The use of radiofrequency in cancer

Radiofrequency ablation (RFA) provides an effective technique for minimally invasive tissue destruction. An alternating current delivered via a needle electrode causes localised ionic agitation and frictional heating of the tissue around the needle. Image-guided, percutaneous ablation techniques have been developed in most parts of the body, but the most widely accepted applications are for the treatment of hepatocellular carcinoma (HCC) in early cirrhosis, limited but inoperable colorectal liver metastases, inoperable renal cell carcinoma and inoperable primary or secondary lung tumours. The procedures are well tolerated and the complication rates low. Patients with coexistent morbidity who are not suitable for surgery are often able to undergo RFA. Most treatments in the lung, kidney and for HCC are performed under conscious sedation with an overnight hospital stay or as a day-case. Larger more complicated ablations, for example, in hepatic metastases may require general anaesthesia. Limitations of RFA include the volume of tissue that can be ablated in a timely fashion, that is, most centres will treat 3-5 tumours up to 4-5 cms in diameter. Early series reporting technical success and complications are available for lung and renal ablation. Liver ablation is better established and 5-year survival figures are available from several centres. In patients with limited but inoperable colorectal metastases, the 5-year survival ranges from 26 to 30% and for HCC it is just under 50%. In summary, RFA provides the opportunity for localised tissue destruction of limited volumes of tumour; it can be offered to nonsurgical candidates and used in conjunction with systemic therapy.     

Optimal combination of radiofrequency ablation with chemoradiotherapy for locally advanced pancreatic cancer

Problems have been reported in the treatment of pancreatic cancer with radiofrequency ablation (RFA), such as the friability of the organ itself. This report presents possible solutions to such problems. Although our patient suffered from locally advanced unresectable pancreatic cancer, she remained well at 18 mo after RFA with no evidence of recurrence. To ameliorate the side effects of RFA, after a palliative bypass procedure, the subject was treated with combined radiotherapy and chemotherapy. After this regimen had been administered, a contrast-enhanced computed tomography scan confirmed that RFA is a viable approach to the treatment of pancreatic cancer as the chemoradiotherapy had resulted in marked tumor shrinkage and pancreatic fibrosis; i.e., sufficient tumor ablation was achieved without serious RFA-related complications, such as pancreatitis or pancreatic fistulae. The present case suggests that RFA combined with preceding chemoradiotherapy is safe and effective for the palliative treatment of locally advanced pancreatic cancer.     

High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer

BACKGROUND AND OBJECTIVES: To report and discuss the effect, complications and mortality of cool-tip radiofrequency ablation (RFA) for unresectable pancreatic cancer. METHODS: During October 2003 to July 2004, sixteen patients with unresectable pancreatic cancer were treated by open cool-tip RFA. One-half of the 16 patients had tumors located in the pancreatic head. A 5-mm minimum safe distance between RFA site and major peripancreatic vessels was kept to avoid injury to the vessels. RESULTS: Six of twelve patients with back pain got pain relief postoperatively. Pancreatic fistula occurred in three patients (18.8%) and healed smoothly in 7-10 days with routine abdominal drainage. The mortality was 25% (4/16). In the four death cases, tumors were all located in the pancreatic head; three patients with tumor close to portal vein died suddenly of massive gastrointestinal hemorrhage on the 4th, 30th, 40th postoperative day respectively and a 79-year-old patient died of acute renal failure on the 2nd postoperative day. CONCLUSIONS: Standard use of cool-tip RFA was dangerous for pancreatic head cancer close to portal vein, in which a 5-mm minimum safe distance between RFA site and major peripancreatic vessels might not be enough to avoid injury to the vessels.     

