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Diagnostic Imaging.

Physician Information: RFA Overview

September 9, 2007

Percutaneous tumor ablation is a minimally invasive method of destroying tumors.It is safe, fast, relatively inexpensive, and can be used to attack tumors thatare not eligible for surgical resection. Current research suggests that tumorablation may be as effective as resection for some tumors.

Radiofrequency ablation (RFA) is the most commonly used method of percutaneoustumor ablation. The technology has been used for years to control some heartarrhythmia and to manage painful bone tumors; now it is becoming a preferredmethod for destroying tumors in patients who cannot withstand or choose not toundergo surgery. Other methods of tumor ablation include cryoablation andmicrowave ablation.

Illustration shows the through-the-skin placement of the needle electrode (RFA probe) in the cancerous tumor. (Provided by the Society of Interventional Radiology, www.sirweb.org)

Types of Tumors Treated
RFA devices have been FDA-approved for the treatment of liver tumors since 1996.Investigators have expanded the use of RFA to treat tumors of the kidney, lung,breast, bone, and adrenal system. In some cases, such as bone tumors, thetreatment is strictly palliative; in others, such as liver and lung tumors, RFAtreats the cancer and can dramatically increase survival rates.

Best Candidates
The technology and methods behind tumor ablation are continuously advancing, butcurrently there is a very specific profile of patients who will reap the mostbenefit from tumor ablation:
• Those who have encapsulated tumors
• Those whose tumors are no less than 0.5 cm and no greater than 3 cm in size
• Those who have no more than three tumors per organ

Tumors that do not fit this profile can still be treated with RFA or otherablation techniques, as the method can relieve pain, shrink large tumors, andboost the efficacy of other treatments.

Patient Profile
RFA and other tumor ablation techniques can be safely used in patients who arenot surgical candidates.

Tumor ablation can successfully be used on patients who
• Have already undergone major surgery, to treat a recurrence of tumors
• Have already lost an organ or a portion of an organ to previous surgery
• Are too frail for a major surgical procedure
• Have suppressed immune systems
• Are at increased risk of bleeding
• Would face too much organ damage with conventional surgical treatment
• Would suffer an unacceptably adverse reaction to systemic treatments

Risks and Side Effects
The risk of complications is minimal with RFA—complications occur in 1% to 4% ofpatients across all procedures. The risk of bleeding is less prevalent than withother treatments, because the heat from the procedure cauterizes tissue. Thereis a slight risk of infection, pain, bruising, and bleeding at the needleelectrode insertion site. RFA performed on the liver and upper kidney carries aslight risk of lung collapse.

In addition, tumors located next to major blood vessels face a slight risk ofuneven treatment, as the relatively cooler blood can carry the heat away fromthe site. But new techniques are making RFA viable for tumors in organs andlocations that had previously been considered off-limits. Where heat-basedablative techniques are impractical, such as in the prostate or kidney,cryoablation can achieve similar results.