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LETTER TO EDITOR
Year : 2008  |  Volume : 4  |  Issue : 3  |  Page : 144

Radiofrequency ablation should not be considered as an alternative to surgical resection


Division of Solid Organ Transplant and Hepatobiliary Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY, 14642, USA

Date of Web Publication27-Sep-2008

Correspondence Address:
Rajeev Sharma
60 Crittenden Blvd. Apt 138, Rochester, NY 14620
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.43152

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How to cite this article:
Sharma R. Radiofrequency ablation should not be considered as an alternative to surgical resection. J Can Res Ther 2008;4:144

How to cite this URL:
Sharma R. Radiofrequency ablation should not be considered as an alternative to surgical resection. J Can Res Ther [serial online] 2008 [cited 2020 Oct 25];4:144. Available from: https://www.cancerjournal.net/text.asp?2008/4/3/144/43152

Sir,

I read with great interest the article by Rath et al . [1] They report good results in 40 patients with liver metastasis at 2-year follow-up. However, several questions remain unanswered. Surgical resection of primary and metastatic hepatic tumors remains the gold standard of therapy. The small tumor size (median tumor size = 1.5 cm) reported in the study, and the fact that 34 (85%) patients had a solitary liver lesion raises the question: why were these patients not offered surgery? I am sure the authors had a valid reason to consider radiofrequency ablation (RFA) as the therapeutic modality, but nowhere in their report do they mention the reason why surgery was not offered. One would also be curious to know the site and status of primary disease in all 40 patients, also not reported, since it is of paramount importance in selection of the treatment modality.

RFA should not be considered as an alternative to surgical resection, which has a well-documented record of safety and clinical efficacy. [2] The absolute contraindications to resection of disease metastatic to the liver are inability to resect the tumor completely, the presence of metastatic disease involving hepatic or celiac nodes, or unresectable extrahepatic disease. The relative contraindications to resection are finding multiple nodules (more than 4) or a tumor size that would require an extended resection. [3] Although there is clarity regarding absolute unresectability, there is variation among individual liver surgeons regarding borderline cases, as illustrated in the study by Alberts et al . [4] Although the results reported by the authors are comparable to the landmark study by Curley et al. , [5] more information about the site and status of primary malignancy, and the reason for not offering surgery as the primary modality for management of these liver secondaries would have added a greater value to an otherwise well conceived and written article.

 
 > References Top

1.Rath GK, Julka PK, Thulkar S, Sharma DN, Bahl Amit, Bhatnagar S. Radiofrequency ablation of hepatic metastasis: Results of treatment in forty patients. J Cancer Res Ther 2008;4:14-7.  Back to cited text no. 1
    
2.Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: Analysis of 1001 consecutive cases. Ann Surg 1999;230:309-21.  Back to cited text no. 2
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3.Wanebo HJ, Chu QD, Vezeridis MP, Soderberg C. Patient selection for hepatic resection of colorectal metastases. Arch Surg 1996;131:322-9.  Back to cited text no. 3
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4.Alberts SR, Horvath WL, Sternfeld WC, Goldberg RM, Mahoney MR, Dakhil SR, et al. Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: A North Central Cancer Treatment Group phase II study. J Clin Oncol 2005;23:9243-9.  Back to cited text no. 4
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5.Curley SA. Radiofrequency ablation of malignant liver tumors. Oncologist 2001;6:14-23.  Back to cited text no. 5
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This article has been cited by
1 Radiofrequency ablation in liver metastasis: Authorsę reply
Rath, GK and Julka, PK and Thulkar, S. and Sharma, DN and Bahl Amit, B.S.
Journal of Cancer Research and Therapeutics. 2008; 4(3): 145-145
[Pubmed]
2 Radiofrequency ablation should not be considered as an alternative to surgical resection.
Sharma, R.
Journal of cancer research and therapeutics. ; 4(3): 144
[Pubmed]



 

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