
3. National Institutes of Health (NIH). Radiofrequency Ablation Background. Available at: http://www.cc.nih.gov/drd/rfa/frame-background.html . Accessed July 20, 2005.
4. National Institutes of Health. Radiofrequency  Ablation. Frequently Asked Questions. Available at: http://www.cc.nih.gov/drd/rfa/frame-faq.html.
5. Society of Interventional Radiology. Treating Cancer with RFA. Available at: http://www.sirweb.org/patPub/rfa-cancer.shtml#2.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.