Radiofrequency ablation
Radiofrequency ablation (RFA) is a minimally invasive medical procedure that utilizes high-energy radio waves to heat and destroy abnormal tissues, primarily cancerous tumors. This technique is particularly beneficial for patients with tumors that cannot be surgically removed, those who are not suitable candidates for surgery due to health conditions, or individuals seeking less invasive treatment options. RFA is used to treat various types of cancer, including liver, breast, lung, bone, prostate, and kidney cancers, and is being explored for other malignancies as well.
During the procedure, a thin probe is inserted into the tumor, delivering localized radiofrequency energy that raises the temperature enough to destroy cancer cells while minimizing damage to surrounding healthy tissue. The procedure is typically performed under sedation or local anesthesia, lasts two to four hours, and allows for quicker recovery compared to traditional surgical methods. Post-procedure, most patients can resume light activities within a day, though they should avoid strenuous tasks for a short period.
While RFA has a low complication rate, potential risks vary based on tumor location and type. Results indicate that RFA can effectively reduce tumor size and alleviate symptoms associated with certain cancers, with promising long-term outcomes. Regular follow-ups using imaging tests are essential to assess treatment effectiveness and monitor for recurrence.
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Radiofrequency ablation
ALSO KNOWN AS: RFA, thermal ablation
DEFINITION: Radiofrequency ablation is the application of high-energy radio waves (radiofrequency thermal energy) through a catheter probe to heat and destroy abnormal tissues. As a cancer treatment, radiofrequency ablation is used to ablate (destroy) cancerous tumors by directing the radiofrequency heat directly to the tumor, causing the cancerous cells to die.
Cancers treated: Primary and metastatic liver cancer, early-stage breast cancer, lung cancer, bone cancer, prostate cancer, and kidney and adrenal gland cancers; RFA is also being investigated as a treatment option for many other cancers.
Why performed: Radiofrequency ablation is a minimally invasive, percutaneous procedure that offers an alternative treatment option for some patients with tumors that cannot be surgically removed, for patients who are not surgical candidates because of comorbid conditions or other risk factors, or for those who desire a less invasive treatment. In some cases, radiofrequency ablation can be used to ease certain side effects of cancer treatment, such as chronic pain caused by some cancers. Radiofrequency ablation may be combined with chemotherapy or other cancer treatments to improve a patient’s quality of life and survival.
The recommendation for radiofrequency ablation depends on the type of cancer, the patient’s overall medical condition, the number of tumors, and the tumor size and location. Physicians have several choices of radiofrequency abolition types—pulsed radiofrequency ablation (PRF), water-cooled radiofrequency ablation (WCRF), or cryoneurolysis (CN).
Patient preparation: Tests performed before the procedure include positron emission tomography (PET) testing and computed tomography (CT) scanning. Radiofrequency ablation does not interfere with most standard cancer therapies and can be performed for some patients who are actively receiving chemotherapy.
A few days before the procedure, patients must stop taking aspirin and products containing aspirin, ibuprofen, and anticoagulants, as directed. Other medications may be prescribed if necessary before the procedure. Antiarrhythmic medications may also need to be discontinued. Patients with diabetes may need to adjust their diabetes medications, insulin dosages, or meal plan as directed by the physician. Patients must not eat or drink for eight hours beforehand.
Patients should remove all makeup and nail polish. The patient will change into a hospital gown before the procedure.
Steps of the procedure: An intravenous (IV) line is inserted into a vein in the patient’s arm to deliver medications. A sedative is usually given before the procedure to calm the patient. General anesthesia is used in some cases. An interventional radiologist usually performs the procedure, although a surgeon can also do so.
If general anesthesia is not used, local anesthetic is injected into the procedure site to numb the area. A thin, needlelike probe is placed through a puncture or small incision in the skin, guided by ultrasound or CT into the core of the tumor. Once in place, thin, hook-shaped wires (tines) on the end of the probe extend upon deployment to an area beyond the diameter of the tumor. Localized radiofrequency energy is transmitted through the probe, which is attached to a radiofrequency generator. Energy is applied to each targeted area for ten to fifteen minutes, heating and destroying the tissue. The temperature of the applied energy is carefully controlled. Beyond 60 degrees Celsius, cells begin to die, resulting in an area of tissue death surrounding the probe. The probe may be deployed more than once for tumors larger than three centimeters.
Multiple tumors may be treated during the ablation procedure. A small region of normal cells around the tumor (margin) is also heated and destroyed to eradicate cancer in surrounding tissues. The procedure lasts two to four hours.
After the procedure: The RFA probe is removed, and pressure is applied to the insertion site to prevent bleeding. No stitches are needed unless a small incision is made. A small sterile dressing (bandage) will cover the insertion site. The patient may need to stay in bed for one to six hours after the procedure to prevent bleeding.
Most patients stay in the hospital overnight for observation after the procedure, but some go home the same day. The patient may experience discomfort for two to three days. Pain medication may be prescribed, or the patient may take acetaminophen (Tylenol) to relieve discomfort.
The patient should not drive or operate machinery for eight hours after the procedure. Within twenty-four hours, the patient can usually return to light activity but should avoid vigorous physical activity and heavy lifting after the procedure, as directed by the physician. The average recovery time is three to seven days, after which the patient may resume regular activities. The recovery time for radiofrequency ablation is much faster than that for surgical treatment, which can take two to three months for full recovery.
Patients usually have a follow-up CT or magnetic resonance imaging (MRI) scan one week after the procedure to evaluate the effectiveness of the treatment. Based on the patient's condition, follow-up CT scans and blood tests are performed every three months or more frequently.
Risks: The risks of radiofrequency ablation vary depending on the type of cancer and the area being ablated. For example, the risks of RFA applications for lung cancer include pleural effusion and pneumothorax. The risks of RFA applications for liver cancer include portal vein thrombosis, liver abscess, or acute renal insufficiency. The physician who performs the procedure discusses the potential risks with the patient according to the type of cancer being treated.
The rate of overall complications is around 3 percent, depending on the disease treated and the patient’s overall health. Most complications are minor and often relieved independently without further treatment or intervention. The risk of infection is rare since there is no open wound.
Results: Radiofrequency ablation is a safe and effective treatment option. Tumors from one to ten centimeters in size can be successfully treated with radiofrequency ablation, though those bigger than three centimeters might need to be treated in conjunction with embolization. A tumor or lesion that is successfully ablated should be reduced in size or disappear altogether and show no blood flow on follow-up CT scans. In addition to other cancer treatments, radiofrequency ablation can reduce the size of an inoperable tumor. RFA also eases tumor-related symptoms, such as flushing, diarrhea, or hypertension, associated with some hormone-secreting tumors.
Long-term outcomes following radiofrequency ablation are promising. Based on literature reviews, complete tumor ablation with low recurrence rates can be achieved, particularly for smaller cancers. Research is ongoing to evaluate the procedure’s long-term outcomes—RFA combined with standard radiation therapy has shown two-year and five-year survival rates of 50 and 39 percent, respectively, for the treatment of Stage I and Stage II non-small-cell lung cancer. Research shows the local recurrence rate after RFA of colorectal cancer liver metastases averages less than 10 percent. Recurrence rates are related to the lesion size.
Repeat radiofrequency ablations can be performed for patients who develop new or recurrent tumors. Radiofrequency ablation does not preclude patients from undergoing other cancer treatments if necessary.
Bibliography
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