Radiofrequency ablation RFA

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Radiofrequency ablation (RF ablation) is a minimally invasive treatment for cancer that is approved by the Food and Drug Administration. It is used to treat liver and kidney cancer and to manage pain resulting from small bone cancers. RF ablation is an alternative to surgery, when surgery is not likely to be successful or has failed or when other medical conditions increase the risk of surgery.

RFA Technique-Click to zoom

Thermal injury to cells begins at 42℃. Only 8 minutes at 46℃ is needed to kill malignant cells, and 51℃ can be lethal after only 2 minutes. At temperatures above 60℃, intracellular proteins are denatured (killed) rapidly, cell membranes are destroyed through dissolution and the melting of lipid bilayers, and lastly, cell death is inevitable.

Radiofrequency ablation (RFA) is a new technique for treating tumors localized to certain organs. A needle electrode is advanced into the targeted tumors via either a percutaneous, laparoscopic, or open (operation) route. The RF energy causes the tissue around the tip of the probe to heat up to a high temperature above which cells break apart and die. For eradication of all cancerous cells, the goal is to place the probes so that they destroy the entire tumor plus an adequate "rim" of non-cancerous tissue around it. 

Application

 
The following types of cancers that originate in the liver are most likely to be successfully treated with RF ablation:
  • Tumors 4 centimeters (cm) or smaller (larger tumors may require additional therapies), Three or fewer tumors per patient (if there are more than three, RF ablation can be performed but it is less successful).
  • The most common metastatic disease in the liver treated by RF ablation has been colon cancer. Results with RF ablation are good if the tumors are small and few in number. The ideal candidates for treatment have these conditions:
    - Tumors are less than 4 cm;
    - No more than three tumors;
    - No evidence of metastatic disease elsewhere.
  • Radiofrequency ablation may also help in patients who are undergoing surgery. For example, RF ablation can be combined with surgery to treat a patient who has several tumors in different locations. RF ablation also can be used to treat tumor recurrence; for instance, in patients who have had surgical resection of a metastatic tumor that recurs.
  • Lung Cancer that are limited in size (less than 3 cm in diameter) and few in number (one or two) can be treated with RF ablation, if they are separate from vital structures. RF ablation can help lung Cancer patients who are not candidates for traditional surgery, due to advanced disease in the lungs, poor cardiac function and/or poor pulmonary function.
  • The experience with kidney cancer ablation is very encouraging with approximately 95 percent of small tumors showing no evidence of recurrence on follow up imaging exams. Surgery is the treatment of choice for most kidney tumor patients; however, in the following situations, RF ablation might be considered:
    - Patients with one kidney;
    - Patients with other medical conditions which might prevent surgery;
    - Elderly patients in whom surgery or postsurgical recovery would be difficult;
    - Patients with tumors less than 4 cm in size.
 

Advantages

  • Effective treatment for small cancers
  • Minimally invasive procedure with no skin incision
  • Minimal risk to patient
  • Typically little or no pain after the procedure
  • Minimal hospital stay
  • Procedure can be repeated if new cancer appears

 
Indication

With intent to cure:
Liver: for primary or metastatic cancer
Kidney: for small cancers.
Lung: for cancers limited in size and few in number.
Others: uterine tumors, breast cancer, adrenal tumor, local lymphoma
With intent to control pain:
Bone: cancer that has spread to the bones can be treated to control severe pain.

Adverse Effects

 
Any invasive procedure has risks. Based on experience, however, complications from the minimally invasive RF ablation are uncommon, occurring in about 5 percent or less of patients.
  • When a tumor is destroyed local nerve endings may become irritated or some bleeding may occur. This can cause an aching, dull pain in and around the treated area. Many patients feel no pain and are symptom free after the procedure while others have discomfort requiring pain medication. Almost all patients are pain and symptom free within two weeks of the procedure.
  • The normal tissue nearby may be injured if heated. Organs that are commonly at risk of injury include adjacent bowel, gallbladder, bile ducts and diaphragm. If a significant local injury occurs, surgery may be needed for correction. However, this only happens about three (3%) to five (5%) percent of the time. The risk is very dependent on the location of the tumor and the structures that surround it.

 
Summary

it is important to point out that:

1) Radiofrequency ablation remains experimental;
2) Radiofrequency ablation is not a substitute for resection (surgical removal) whenever possible, as removal of the tumor is considered the "gold standard" for treatment in appropriate patients;
3) The chances of successful (complete) tumor destruction is about 75% ,less for tumors larger than 3 cm and more for tumors smaller than 3 cm;
4) It is exceedingly rare that patients with liver metastases from cancer of the pancreas, lungs, stomach, or esophagus are candidates for radiofrequency ablation, unless they have no more than two tumors measuring no more than 4.0 cm in size, otherwise cryosurgery may be choice.

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