Review Article
Image-guided Radiofrequency Tumor Ablation: Challenges and Opportunities—Part II

https://doi.org/10.1016/S1051-0443(07)61670-4Get rights and content

Section snippets

Management

Although other methods of thermal ablation such as laser, microwave, and US are being performed in the liver, RF is currently receiving the greatest attention in light of several factors: its general availability, the recent technical advances facilitating its use, and the active marketing on the part of multiple manufacturers. Currently, more than 2,500 RF ablation procedures for the treatment of primary and secondary liver tumors have been reported, at least in abstract form (6, 7, 8, 9, 10,

OSTEOID OSTEOMAS

RF has been used to treat both benign and malignant bone tumors. Its first use was for the thermal coagulation of small painful benign bone tumors: osteoid osteomas (37, 38, 39) (Fig 2). Osteoid osteomas predominantly occur in the pediatric age group and arise within the cortex of long bones. The cause of these tumors is unknown. Nocturnal pain relieved with anti-inflammatory drugs is the classic clinical scenario exhibited by these patients. Pain is related to prostaglandin production within

METASTATIC BONE DISEASE

Metastatic cancer is the most common neoplasm involving the skeletal system (40). Of approximately 965,000 new cancer cases each year in the United States, approximately 30%–70% will develop skeletal metastases. Given the high prevalence of carcinomas of the breast, lung, and prostate, these cancers account for more than 80% of cases of metastatic bone disease. Bone metastases lead to significant morbidity from pain, pathologic fracture, and neural compression. Pain from bone metastases can be

HEAD AND NECK

An additional venue in which RF ablation may hold promise is the treatment of recurrent head and neck tumors. Many patients may not be surgical candidates for tumor resection because of the location and extent of tumor, concomitant debilitating medical conditions, or a history of multiple surgeries. These patients may be safely treated with RF ablation because the procedure is performed almost exclusively in the outpatient setting with local anesthesia and intravenous conscious sedation. RF

BREAST

Historically, there has been a trend of minimizing surgical trauma at the primary breast cancer resection site whenever possible. Therefore, recently, RF ablation has been used to treat primary breast cancer (49). In a small group of patients treated with a multitined array RF electrodes before surgical resection, histologic specimens demonstrated effective coagulation necrosis of infiltrative breast carcinoma. This work and our experience suggest that further investigation is warranted. Unlike

LUNG

RF ablation is a promising new minimally invasive technique for the treatment of solid lung malignancies (51, 52) (Fig 6). Lung tumors are well suited to RF ablation because the surrounding air in adjacent normal lung parenchyma provides an insulating effect and concentrates the RF energy within the tumor tissue (53). Hence, less RF energy deposition is required to achieve adequate tumor heating than with intrahepatic pathology. The majority of patients with primary and secondary lung

ADRENAL GLAND

Although no literature exists concerning the application of RF to adrenal pathology, there may be a role, particularly because adrenalectomy for metastatic lung cancer is being proposed in the surgical literature (55) (Fig 7). If in fact patients with adrenal metastases benefit from surgical removal of the adrenal gland, applying a less invasive alternative may be beneficial. In addition to malignant adrenal pathology, benign functioning lesions such as hyperaldosteronism secondary to an

KIDNEY

Solid renal masses have been traditionally removed surgically with either total or, if possible, partial nephrectomy. Many patients who present with small incidental solid renal masses are in their later stages of life. These masses are often exophytic, slowly growing renal cell carcinomas that will not often affect patient longevity. Recent reports (56, 57, 58) suggest that RF ablation can provide safe tumor reduction in patients (Fig 9). In our experience, the procedure is well tolerated with

PELVIS

Recurrent malignancies involving the pelvis are commonly seen in colorectal cancer, as well as in prostate and gynecologic malignancies. Recurrent surgery and pelvic radiation are the primary methods of treatment. Unfortunately, these methods are often ineffective and recurrent tumor often causes pain from infiltration into the lumbosacral plexus. However, to our knowledge, most investigators who use RF ablation have not focused on this group of patients. Yet, we have found in certain instances

