Radiofrequency Ablation (RF)
What is Radiofrequency Ablation?
Radiofrequency Ablation is a minimally invasive method of eliminating tumors without surgery. In the past, patients with cancer and other tumors had only two options to locally treat their disease: surgical removal or radiation therapy. Radiofrequency Ablation (RF Ablation) can destroy a tumor without surgery and without the side effects of radiation therapy or chemotherapy. A special probe is placed in the tumor. It is connected to a machine that sends a current into the probe causing the probe to emit radio waves. These waves heat up the tumor until it is destroyed. The principle is similar to heating food in a microwave oven, but because the wavelength of energy emitted is different than a microwave, the heat is deposited only next to the probe. This allows us to destroy the tumor or diseased tissue while preserving as much normal tissue as possible.
What types of tumors can be treated this way?
The most common type of tumor or cancer treated by RF Ablation is cancer of the liver. This may either be primary liver cancer (hepatocellular carcinoma) or metastatic cancer that has traveled to the liver. Other tumors treated with RF Ablation may be in the bones, kidneys, or other organs.
How is it determined if a patient is a candidate for this treatment?
The patient's oncologist best understands the patient's history and discusses the imaging studies with an interventional radiologist. Together they review the type, size, and location of tumors in order to determine whether or not the patient is a suitable candidate for RF ablation. If it is felt that this treatment could benefit the patient, a patient consultation is arranged with the interventional radiologist that will perform the procedure. During this evaluation the radiologist reviews the imaging studies and blood work and may recommend additional tests. An RF Ablation treatment will then be scheduled.
What happens during the procedure?
RF Ablation is an image directed procedure usually done under CT or ultrasound guidance. The patient is positioned supine and the tumor located with the CT or ultrasound machine. Sedation is administered by an anesthesiologist so that there is no discomfort and the patient is unconscious during the procedure. Using imaging, the radiologist places the needle shaped probe into the tumor where it is heated and destroyed. More than one area of tumor or cancer may be heated and destroyed at this time. Each heat treatment given takes about twelve minutes. The total procedure takes between one and three hours. After the radiologist feels as much treatment as indicated has been completed the patient is sent to the recovery room for observation.
What can be expected after the procedure?
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. If this is necessary, the radiologist and nurse will provide appropriate analgesics. Almost all patients are pain and symptom free within two weeks of the procedure.
What are the risks?
Any invasive procedure has risks. The probe must be placed precisely in the tumor. 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.
This procedure is performed by SDI radiologists at St. Joseph's Hospital.
References
Goldberg SN, Gazelle GS, Solbiati L, Livraghi T, Tanabe KK, Hahn PF, & Mueller PR. Ablation of Liver Tumors Using Percutaneous RF Therapy. American Journal of Radiology. 1998; 170:1023-1028.
Lencioni R, Cioni D, Goletti O, & Bartolozzi C. Radiofrequency Thermal Ablation of Liver Tumors: State-of-the-Art. Cancer Journal. 2000; 6 (supplement 4):S304-S315.
Siperstein AE, & Gitomirski A. History and Technological Aspects of Radiofrequency Thermoablation. Cancer Journal. 2000; 6 (supplement 4):5293-5303.
Iannitti DA, & Dupuy DE. Minimally Invasive Management of Hepatic Metastases. Seminars in Laparoscopic Surgery. 2000; 7(2):118-128.
Goldberg SN, Gazelle GS, & Mueller PR. Thermal Ablation Therapy for Focal Malignancy: A Unified Approach to Underlying Principles, Techniques, and Diagnostic Imaging Guidance. American Journal of Radiology. 2000; 174:323-331.
McGahan JP, & Dodd III GD. Radiofrequency Ablation of the Liver: Current Status. American Journal of Radiology. 2001; 176:3-16.
Elias D, de Baere T, Goharin A, Lasser P, & Roche A. Transpleurodiaphragmatic Radiofrequency ThermoAblation of a Liver Metastasis. Journal of the American College of Surgeons. 2000 Dec; 191(6):683-685.
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