Radiofrequency Ablation of Hepatic Tumors: Increased Tumor Destruction with Adjuvant Liposomal Doxorubicin Therapy

• Published in: American journal of roentgenology (1976) Vol. 179; no. 1; pp. 93 - 101
• Main Authors: Goldberg, S. Nahum, Kamel, Ihab R, Kruskal, Jonathan B, Reynolds, Kevin, Monsky, Wayne L, Stuart, Keith E, Ahmed, Muneeb, Raptopoulos, Vassilos
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01-07-2002; American Roentgen Ray Society
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - surgery; Catheter Ablation; Chemotherapy, Adjuvant; Combined treatment; Doxorubicin - administration & dosage; Doxorubicin - therapeutic use; Female; Humans; Liposomes; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Liver Neoplasms - surgery; Male; Medical sciences; Middle Aged; Neuroendocrine Tumors - diagnostic imaging; Neuroendocrine Tumors - drug therapy; Neuroendocrine Tumors - surgery; Pilot Projects; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Treatment. General aspects; Tumors; Antineoplastic agent; Human; DNA topoisomerase (ATP-hydrolysing); Enzyme; Liver; Enzyme inhibitor; Liposome; Hepatic disease; Malignant tumor; Doxorubicin; Chemotherapy; Isomerases; Radiofrequency irradiation; Digestive diseases; Anthracyclins; Combined treatment
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.179.1.1790093

The purpose of this study was to determine whether the administration of liposomal doxorubicin before radiofrequency ablation increases coagulation more than radiofrequency alone in focal hepatic tumors.
Fourteen focal hepatic tumors (diameter: mean +/- SD, 4.0+/-1.8 cm) in 10 patients (colorectal cancer, n = 3 patients; hepatocellular carcinoma, n = 4; neuroendocrine tumor, n = 2; breast cancer, n = 1) were treated with internally cooled radiofrequency ablation. In addition to undergoing radiofrequency, five patients (n = 7 lesions) were randomly assigned to receive 20 mg of IV doxorubicin in a long-circulating stealth liposome carrier (Doxil) 24 hr before ablation. Contrast-enhanced helical CT was performed immediately (within 30 min) after radiofrequency ablation (baseline) and 2-4 weeks after ablation. The volume of induced coagulation was measured by three-dimensional reconstruction techniques, and the measurements were compared.
For tumors treated with radiofrequency alone, the volume of the thermal lesion had decreased 12-24% (mean +/- SD, 82.5% +/- 4.4% of initial volume) at 2-4 weeks after ablation. By comparison, increased tumor destruction at 2-4 weeks after ablation was observed for all lesions treated with combined Doxil and radiofrequency (p<0.001). Six lesions increased 24-36% in volume, and coagulation surrounding a small colorectal metastasis increased 342%. No coagulation was identified in four unablated control lesions in the two patients receiving Doxil alone.
Our pilot clinical study suggests that adjuvant Doxil chemotherapy increases tumor destruction compared with radiofrequency ablation therapy alone in a variety of focal hepatic tumors. Optimization of this synergistic strategy may ultimately allow improved clinical efficacy and outcome.