Question: My father was recently treated with radiofrequency ablation for his inoperable lung tumor. His tumors were completely destroyed in an outpatient procedure that lasted about an hour. Can CURE please feature this procedure and let other patients know what it is and who is a candidate for it?
—Laura Bogner
Fort Smith, Arkansas

Answer: Radiofrequency ablation, or RFA*, is at the forefront of a new promising trend toward minimally invasive image-guided elimination of cancerous tumors. This novel method has been proven to destroy cancer cells using localized heat, eliminating the need for conventional surgery, and thus significantly reducing complications and recovery time.

Specifically, the treatment involves application of a high-frequency (100 to 500 kilohertz) alternating current via a needle-shaped applicator to a tumor. The minimally invasive aspects of the device are preserved, as only a single needle is introduced under guidance into the tumor. The needle tip is expanded by deploying umbrella-shaped tines contained within the needle shaft, allowing for effective treatment of a larger diameter of tissue.

The ions within the tissue vibrate rapidly as they respond to the current, leading to frictional heating of the tissue. Controlled and gradual heating of the tissue is performed to maximize the volume of tissue destroyed and to ensure that the entire volume of tumor is eliminated. The systems are designed to provide feedback during the heating process to determine when the tissue has been destroyed and the procedure can be terminated.

With ultrasound or computed tomography guidance, radiologists and surgeons often perform the procedure under general anesthesia, although it can be performed under moderate conscious sedation or “twilight anesthesia.” RFA can frequently be done as an outpatient, with the patient sent home with just a bandage over a tiny incision measuring 2 to 3 mm. Patients are then followed with periodic imaging to check for recurrence.

Radiofrequency has been used to destroy tumor in a myriad of tissue types, including kidney, lung, bone, adrenals, prostate, breast and bladder, with encouraging results. Most of the literature involves the liver, where multiple studies show that RFA is as effective as surgery in the removal of tumor in small lesions. New data is emerging with new techniques and a new generation of devices that suggest moderate-size lesions can be effectively treated as well.

The first RFA probes produced were limited in the volume of tumor they could effectively treat. The most promising and the most commonly used device is the multiprobe or array system, which is in essence a self-contained expandable needle tip system. Currently, tumors as large as 7 cm in diameter can be treated with a single application of energy lasting about 20 minutes. Results in patients with lung and kidney tumors, although early, suggest RFA is equally effective in these organs.

Surgery remains the gold standard in patients who are healthy enough to undergo surgery and whose tumors are resectable. RFA was initially performed in patients who did not meet these criteria either because of concurrent illnesses or because their tumors were not safely removable by surgery. Recently, however, RFA has been offered to patients as a viable alternative to surgery for small liver tumors, because new literature with substantial follow-up suggests comparable results to surgery in these patients with less complications and significantly faster recovery. Early indications suggest that we may also look forward to similar results in kidney and lung tumors.

—Jonathan Susman, MD, is an assistant professor of radiology at
New York Presbyterian Medical Center/Columbia.

*©Boston Scientific