CT-guided radiofrequency ablation for lung cancer

Recently, percutaneous radiofrequency (RF) ablation has been increasingly performed as a local treatment for lung malignancies. In RF ablation, the application of radiofrequency agitates ions in the tissues surrounding the electrode, causing them to fluctuate at high speed, and this generates frictional heat. The generated heat coagulates the tissues. Puncture is carried out under computed tomography (CT) guidance in the same manner as that for needle biopsy. In animal studies, it was speculated that air functioned as an insulator and that the heat did not damage normal surrounding lung parenchyma to any great extent, because lung is filled with air. An experimental VX2 tumor in rabbits was well controlled by RF ablation. Since the clinical use of RF ablation for lung malignancies was first reported in 2000, many series have been published. The patients reported in these studies were not candidates for surgical treatment, either because of poor cardiopulmonary function and comorbidities, or because they refused surgery. With RF ablation, complete necrosis can be expected for tumors with a diameter of 3 cm or less. Palliative RF ablation may be indicated for large tumors. The most frequent complication associated with puncture was pneumothorax, with a frequency higher for RF ablation compared with that for needle biopsy. The initial results have been promising, but we await future reports for long-term results.     

冷循环射频消融术治疗肺癌的临床研究

目的:探讨冷循环射频消融术治疗肺癌的临床疗效.方法:收集原发及转移性肺部恶性肿瘤患者46例,病灶总数51个,直径< 3 cm的病灶31个,直径> 3 cm的病灶20个,经冷循环射频消融术治疗后1～6个月采用螺旋CT增强扫描评价治疗效果.结果:所有病灶经消融治疗后完全去血管化的29个(56.9%),大部分去血管化的22个(43.1%).3例患者获得完全缓解,27例患者获得部分缓解,有效率为65.2%.所有病例均顺利完成治疗,无严重并发症发生.结论:冷循环射频消融术治疗肺癌疗效确切,创伤小,并发症少,安全性高,是治疗肺癌的有效方法之一.     

Variation of tumoral marker after radiofrequency ablation of pancreatic adenocarcinoma

Background

To evaluate the correlation between variations of CA 19.9 blood levels and the entity of necrosis at CT after radiofrequency ablation (RFA) of unresectable pancreatic adenocarcinoma.

Methods

In this study, from June 2010 to February 2014, patients with diagnosis of unresectable and not metastatic pancreatic ductal adenocarcinoma, expressing tumor marker CA 19.9, treated with RFA procedure were included. All these patients underwent RFA. CT study was performed 1 week after RFA. The dosage of CA 19.9 levels was performed 1 month after RFA. Features of necrosis at CT, as mean entity, density and necrosis percentages compared to the original lesion, were evaluated and compared by using t-test with CA 19.9 blood levels variations after RFA procedure.

Results

In this study were included 51 patients with diagnosis of unresectable and not metastatic pancreatic ductal adenocarcinoma, expressing tumor marker CA 19.9, treated with RFA procedure and with CT study and CA 19.9 available for analysis. After the procedure, CA 19.9 blood levels reduced in 24/51 (47%), remained stable in 10/51 (20%) and increased in 17/51 (33%). In patients with CA 19.9 levels reduced, the tumor marker were reduced less than 20% in 4/24 (17%) and more than 20% in 20/24 (83%); instead the tumor marker were reduced less than 30% in 8/24 (33%) and more than 30% in 16/24 (67%). At CT scan necrotic area density difference was not statistically significant. Also there was no statistically significant difference among the mean area, the mean volume and the mean ablation volume in percentage related to the treated tumor among the three different groups of patients divided depending on the CA 19.9 blood levels. But a tendency to a statistically significant difference was found in comparing the mean percentage of ablation volume between two subgroups of patients with a decrease of CA 19.9 levels with less or more than 20% reduction of tumor markers and between two subgroups with less or more than 30% reduction of CA 19.9 levels.

Conclusions

RFA of unresectable pancreatic adenocarcinoma induces reduction of CA 19.9 blood levels in about half of the cases.     

Histologic evaluation of radiofrequency ablation in renal cancer.

AIM: To report on the histologic evaluation of renal tumors after intraoperative radiofrequency ablation (RFA) performed immediately before surgical nephrectomy. MATERIALS AND METHODS: Ten patients with renal tumors were studied. All tumors were confirmed to be renal cell carcinoma before radio frequency ablation treatment. All specimens were stained with hematoxylin and eosin and nicotinamide adenine dinucleotide (NADH). RESULTS: Mean tumor size was 29 mm (range 14 to 48 mm). Of the 10 tumors 5 were completely devitalized with a treatment margin ranged from 1 to 20mm. One tumor needed two treatment sessions. No complication related to radiofrequency treatment was recorded. CONCLUSIONS: Our data indicate that RFA can completely destroy renal tumors. However, in our study, complete tumor cell death was obtained only in 50% of cases. More studies are needed to ensure that is technique is an effective and reproducible treatment.     

