Liver Cancer | Kidney Cancer | Lung Cancer
RFA has been used with success to treat primary liver cancer (otherwise known as hepatocellular carcinoma) and cancers that have spread to the liver from other places, such as colon cancer. Surgical resection of these tumors in carefully selected patients can lead to significant long-term survival but only a small percentage of these patients are candidates for surgery.
Despite the fact that the evolution of surgical technique has increased the numbers of patients considered candidates for surgery, there are still many patients with cancer involving the liver that can potentially benefit from a procedure such as RFA.
Patients with symptomatic neuroendocrine (carcinoid) tumors are also ones that can benefit from RFA. Carcinoid tumors often arise from the GI tract or lung and can then metastasize to the liver.
Even though these tumors tend to be slow-growing, they are often associated with significant symptoms relating to hormone production. These symptoms, known as the carcinoid syndrome, include flushing, palpitations, and diarrhea that can often be debilitating. Treating these tumors with local tumor therapy can relieve or reduce symptoms which can improve quality of life in these patients.
A consultation with one of the interventional radiologists of Interventional Care will help determine if a patient is a candidate for radiofrequency. This involves reviewing all imaging studies that the patient may have had during the course of their treatment with an oncologist in order to determine the extent of tumor involvement within the liver.
The ideal size of a lesion to be treated with RFA is <4 cm because larger tumors may recur due to incomplete necrosis of the tumor cells. However, patients with tumors up to 6 cm in diameter can be considered for RFA and for those patients, multiple overlapping ablations may need to be performed to increase our certainty that the entire tumor is treated.
We also tend to prefer that patients have three or fewer tumors in the liver in order to be considered for RFA since it is unlikely that patients with a greater number of lesions will realize a survival benefit from RFA. Patients with more tumors may be considered possible candidates for regional therapy such as chemoembolization and radioembolization with RF ablation considered in these patients if three or fewer lesions do not respond to that initial regional therapy.
Lesions deep within the liver tend to be more preferable to treat then lesions immediately under the surface of the liver since there tends to be slightly more post-procedure pain associated with RFA of lesions near the capsule or surface of the liver.
Finally, it is desirable to treat lesions with RFA that are not immediately adjacent to large blood vessels because blood flow near the tumor can potentially cool the tissue during the procedure and prevent a full ablation. This can put that patient at risk for tumor regrowth.
It is often said that therapies such as RF ablation should not be considered if extrahepatic metastatic disease has been found. We choose to not issue such broad statements and instead consider each patient individually in order to determine the relative severity of the intrahepatic and extrahepatic disease. In this way, if the presence of liver disease is felt to be placing a patient at risk for future liver failure, then we consider that patient to be a potential candidate for RF ablation if the other, above-mentioned criteria are met.
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Although surgery continues to remain the treatment of choice for most kidney tumors, some patients can potentially benefit from RFA. This includes patients with a high degree of surgical risk due to multiple medical problems, borderline kidney function, or one kidney. In addition, patients with multiple recurrent tumors (as seen in conditions such as Von-Hippel Lindau disease) can benefit from RFA.
Almost all tumors <3 cm and located on the outside or periphery of the kidney can be successfully treated with RFA. Tumors that are close to the collecting system of the kidney can potentially be treated with percutaneous cryoablation.
Before RFA of the kidney is performed, a complete urologic and imaging evaluation must be performed to be certain that the disease is confined to the kidney, with no extension into the blood vessels surrounding the kidney.
RFA is now considered to be an option for patients with primary lung cancer or metastatic disease involving the lung who wish to avoid conventional surgery or are too ill to undergo surgery due to advanced disease in the lungs or poor cardiac and/or pulmonary function.
In addition, RFA is not intended to replace surgery, radiation, or chemotherapy but can be helpful to some patients when used alone or in conjunction with these treatments. It is most often used to treat cancers that are limited in size (<3 cm in diameter) and are separate from vital structures in the chest.
RFA has also been used to successfully address the pain associated with masses involving the chest wall and to debulk tumors that are too large to remove surgically. Debulking may allow the remaining parts of the tumor to be treated with chemotherapy or radiation therapy.
Finally, RFA can be used to treat patients with recurrent disease after radiation therapy since these patients are often not candidates for surgery or additional courses of radiation.