University of Texas Southwestern Medical Center, Department of Radiology
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 Tuesday
 07/22/2014

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Radiofrequency Ablation
 
Basic Facts
Radiofrequency ablation (RFA) is a minimally invasive technique that destroys cancer tumors. Bursts of radiofrequency energy are sent through a catheter (a long, thin tube) to heat and destroy diseased tissue.
Currently, RFA is a standard treatment for patients with inoperable liver tumors. It is being increasingly used for other cancers, such as lung cancers, kidney (renal), and certain benign and malignant bone tumors, and is being tested for other types of cancer.
RFA destroys cancer cells and can sometimes cure cancer, possibly in a similar way to surgical removal, relieve pain and suffering, and may prolong life.
Radiofrequency ablation (RFA) is a local treatment for cancer that delivers radiation directly to a tumor.

Radiofrequency energy comes from electric and magnetic energy and is absorbed by the body as heat. In RFA, the physician inserts a metal probe through the skin into a tumor. This heat destroys the cancerous cells but spares healthy tissue.

Currently, RFA is approved for patients with primary or secondary liver cancer. In experimental procedures, RFA has also been used to treat the following cancers:
  • Adrenal;
  • Kidney;
  • Breast;
  • Bone;
  • Lung; and
  • Prostate.
RFA may increase longevity and relieve pain, and it can sometimes cure cancer.

RFA has fewer complications, is less risky, and causes fewer side effects than surgery to remove a tumor.

RFA may be used with other interventional cancer therapies, such as chemoembolization, and traditional cancer treatments, for example, chemotherapy.

WHEN IS IT INDICATED?

RFA is indicated in patients who have liver cancer for whom surgery is not possible. RFA may also be used to shrink large liver tumors before surgery.

PRE-TREATMENT GUIDELINES

Before treating cancer, the physician will order tests to determine the location, type, and severity of the cancer. These tests include:
  • Liver function test;
  • Biopsy;
  • Blood tests;
  • Computed tomography (CT) scan;
  • Spiral CT scan; and
  • Magnetic resonance imaging (MRI).
The night before the procedure, the patient is usually required to fast. However, water is usually allowed up to 2 hours before the procedure.

WHO IS ELIGIBLE?

Eligible patients have liver cancer. Additionally, patients with small kidney tumors, lung tumors, or bone cancer may be eligible.

Patients with large or multiple liver tumors may be ineligible for RFA. RFA may not be as successful for liver metastases as for primary liver tumors.

WHAT TO EXPECT

RFA is frequently performed as an outpatient procedure by an interventional radiologist. In most cases, only a mild sedative and a local anesthetic are needed.

Interventional procedures are generally painless. Because there are no nerve endings inside the arteries, people cannot feel the catheters (long, thin tubes) as they move through their body.

The interventional radiologist will locate the tumor using imaging tests and choose an insertion point above a blood vessel for the catheter. Through this catheter, the physician inserts a probe with electrodes that transmit radiofrequency energy.

The interventional radiologist guides the probe to the site of the tumor while watching real-time images on a monitor. The patient may need to lie still or hold his or her breath as the probe is placed into the tumor. A generator sends radiofrequency energy through the probe. Heat kills the cancer cells surrounding the probe. This portion of the procedure typically takes 10 to 30 minutes.

When treatment is complete, the physician slowly removes the probe and places a small bandage over the site of the insertion. The entire procedure takes 1 to 3 hours.

POST-TREATMENT GUIDELINES AND CARE

The physician takes CT or MR images to ensure that the treatment has destroyed the tumor. If necessary, the procedure may be repeated.

For the first 2 to 3 hours after the procedure, the patient is placed on bed rest and his or her vital signs are monitored. Painkillers may be given. Patients stay in the hospital overnight.

For 24 hours following the procedure, the patient should avoid driving a car, exercising strenuously, or making important decisions if they have been given sedatives. Otherwise, patients can resume normal activities immediately.

Patients receiving RFA return for follow-up imaging tests. If the tumors have not shrunk, some patients may need additional treatments.

POSSIBLE COMPLICATIONS

In general, RFA is safe and has a low rate of minor complications, including:
  • Low-grade fever;
  • Bruising;
  • Bleeding;
  • Pain; and
  • Infection.
If a tumor in the liver or upper kidney is being treated, there is a small risk of lung collapse during the insertion of the probe.

Recurrence rates of liver tumors treated with RFA range from 1.8 percent to 28 percent. Long-term results of the procedure are not yet known.

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