Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases

Authors

  • Bradford J. Wood M.D.,

    Corresponding author
    1. Special Procedures, Department of Diagnostic Radiology, Clinical Center, National Institutes of Health Clinical Center, Bethesda, Maryland
    2. National Cancer Institute, Surgery Branch, National Institutes of Health Clinical Center, Bethesda, Maryland
    • Special Procedures, Department of Diagnostic Radiology, Clinical Center, National Institutes of Health, Building 10, Room 1C-660, Bethesda, MD 20892
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    • Fax: (301) 496-9933

  • Jame Abraham M.D.,

    1. National Cancer Institute, Medicine Branch, National Institutes of Health Clinical Center, Bethesda, Maryland
    2. Section of Hematology Oncology, Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia
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  • Julia L. Hvizda R.N.,

    1. Special Procedures, Department of Diagnostic Radiology, Clinical Center, National Institutes of Health Clinical Center, Bethesda, Maryland
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  • H. Richard Alexander M.D.,

    1. National Cancer Institute, Surgery Branch, National Institutes of Health Clinical Center, Bethesda, Maryland
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  • Tito Fojo M.D.

    1. National Cancer Institute, Medicine Branch, National Institutes of Health Clinical Center, Bethesda, Maryland
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  • This article is a US Government work and, as such, is in the public domain in the United States of America.

Abstract

BACKGROUND

The current study was performed to analyze the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of primary and metastatic adrenal neoplasms including adrenocortical carcinoma.

METHODS

The procedure was performed using 36 treatment spheres on 15 adrenocortical carcinoma primary or metastatic tumors in eight patients over 27 months. Tumors ranged from 15 to 90 mm in greatest dimension with a mean of 43 mm. All patients had unresectable tumors or were poor candidates for surgery. Mean follow-up was 10.3 months.

RESULTS

All patients were discharged or were free of procedure-related medical care 6–48 hours after the procedures without major complications. All treatments resulted in presumptive coagulation necrosis by imaging criteria, which manifested as loss of previous contrast enhancement in ablated tissue. Eight of 15 (53%) posttreatment thermal lesions lost enhancement and stopped growing on latest follow-up computed tomographic scan. Three of 15 (20%) demonstrated interval growth and four did not change in size. Of these four lesions, two showed contrast enhancement. For smaller tumors with a mean greatest dimension less than or equal to 5 cm, 8 of 12 (67%) tumors were completely ablated, as defined by decreasing size and complete loss of contrast enhancement. Three of 15 (20 %) tumors and related thermal lesions were found to have disappeared nearly completely on imaging.

CONCLUSIONS

Percutaneous, image-guided RFA is a safe and well tolerated procedure for the treatment of unresectable primary or metastatic adrenocortical carcinoma. The procedure is effective for the short-term local control of small adrenal tumors, and is most effective for tumors less than 5 cm. The survival rate for patients with adrenocortical carcinoma improves when radical excision is performed in selected patients. Aggressive local disease control may potentially influence survival as well. However, further study is required to evaluate survival impact, document long-term efficacy, and to determine if RFA can obviate repeated surgical intervention in specific clinical scenarios. Cancer 2003;97:554–60. Published 2003 by the American Cancer Society.

DOI 10.1002/cncr.11084

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