Hepato-pericardial fistula following radiofrequency ablation (RFA) for liver metastasis: a case report and review of the literature.

INTRODUCTION: Recent large-scale studies have demonstrated the efficiency and safety of radiofrequency ablation (RFA) for unresectable hepatic tumors. Nevertheless, severe side effects especially relating to non-target thermal injury have occurred after radiofrequency ablation. CASE REPORT: We observed the development of a hepato-pericardial fistula leading to pericardial empyema after RFA of a metastatic hepatic lesion. Concerning the genesis of the fistula, development from thermal damages in the diaphragm and pericardium as well as abscess formation in the liver is assumed. Treatment consisted of percutaneous drainage and flushing via remaining hepatic and pericardial catheters. Recovery was achieved conservatively after 2 months. To the best of our knowledge, a hepato-pericardial fistula as a complication of RFA has not been reported so far. The review of the literature revealed several cases of intrahepatic abscess formation after RFA as well as one case of pericardial empyema due to perforation of hepatic amoebic abscess. Two cases of pericardial tamponade after RFA are reported in the literature leading to death. Treatment via percutaneous drainage has been successful in this case and correlates with the successful treatment of abscess formation after RFA of metastatic pancreatic cancer. Other authors suggest pericardectomy or thoracotomy in the treatment of pericardial empyema. CONCLUSION: The management of hepatic abscess formation subsequent to RFA of metastatic hepatic malignancies is not well described. We regard the percutaneous drainage as treatment of pericardial empyema as well as hepatic abscess as less invasive and sufficient, as demonstrated in this case.

Tumour-dendritic hybrid cell vaccination for the treatment of patients with malignant melanoma: immunological effects and clinical results.

Hybrid cell vaccines of autologous tumour cells fused with allogenic dendritic cells (DC) combine the tumour's antigenicity with the immune-stimulatory capacity of mature dendritic cells and allogenic MHC class II molecules to activate T cell help and induce tumour-specific cytotoxic T cells. This concept was tested in a clinical trial with melanoma stage III and IV patients. Seventeen patients were evaluated: one experienced complete, one partial response and six stable disease with long survival times. Eleven of fourteen patients, clinical responders and non-responders alike, mounted high-frequency T cell responses to various tumour-associated antigens. Failing clinical responses correlated with loss of antigenicity.

Vaccination with hybrids of tumor and dendritic cells induces tumor-specific T-cell and clinical responses in melanoma stage III and IV patients.

Hybrid cell vaccination was developed as therapeutic approach that aims at stimulating tumor-specific cytotoxic T-cell responses in cancer patients using hybrids of autologous tumor and allogeneic dendritic cells. We tested this concept and the efficacy of the vaccines in inducing clinical and immunologic responses in a clinical trial with melanoma stage III and IV patients. Of the 17 patients evaluated, 1 experienced a complete response, 1 a partial response and 6 stable disease with remarkably long survival times. In 11 of 14 patients analyzed, high-frequency T-cell responses to various tumor-associated T-cell epitope were induced and detectable in the peripheral blood. These immune responses were detected in clinical response patients as well as nonresponders. Failures of clinical responses in all the cases investigated correlated with loss of antigen expression and presentation. Hybrid cell vaccination thus proves effective in inducing tumor-specific T-cell responses in cancer patients.