Radiofrequency Ablation for Liver Abscesses From Chronic Granulomatous Disease

Study Description

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Brief Summary:

Background:

- Abscesses are a pocket of infection in an organ or tissue. Patients with a disease called chronic granulomatous disease (CGD) often develop these abscesses. CGD is an inherited disorder that affects how white blood cells function. Liver abscesses in people with CGD often require surgery to remove them and treat the infection. However, some people with CGD cannot have full surgery because it would be too risky. Researchers want to try a procedure called radiofrequency ablation (RFA) to treat these liver abscesses. RFA can usually be done without a major operation. This study will see if RFA is a safe and effective treatment for liver abscesses in patients with CGD.

Objectives:

- To see if RFA is a safe and effective treatment for CGD-related liver abscesses.

Eligibility:

- Individuals between 18 and 75 years of age with CGD who have liver abscesses that cannot be treated with surgery.

Design:

• Participants will be screened with a physical exam and medical history. Blood and urine samples will be collected. Imaging studies will be performed on the liver.
• Participants will have RFA for the abscesses. RFA is an image-guided technique that heats and destroys specific tissue, such as tumor tissue. It will target any abscesses on the liver.
• After the procedure, participants will stay in the hospital for monitoring before being released.
• Participants will have regular follow-up visits for up to 1 year after treatment. Blood and urine samples will be collected. Additional imaging studies will be performed.

Condition or disease	Intervention/treatment	Phase
Chronic Granulomatous Disease (CGD)	Device: Cool-tip RF Ablation System	Phase 1

Detailed Description:

Radiofrequency Ablation (RFA) has become an increasingly common therapeutic treatment for neoplasms in the liver. A number of devices are now Food and Drug Administration cleared for this indication, and a growing body of literature supports this technique as a therapeutic option for patients with primary or metastatic hepatic malignancies. In vivo animal studies have also shown that this technique can also be used to treat infections. Insertion of the thermal energy delivery probe into an infected liver abscess destroys the bacteria while preserving surrounding tissue. Off-label use of RFA was successfully used to treat 22 abscesses in 4 patients with chronic granulomatous disease who had inoperable liver abscesses. The proposed clinical trial will specifically evaluate the feasibility, safety, and to a lesser extent, efficacy of RFA to treat liver abscesses in subjects with previously diagnosed chronic granulomatous disease. This will be a non-randomized case study conducted at the Clinical Center at the National Institutes of Health. One RFA device will be used. Ten subjects will be enrolled. If the method proves to be both feasible and safe, detailed analysis on efficacy will be performed. RFA eventually could play an important clinical role in patients with chronic granulomatous disease and liver abscesses that are not amenable to surgical management and are without other effective therapeutic options, or might otherwise be incompletely treated with surgical resection and debridement alone.

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	30 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Radiofrequency Ablation (RFA) for the Treatment of Liver Abscesses in Patients With Chronic Granulomatous Disease
Study Start Date :	May 8, 2013
Estimated Primary Completion Date :	January 1, 2020
Estimated Study Completion Date :	January 1, 2021

Arms and Interventions

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Arm	Intervention/treatment
Experimental: RFA; All subjects enrolled onto this study will receive treatment of their liver abscess (es) by RFA ablation	Device: Cool-tip RF Ablation System; RFA therapy will be administered according to the instructions of the RFA device manufacturer.

Outcome Measures

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Primary Outcome Measures :

1. The primary objective of this study is to determine the safety ofradiofrequency ablation (RFA) in the treatment of liver abscesses insubjects with chronic granulomatous disease (CGD). [ Time Frame: Throughout ]

Secondary Outcome Measures :

1. To determine if RFA is a reasonable treatment option for patients with liver abscesses who are not suitable candidates for completely curative hepatic surgery [ Time Frame: Throughout ]
2. To compare the recovery outcomes of patients undergoing RFA versus historical controls for patients undergoing surgery for treatment of liver abscesses [ Time Frame: Throughout ]

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 75 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

• INCLUSION/ELIGIBILITY CRITERIA:

A patient will be included if he or she meets all of the following criteria:

1. Has documented chronic granulomatous disease
2. Age 18 - 75
3. Has a liver abscess infected with Staphylococcus aureus, but is not an optimal candidate for curative surgical resection either due to location of disease, multiplicity of disease, or previous surgery or other comorbidities, such as pulmonary insufficiency, or has other contraindications to general anesthesia or perioperative management or refuses surgery.
4. Is willing to return to NIH for imaging scans
5. Is willing to undergo testing or procedures associated with this protocol
6. Has failed long term antibiotic treatment and abscess drainage if applicable.

EXCLUSION CRITERIA:

A patient will be excluded if he or she satisfies 1 or more of the following criteria:

1. Positive results for toxin-producing bacteria obtained from liver biopsy in the pertinent abscess.
2. Is a good candidate for liver-curative open surgical resection and does not refuse the surgery
3. Is not a candidate for RFA therapy due to lesion size, location, and/or infection with a non staphylococcal bacteria.
4. Has a prothrombin time (PT) or partial thromboplastin time (PTT) >1.5 times normal (except in patients who have a known lupus anticoagulant or other condition which a hematologist deems will not cause excessive bleeding despite the abnormal coagulation parameters).
5. Has a platelet count <50,000/mm(3) which cannot be maintained despite platelet transfusions.
6. If you are pregnant.
7. Any condition that, in the investigator s opinion, places the patient at undue risk by participating in the study

Please Note: Co-morbidities in critically ill patients will not themselves constitute exclusion criteria because the cause of their illness/condition may require the use of RFA as a less invasive treatment than surgery.

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Contacts

Contact: Patricia L Littel, R.N.	(301) 402-5964	plittel@cc.nih.gov
Contact: Elizabeth M Kang, M.D.	(301) 402-7567	ekang@niaid.nih.gov

Locations

United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike	Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR) 800-411-1222 ext TTY8664111010 prpl@cc.nih.gov

Sponsors and Collaborators

National Institute of Allergy and Infectious Diseases (NIAID)

Investigators

Principal Investigator:	Elizabeth M Kang, M.D.	National Institute of Allergy and Infectious Diseases (NIAID)

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Additional Information:

NIH Clinical Center Detailed Web Page 

Publications:

Livraghi T. Radiofrequency ablation, PEIT, and TACE for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2003;10(1):67-76. Review.

Lublin M, Bartlett DL, Danforth DN, Kauffman H, Gallin JI, Malech HL, Shawker T, Choyke P, Kleiner DE, Schwartzentruber DJ, Chang R, DeCarlo ES, Holland SM. Hepatic abscess in patients with chronic granulomatous disease. Ann Surg. 2002 Mar;235(3):383-91.

Responsible Party:	National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:	NCT01851460 History of Changes
Other Study ID Numbers:	130117; 13-I-0117
First Posted:	May 10, 2013
Last Update Posted:	March 29, 2018
Last Verified:	November 22, 2017

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) ):

Staphylococcus Infection; RFA; Hepatic; CGD

Additional relevant MeSH terms:

Granulomatous Disease, Chronic; Granuloma; Liver Abscess; Lymphoproliferative Disorders; Lymphatic Diseases; Pathologic Processes; Phagocyte Bactericidal Dysfunction; Leukocyte Disorders; Hematologic Diseases; Genetic Diseases, X-Linked	Genetic Diseases, Inborn; Immunologic Deficiency Syndromes; Immune System Diseases; Abdominal Abscess; Abscess; Suppuration; Infection; Liver Diseases; Digestive System Diseases