Dr. Francis Facchini, an attending radiologist at Decatur Memorial Hospital and an assistant professor at Northwestern University’s Feinberg School of Medicine, is one of three dedicated interventional radiologists performing radiofrequency ablation and other tumor ablation procedures in the hospital’s cancer practice. He spoke to Diagnostic Imaging’s Tumor Ablation Clinic about the practical aspects of incorporating RFA into a cancer practice and what role he expects the technology to play in the future.
Lung carcinoma remains the leading cause of cancer death in the U.S. Over the past decade, lung cancer death rates have more than quadrupled, from 5.4 to 29.4 per 100,000.1 The American Cancer Society estimates that in 2005 the number of lung cancer deaths will rise to 163,510-90,490 men and 73,020 women-accounting for 28% of all cancer-related deaths. The number of newly diagnosed lung cancers will rise to 172,570, or 93,010 new cases in men and 79,560 in women.2 Nearly 60% of those diagnosed with lung cancer die within one year of their diagnosis and nearly 75% within two years.2
Over 35,000 new cases of renal cell carcinoma occurred in the U.S. in 2001,1 most of them detected as incidental imaging findings on CT, MR, or ultrasound.2,3 Since most of these tumors are relatively small when detected, the classic clinical triad of flank pain, hematuria, and palpable mass is now rarely encountered. Many of these incidentally discovered RCCs are also slow growing. Bosniak et al showed that RCCs smaller than or equal to 3.5 cm grow at an average rate of 0 to 1.1 cm/year (mean 0.36 cm/year).4
Reimbursement for radiofrequency ablation of tumors continues to broaden, with local Medicare agencies and most major insurers covering the procedure for unresectable liver neoplasms. Palliative RFA treatment of bone metastases follows as the next most widely accepted procedure. These positions are bolstered by existing CPT codes for the treatments.
As more medical practitioners accept RFA and other tumor ablation methods for cancer treatment, physicians must determine how to integrate the procedure into their practices. The leap from academia to a clinical setting may be perilous, as tumor ablation doesn’t fit neatly into any one specialty. Does RFA belong in the interventional radiology box, the surgery box, or the oncology box?