Radiofrequency ablation is useful for selected cases of pelvic recurrence of rectal carcinoma.

Abstract

We evaluated radiofrequency ablation (RFA) as a new local treatment for pelvic recurrence of rectal carcinoma. Fourteen lesions in 10 patients were treated by RFA. Four patients with a solitary recurrent tumor were treated curatively, while 10 lesions in the remaining 6 patients with distant metastases were treated palliatively mainly to control pain. RFA was performed under CT guidance and epidural anesthesia. It was carried out by a single insertion for tumors 3 cm or less in diameter or by multiple insertions for tumors greater than 3 cm. Ablation effectiveness was evaluated by magnetic resonance imaging. For palliative cases, severity of pain was assessed using a visual analogue scale. Needle placement and ablation were accomplished in all 14 lesions. Complications following RFA consisted of 2 cases of abscess formation, 2 cases of neuralgia and one case of bleeding. To obtain complete necrosis, the tumor should be under 4 cm in diameter and not involve any major iliac vessels. Three of 4 patients treated curatively met these conditions. Among these 4 patients, only one recurrence was observed after RFA (follow-up, 6-36 months). Five of 6 patients treated palliatively had tumours greater than 4 cm in diameter or involving iliac vessels. In none of the patients did we achieve complete necrosis and satisfactory analgesia. Although certain conditions must be met, RFA is a feasible and effective treatment, and it should be considered as one of the treatment options for pelvic recurrence of rectal carcinoma.