Radiofrequency Thermal Ablation of Hepatic Metastases of Adrenocortical Cancer - A Case Report and Review of the Literature

Aim: Radiofrequency thermal ablation (RFA) has shown promise as a technique for treating solid tumors. This method has been suggested as an alternative to surgery in patients with adrenocortical carcinoma (ACC). Materials and Methods: We reviewed the literature, and report the case of a patient with stage 4 ACC who received intraoperative and percutaneous RFA of two liver metastasis according to a standard ablation protocol. Results: Post-interventional imaging in our patient demonstrated that after both interventions, a stellar-like structure of vital tumor tissue had remained within the coagulation necrosis. This was the starting point of a fast and progressive tumor recurrence. We suspect heat-sink effects of blood vessels in the highly vascularized metastasis to cause the tumor recurrence. In literature, there are only a few reports of RFA in ACC patients. In addition, there is no large randomized trial investigating the efficacy of RFA against surgery in those patients. Conclusions: Presently, RFA in ACC should be restricted to patients in whom surgery is contraindicated. It is necessary that strongly vascularized ACC metastases deserve a modified ablation protocol due to perfusion related cooling effects and to increase the efficacy of RFA.