Successful rectal cancer local recurrence radiofrequency ablation

Local rectal cancer recurrences represent a great challenge, as surgical re-excisions or re-irradiation procedures are not always feasible. Moreover, scar or local recurrence is hard to elucidate with conventional diagnosis techniques. Emerging diagnostic and therapeutic procedures may be useful in this setting. A local rectal cancer recurrence radiofrequency ablation is reported. PET scan confirmed the recurrence, defined the target volume and assessed the success of the local therapy.     

Feasibility of radiofrequency ablation for primary breast cancer

As the management of breast cancer evolves towards less invasive treatment, the next step is the possibility of removing the primary tumor without surgery. The most promising of the noninvasive ablation techniques is radiofrequency ablation, which uses frictional heating caused when ions in the tissue attempt to follow changing directions of a high frequency alternating current. The radiofrequency probe is typically placed into the tumor under ultrasound guidance, and the ablation is performed with real time ultrasound monitoring. Preliminary studies in which RFA was followed by standard surgical resection have indicated that this technique is effective for the surgical ablation of small (相似文献   

CT引导下射频消融术在肝脏恶性肿瘤患者治疗中的应用

目的探讨CT引导下射频消融术(RFA)在肝脏恶性肿瘤治疗中的临床应用。方法选取2011年3月到2016年3月间江苏省泰州市第二人民医院收治的80例肝脏恶性肿瘤患者,采用随机数表法分为试验组和对照组,每组40例。给予试验组患者CT引导下的射频消融治疗,给予对照组患者常规肝动脉灌注化疗栓塞术(TACE)治疗。观察两组患者治疗后6个月、1年和2年内的存活率,比较不同时间点两组患者的肿瘤体积,检测治疗前和治疗后3个月两组患者血清肿瘤标志物(甲胎蛋白和癌胚抗原)的水平。结果治疗后6个月两组患者的存活率比较,差异无统计学意义(P>0.05),治疗1年和2年后试验组的存活率明显高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后的肿瘤体积都缩小,且与治疗前比较差异有统计学意义(P<0.05),但是治疗6个月和治疗12个月以后,试验组患者的肿瘤体积较对照组患者更小,差异有统计学意义(P<0.05);治疗后两组患者甲胎蛋白和癌胚抗原水平均显著降低,差异有统计学意义(P<0.05),且试验组患者均显著低于对照组患者,差异有统计学意义(P<0.05)。结论 CT引导下的RFA治疗肝脏恶性肿瘤,可以有效提高治疗的远期疗效,值得临床推广。     

Outcomes of radiofrequency ablation for kidney cancer.

BACKGROUND: The incidence of small (< 4 cm) solid enhancing renal masses has been rising, and the majority (60% to 80%) of these tumors are renal cell carcinomas (RCCs) when pathologic analysis is performed. Needle ablation for small incidental renal masses is an attractive therapeutic option. Reasons include its decreased morbidity, shorter convalescence, and the ability to avert the higher risk of extirpative surgery in an aging patient population. Radiofrequency ablation (RFA) is a thoroughly studied needle ablative method used for RCC. METHODS: The current published literature on renal tumor RFA was reviewed. The in vitro experiments, animal studies and clinical experience with RFA for treatment of small RCCs were analyzed and various controversies in renal RFA are presented for discussion. RESULTS: Percutaneous and laparoscopic renal RFA can be safely performed and can eradicate small RCCs with cancer specific survival rates over 90% to 95% in many series. While long-term (5 years or greater) cancer control data are not yet available, these intermediate-term results are similar to those achieved with traditional nephron-sparing surgical options. However, the optimal method to perform RFA for renal masses is still evolving. CONCLUSIONS: While long-term cancer control data are not yet available, the current literature suggests that RFA can effectively eradicate small RCCs. Further research is needed to elucidate the influence of various treatment variables, including impedance vs temperature-controlled RFA, sonographic vs computed tomographic guidance, general anesthetic vs conscious sedation, and radiologist vs urologist delivery of renal RFA.     