PRINCIPLES TO IMPROVE THE SAFETY OF RF TECHNIQUES

A fundamental understanding of RF principles is necessary to ensure maximum safety when performing this procedure in clinical practice. It must also be stressed in no uncertain terms that the safety (and efficacy) of the RF ablation procedure will be highly dependent on the degree of operator experience and familiarity with RF and thermal ablation procedures. RF ablation is a highly complex procedure that mandates appropriate and adequate training, operator skill, and dedicated clinical

CONCLUSIONS

RF ablation is an exciting technology with many new applications in patients with cancer. This exciting new outpatient procedure has already demonstrated significant benefits in patients with limited focal neoplasia while achieving low morbidity. Additionally, RF therapy has been used as a primary treatment modality for hormonally active, nonmetastatic neoplasms and for palliation in patients in whom conventional treatment with surgery, chemotherapy, or radiation therapy has been exhausted. As

First page preview

First page preview
Click to open first page preview
View PDF

References (61)

  • GD Dodd et al.

    Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough

    Radiographics

    (2000)
  • GS Gazelle et al.

    Tumor ablation with radio-frequency energy

    Radiology

    (2000)
  • JP McGahan et al.

    Radiofrequency ablation of the liver: current status

    AJR Am J Roentgenol

    (2001)
  • SN Goldberg et al.

    Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance

    AJR Am J Roentgenol

    (2000)
  • S Rossi et al.

    Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode

    AJR Am J Roentgenol

    (1998)
  • L Solbiati et al.

    Hepatic metastases: percutaneous radiofrequency ablation with cooled-tip electrodes

    Radiology

    (1997)
  • Solbiati L, Livraghi T, Goldberg SN, Ierace T, DellaNoce M, Gazelle GS. Percutaneous radiofrequency ablation of hepatic...
  • T Livraghi et al.

    Small hepatocellular carcinoma: treatment with radiofrequency ablation versus ethanol injection

    Radiology

    (1999)
  • T Livraghi et al.

    Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions

    Radiology

    (2000)
  • R Lencioni et al.

    Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial

    Eur Radiol

    (1998)
  • SA Curley et al.

    Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis

    Ann Surg

    (2000)
  • T de Baere et al.

    Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year

    AJR Am J Roentgenol

    (2000 Dec)
  • L Solbiati et al.

    Local control of focal liver malignancies treated with RF ablation: initial report of the Italian Multicenter Cooled-tip RF Study Group [abstract]

    Radiology

    (2000)
  • S Rossi et al.

    Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply

    Radiology

    (2000)
  • SN Goldberg et al.

    Treatment of intrahepatic malignancy with radiofrequency ablation: radiologicpathologic correlation

    Cancer

    (2000)
  • A Siperstein et al.

    Local recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors

    Ann Surg Oncol

    (2000)
  • O Kainuma et al.

    Combined therapy with radiofrequency thermal ablation and intra-arterial infusion chemotherapy for hepatic metastases from colorectal cancer

    Hepatogastroenterology

    (1999)
  • N Petrelli et al.

    Morbidity and survival of liver resection for colorectal adenocarcinoma

    Dis Colon Rectum

    (1991)
  • G Steele et al.

    A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: gastrointestinal tumor study group protocol 6584

    J Clin Oncol

    (1991)
  • Y Fong et al.

    Surgical treatment of colorectal metastases to the liver

    CA Cancer J Clin

    (1995)

    • Cited by (425)

    • Outpatient percutaneous image-guided microwave ablation with monitored anesthesia care: An exploratory study

      2023, Clinical Imaging

    • Thermosensitive liposomes for targeted breast cancer therapy

      2022, Targeted Nanomedicine for Breast Cancer Therapy

    • Thermal Ablation Therapy: Theory and Simulation

      2021, Thermal Ablation Therapy: Theory and Simulation

    • Ablation and Combination Treatments of Musculoskeletal Lesions

      2020, Image-Guided Interventions: Expert Radiology Series, Third Edition

    • Lung Ablation

      2020, Image-Guided Interventions: Expert Radiology Series, Third Edition

    • Interventional radiology to treat vertebral diseases

      2019, Presse Medicale
    View all citing articles on Scopus
    View full text
    Copyright © 2001 Society of Interventional Radiology. Published by Elsevier Inc. All rights reserved.