Percutaneous radiofrequency tissue ablation for the treatment of post-transplant lymphoproliferative disorders (PTLD): case report

Background. PTLD is an EB V-driven disorder characterised by a severe prognosis and a mortality rate of 50-80%. Standard treatment of this condition is yet to be defined: reduction of immunosuppression, antiviral, Interferon-alpha, antibody therapy have been used with varying results. Chemotherapy is considered by some Authors as a last resort due to its high toxicity; surgery and radiotherapy have a role in the treatment of suitable isolated lesions. Among liver transplanted pts, PTLD frequency is 1-6% and chemotherapy administration is known to increase the risk of hepatitis virus reactivation, often making treatment of these patients problematic. We describe the case of a liver allograft recipient successfully treated with percutaneous radiofrequency tissue ablation. This technique involves placement of an electrode which conveys the energy developed by a radiofrequency generator directly into the tumour. Cell death is induced via thermally mediated coagulation necrosis. Case reportithis 35 y-o male patient underwent liver transplant for HB V chronic hepatitis-related hepatocarcinoma in May 1999. Eight months later he developed jaundice; total body CT scan showed enlarged mediastinal and hepatic hylum nodes and presence of an isolated liver parenchymal lesion, 6 cm in diameter, located to the fourth liver segment. Liver biopsy was diagnostic for EBV-positive B cell pleomorphic high grade non Hodgkin lymphoma. EBV DNA testing was 200 genome copies/WPBL. Immunosuppression was reduced followed by combined treatment with acyclovir+chemotherapy (VACOP-B: etoposide, adriamycine, cyclophosphamide, vincristine, bleomycine, prednisone). Chemotherapy had to be discontinued after 8 weeks because of HBV reactivation and progressive deterioration of liver function. At that time, EBV genome copies were 10/105 PEL and CT scan showed persistence of the parenchyma liver lesion only (3 cm in diameter). Due to its peculiar location, the lesion could not be managed with either surgery or radiotherapy. Therefore the patient underwent, under CT guidance, a single treatment session of percutaneous radiofrequency tissue ablation using Le Veen needle electrode with a 3,5 cm diameter array. Treatment was well tolerated. Alpha-interferon, 3 MU/ 3 times weekly, was subsequently started. At three months follow-up, the patient is alive with no evidence of PTLD recurrence, normal liver function, EBV genome copies <10/10'PBL. Conclusion. Percutaneous radiofrequency is safe and could be effectively employed for the treatment of suitable PTLD localisations.