This month's journal articles report on promising combination therapies, evaluate the effectiveness of new equipment, and assess liver and kidney treatments.

Combination therapies

Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer
Chest 2006;129:738-745
The authors report their experience with combined CT-guided RFA and conventional radiotherapy in 24 medically inoperable patients with biopsy-proven stage I NSCLC. They experienced low procedural complication rates and no additional major toxicities despite the addition of RFA. Cumulative survival rates were 50% and 39% at the end of two years and five years, respectively. The authors conclude that RFA followed by conventional radiotherapy is feasible in medically inoperable stage I NSCLC patients, and they suggest that local control and survival rates appear to be better with combined therapy than with radiotherapy alone.

New equipment

Radiofrequency ablation of small renal cell carcinomas using multitined expandable electrodes: preliminary experience
JVIR 2006;17:513-519
The authors report their contemporary experience with RCC RFA using multitined expandable electrodes along with an aggressive treatment strategy to displace adjacent viscera away from probe tines. They followed 22 patients with 26 sporadic RCC who underwent 43 ablations during 27 RFA sessions, 26 of which were performed using multitined expandable electrodes. All ablations used CT guidance with moderate sedation. The authors found a 100% technical success rate in targeting and ablation. They used adjunctive water injection techniques in four patients to displace the tail of the pancreas or descending colon. Deliberate penetration of tines beyond the margins of the kidney was performed in 41% of cases. No hemorrhage occurred in these cases. They conclude that multitined expandable RFA electrodes used for small RCCs produce a high rate of local control with a low complication rate, even when tine penetration of the kidney is required for an adequate tumor treatment margin.

Liver

Radiofrequency thermal ablation of liver carcinoma. Prospective study of 82 lesions
Gastroenterol Clin Biol 2006;30(1):130-135
This prospective study evaluates the feasibility of RFA of hepatic tumors. After studying the rates of mortality, morbidity, recurrence, and recorded overall and disease-free survival, the authors conclude that RFA is an effective treatment for hepatic tumors measuring less than 3 cm. In the absence of randomized studies comparing radiofrequency and surgery, however, respective indications cannot be defined in detail.

Kidney

Radiofrequency ablation in the treatment of kidney cancer
Issues Emerg Health Technol 2006 Feb;(80):1-4
The author reviews the use of RFA in the treatment of renal cell carcinoma and concludes that the safety and efficacy of the procedure compares favorably with those of other approaches. The author identifies the persistence of residual tumor as a disadvantage of earlier versions of the technology but notes that more powerful RF generators may reduce such persistence, although definitive evidence is unavailable. Because experience is limited, the author notes that longer follow-up of patients is required to provide an adequate comparison with nephrectomy.