A minimally invasive treatment called radiofrequency ablation
(RFA), one of several types of ablation therapy, may be an alternative when
surgery for certain types of cancer is not a good option. Guided by imaging
techniques, the doctor inserts a thin needle through the skin and into the
tumor. High-frequency electrical energy delivered through this needle heats and
destroys the tumor. Months after the procedure, dead cells turn into a harmless
scar.
RFA can be used to treat certain types of cancers in the liver,
bone, kidney, lung and other locations, destroying cancer cells while
preserving surrounding healthy cells. Whether you are a good candidate for RFA
depends on several issues, such as the size and location of your tumor.
Radiofrequency ablation (RFA) is a minimally invasive
alternative to surgery if you are not a good surgical candidate, have recurrent
or multiple small tumors, or do not benefit from conventional therapies. RFA
can also be used before or after surgery or in combination with radiation
therapy and chemotherapy. Your doctor will
determine whether RFA is the most appropriate treatment for you.
Advantages of RFA include:
·
Effective treatment for small tumors
·
Minimally invasive with no skin incision
·
Minimal risk
·
Few complications
·
Typically little or no pain
·
Minimal hospital stay
·
Can be repeated if new cancer appears
Types of cancer treated with RFA :
·
Liver cancer. RFA can be effective
for cancer that starts in the liver and for some types of cancer that have spread
to the liver, such as colon
cancer.
·
Kidney cancer. For select people,
RFA may be considered for small kidney tumors.
·
Lung cancer. For select people who
have lung cancer tumors that are limited in size and number, RFA may be a
nonsurgical alternative.
·
Bone cancer. RFA may be used to
try to control severe pain caused by bone cancer that's limited to one or two
sites, rather than to cure bone cancer.
Procedure:
The procedure is
performed with patient under conscious sedation (a state of consciousness
achieved through medication where the patient can bear unpleasant procedure
while maintaining cardiorespiratory function. It is now called as procedural
sedation) using drugs like midazolam, fentanyl and meperidine. These drugs are
introduced into the body intravenously.
The instruments that
are used for this procedure include image guiding technique like ultrasound,
MRI or CT scan, a radiofrequency generator to produce radiofrequency waves,
straight needles and straight hollow needles with retractable electrodes,
insulating wires and earthing pads, and an endoscope in case of a laparoscopic
procedure is done. The ablation procedure is performed by a specifically
trained interventional radiologist in an operation theatre or a radiology room.
The patient is connected to a monitor where his pulse, respiratory rate and
blood pressure are monitored continuously throughout the procedure. In case the
patient is sedated under general anesthesia, a tube is inserted down the wind
pipe and connected externally to an artificial breathing unit (ventilator). The
area where the needles are to be inserted is sterilized and draped. The
grounding pads are attached to the back or thigh of the patient. The needles
can be introduced into the patient’s body surgically, percutaneously or through
endoscope.
In the percutaneous method the surgeon makes
small punctures in the skin of the abdomen through which the needle probes are
inserted. The probe is guided towards the site of tumor using the image guiding
option of US, MRI or CT scan or microscopic camera. Once the needle is inside
the target tissue, radiofrequency energy is generated by the generator that
passes between the needle probes and grounding pads. This creates a large
amount of ionic vibration around the needle which in turn produces a lot of
heat. This large amount of heat destroys the cancer cells and closes the nearby
feeding blood vessels, ensuring no nutrition to the tumor cells. The dead cells
shrink away and are replaced by scar tissue. If the tumor is large or located
at multiple places in the same organ, the needles are removed and replaced into
the various tumor sites for complete destruction of the cancer. This helps to
prevent recurrence to a large extent. After the procedure the needles are
pulled out and pressure is put at the entry site to prevent any bleeding. The
skin is covered with a simple dressing. No sutures are required.
Outcome:
The outcome of
this procedure is very encouraging especially for persons with large tumor who
are not in a position to withstand the stresses of conventional surgery. Single
ablation requires around 10-30 minutes and in case of multiple ablations the
procedure takes 1-3 hours. The patient is kept in the recovery room till the
effect of sedation wears away. He is then permitted to go home. Very few
patients experience any pain at the site of needle entry. This pain goes away
in a week’s time and the person is then able to resume his daily activities.
Benefits:
1.
Radiofrequency ablation can be an
effective treatment for primary liver cancer and for cancers that have spread
to the liver in those patients whose liver tumors are unsuitable for surgical
resection.
2.
The success rate for completely
eliminating small liver tumors is greater than 85 percent.
3.
Treatment-related serious complications
are rare and discomfort, pain and muscle weakness is minimal. This reduces the
hospital stay.
4.
Radiofrequency ablation may be used
repeatedly to treat recurrent liver tumors.
5.
The percutaneous method of
radiofrequency ablation, in which electrodes are inserted through the skin, is
minimally invasive, produces few complications, and does not require hospital
admission.
6.
RFA is a relatively quick procedure and
recovery is rapid so that chemotherapy may be resumed almost immediately in
patients who need it.
7.
Radiofrequency ablation is less
expensive than other treatment options.
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