Ablation Therapies
Radiofrequency Ablation
Radiofrequency Ablation For inoperable liver tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Thus, this treatment is much easier on the patient than systemic therapy. Radiofrequency energy can be given without affecting the patient’s overall health and most people can resume their usual activities in a few days.
In this procedure, the interventional radiologist guides a small needle through the skin into the tumor. From the tip of the needle, radiofrequency energy (similar to microwaves) is transmitted to the tip of the needle, where it produces heat in the tissues. The dead tumor tissue shrinks and slowly forms a scar. The FDA has approved RFA for the treatment of liver tumors.
The images above show a 78 year old female with liver cancer, considered a poor surgical candidate due to her age. Preprocedure MRI demonstrates a 3cm (1.2in) tumor in the right lobe of the liver (left side of picture-red arrow). Following combined chemoembolization and RFA, follow-up MRI demonstrates a 5cm(2in) dark necrotic (dead) area where the tumor was with a safe margin of dead liver without spread or new tumors.
RFA is most effective for tumors smaller than 5cm (2 inches) in diameter. Recent studies have shown that RFA, in certain types of cancer, has improved survival compared to surgical resection in small tumors. Because it is a local treatment that does not harm healthy tissue, the treatment can be repeated as often as needed to keep patients comfortable. It is a very safe procedure, with complication rates on the order of two to three percent, and has been available since the late 1990s.
By decreasing the size of a large mass, or treating new tumors in the liver as they arise, the pain and other debilitating symptoms caused by the tumors are relieved. While the tumors themselves may not be painful, when they press against nerves or interfere with vital organs, they can cause pain. RFA is effective for small to medium-sized tumors and emerging new technologies should allow the treatment of larger cancers in the future.
Cryoablation
Recent interventional cryoablation data are showing near 100 percent efficacy for tumors up to four centimeters if localized to the kidney. Larger localized tumors can also be successfully treated with cryoablation depending on size and location. Ablated lesions show as dead tissue (scar) with no recurrences at one-year follow-up on imaging, after one treatment.3 The one-year benchmark is an established and well-accepted benchmark within the medical community.3, 4
Studies are ongoing to compare cryoablation to partial nephrectomy, and it is expected that the two treatments will be shown to be equivalent in the future. The interventional radiology treatment is less invasive and easier on the patient. This treatment spares the majority of the healthy kidney tissue and can be repeated if needed.The treatment has an excellent safety profile, and most patients are sent home the same day as the procedure or go home the next day. The most common complication is a bruise (hematoma) around the kidney that goes away by itself.
These interventional treatments also offer valuable benefits to those patients with advanced or metastatic renal cell carcinoma. While not considered curative for these patients, the lesions can be re-treated as needed. Studies are underway on combination treatments. One such study uses cryoablation to kill the primary kidney tumor and immune system stimulation to treat any metastases. Traditional chemotherapy drugs and radiation are generally ineffective for kidney cancer.5
Cryoablation is delivered directly into the tumor by a probe that is inserted through the skin using imaging to guide it internally. Cryoablation uses an extremely cold gas to freeze the tumor to kill it. This technique has been used for many years by urologists in the operating room, but in the last few years, the needles have become small enough to be used by interventional radiologists through a small incision in the skin without the need for an operation. The “ice ball” that is created around the needle grows in size and destroys the frozen tumor cells.
Source: 2012 society of Interventional Radiology http://www.sirweb.org/patients/kidney-cancer/
NanoKnife
The Nano Knife system employs irreversible electroporation – a novel new in cancer treatment technology that uses a series of microsecond electrical pulses instead of extreme heat, freezing, radiation or microwave energy – to permanently open cell membranes in cancerous tumors. Once the cell membrane pores are opened, the death of the targeted cancer cells is induced. Surrounding veins, nerves and ducts within the targeted area are largely unaffected by the process around them, providing a compelling tool for procedures in difficult-to-treat parts of the body.
The destruction of veins in certain organs or parts of the body, inherent in more traditional treatments, can result in heavy and in some cases potentially dangerous bleeding if not carefully managed. Destruction of nerves can result in other problems that make treatment in sensitive parts of the body a challenge.
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