Safety of radiofrequency ablation in patients with locally advanced,unresectable pancreatic cancer: A phase II study

IntroductionRadiofrequency ablation (RFA) has been proposed as a new treatment option for locally advanced, unresectable pancreatic cancer (LAPC). In preparation of a randomized controlled trial (RCT), the aim of this phase II study was to assess the safety of RFA for patients with LAPC.Materials and methodsPatients diagnosed with LAPC confirmed during surgical exploration between November 2012 and April 2014 were eligible for inclusion. RFA probes were placed under ultrasound guidance with a safety margin of at least 10 mm from the duodenum and 15 mm from the portomesenteric vessels. During RFA, the duodenum was continuously perfused with cold saline to reduce risk for thermal damage. Primary outcome was defined as the amount of major complications (Clavien-Dindo grade ≥III). RFA-related complications were predefined as: pancreatic fistula, pancreatitis, thermal damage to the portomesenteric vessels and duodenal perforation.ResultsIn total, 17 patients underwent RFA. Delayed gastric emptying (DGE) requiring endoscopic feeding tube placement occurred in 4 patients (24%) as only major complication. Five patients (29%) had a major complication other than DGE. One (6%) RFA-related major complications occurred. One patient (6%) died due to complications from a biliary leak following hepaticojejunostomy. After evaluation of the first 5 patients, gastrojejunostomy was no longer performed routinely. Since then severe DGE seemed to occur less (3/5 vs. 3/12 grade C DGE).ConclusionRFA is a major, but safe procedure for patients with LAPC if performed with strict predefined safety criteria. A RCT is currently investigating the true effectiveness of RFA in patients with LAPC.     

Use of radiofrequency ablation in palliative therapy of renal cancer

New methods in management of renal cancer promising better quality-of-life outcomes have been introduced for the past 10-15 years. They offer more opportunity of early detection of cancer, differential diagnosis and more accurate staging. Yet, there is a sizeable percentage of patients who cannot undergo surgery for general health reasons, multiple tumor involving both kidneys or involvement of a single kidney. Such patients may be given radio frequency ablation which causes a.c.-charged intracellular structures to vibrate leading to coagulation of tumor. Being unable of complete cure, the procedure is well tolerated. It gives the feeling of comfort, improves quality of life and is often followed by survival times comparable to postoperative ones.     

内镜下射频治疗晚期食管癌37例疗效总结

目的：探讨内镜下射频治疗食管癌狭窄梗阻的疗效。方法：对37例3、4级狭窄梗阻的食管癌采用内镜下射频治疗。结果：显效22例、有效13例,总有效率达94.6%,不良反应是持续恶心、剧烈会厌反射、胸前区灼热痛、上腹部胀痛。结论：内镜下射频治疗3、4级食管癌在缓解梗阻和解决进食方面近期疗效显著,操作简单,安全可靠。     

内镜下射频治疗晚期食管癌37例疗效总结

目的:探讨内镜下射频治疗食管癌狭窄梗阻的疗效。方法:对37例3、4级狭窄梗阻的食管癌采用内镜下射频治疗。结果:显效22例、有效13例,总有效率达94.6%,不良反应是持续恶心、剧烈会厌反射、胸前区灼热痛、上腹部胀痛。结论:内镜下射频治疗3、4级食管癌在缓解梗阻和解决进食方面近期疗效显著,操作简单,安全可靠。     

射频消融治疗肺癌的研究进展

射频消融(RFA)技术是一种安全、有效、微创治疗实体肿瘤的新方法,近期被用于治疗肺部肿瘤.RFA治疗不能切除的原发性肺癌效果良好、创伤小.是对不能切除的原发性肺癌潜在的补充治疗,能够有效提高肺癌患者的生活质量.而RFA的适应证、禁忌证及治疗后的组织学反应关系到其治疗效果.     

多电极射频消融治疗肝癌的现状与展望

多电极射频消融(RFA)治疗肝癌是较先进的一种姑息疗法，为微创治疗肝癌提供了一种新的有效方法。本文综述多电极射频消融治疗系统的组成、治疗原理、临床效果、适应证、并发症、技术难点及解决方案等。