Efficacy Of Radiofrequency Thermal Ablation Research Articles

Heat can treat: long-term follow-up results after uterine-sparing treatment of adenomyosis with radiofrequency thermal ablation in 60 hysterectomy candidate patients.

Adenomyosis may induce pelvic pain, abnormal uterine bleeding or bulk symptoms. If hormonal treatment proves ineffective or contraindicated, hysterectomy may be necessary. For patients who desire to conserve the uterus despite severe symptomatology, uterine-sparing techniques have been introduced. Radiofrequency thermal ablation (RFA) consists of the local application of high temperature to eliminate diseased tissue, applied recently for adenomyosis treatment. The objective of the study was to analyze the efficacy of RFA for avoiding hysterectomy in patients with adenomyosis-related symptoms. This is a single-center, retrospective cohort study performed in a referral center for endometriosis. The study population consisted of all consecutive patients who underwent Radiofrequency thermal ablation (RFA) treatment as an alternative to hysterectomy for adenomyosis between March 2011 and June 2019 in our institution. RFA was performed using laparoscopic access. To evaluate the impact of RFA treatment on symptoms, follow-up findings were compared to preoperative symptomatology using the ten-point visual analog scale (VAS) for pain assessment. Sixty patients were included in the study, 39 of them (65%), underwent a concomitant surgery for endometriosis in association to RFA. On a long-term follow-up (mean 56months (range 10-115, SD 29), hysterectomy was performed in 8 patients (13%). The mean VAS score before vs after surgery was 7.4 vs 3.3 for dysmenorrhea, 3.7 vs 0.3 for dyschezia, 4.7 vs 0.7 for dyspareunia, and 4.0 vs 1.4 for chronic pelvic pain, being significantly reduced after RFA for all these pain components (p < 0.0001 in every case). Thirty-one patients (52%) suffered from AUB before RFA, this symptom persisted in 10 patients (16%) during follow-up (p < 0.001). Bulk symptoms were present in 16 patients (27%) and disappeared after RFA in all cases. RFA allows for hysterectomy avoidance in most cases. It leads to marked improvements in pain symptomatology, uterine bleeding and bulk symptoms.

Effect of radiofrequency vs other surgeries in the management of obstructive sleep apnoea

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Snoring is an important social problem seen in both men and women. Snoring occurs as a result of soft tissue vibration caused by a partial upper airway collapse during sleep. The aim of the study was to analyse the morbidity and efficacy of radiofrequency thermal ablation of upper airway in patients suffering from OSA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In the Department of ENT, Pondicherry, 40 patients between the age group of 20 to 60 years who were diagnosed to have OSA were operated according to the site of obstruction including RFVTR. Various parameters including ESS, partner scores, post-op pain, bleeding, pharyngeal dryness voice change were measured accordingly on the 1st day, 45th day, 90th day and 180th day postoperatively for the efficacy of treatment and also for assessing the morbidity of treatment provided. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There is a statistically significant reduction in ESS scores and partner scores between pre-operative period and post operatively on the 45th day, 90th day and 180th day. Post-operative pain assessment also showed that patients who underwent RFVTR had lesser pain when compared to other surgeries like zetaplasty, LAUP, etc.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Radiofrequency surgery should be considered as the treatment of choice for mild OSA and hypopneic snorers. The important advantage of these procedures is technically simple and minimally invasive. RFTA of the soft palate leaves the mucosa intact contrary to LAUP, hence the pain comparably less. Relatively cost effective when compared to LASER and Coblator.&lt;/p&gt;

Local Recurrence of Renal Cancer After Surgery: Prime Time for Percutaneous Thermal Ablation?

The purpose of the study was to retrospectively assess the safety and efficacy of radiofrequency thermal ablation (RFA) for retroperitoneal relapse following surgery for renal cell carcinoma (RCC). After open radical nephrectomy or nephron-sparing surgery, eight patients with no evidence of distant metastases were treated for retroperitoneal relapse of RCC with RFA. A total of 16 lesions were ablated. Technical success, tumor response, follow-up duration, and complications were retrospectively analyzed. Disease progression after surgery occurred within a mean time of 57 months (range 9-120). Recurrent tumor size varied from 5 to 34 mm. Five patients previously underwent surgical resection of retroperitoneal recurrent lesions. Six patients were treated with percutaneous approach, while two with recurrent nodes located on the anterior pancreatic surface underwent laparotomic RFA approach. All lesions were completely ablated and patients were followed up with CT at 30 days, after 3 and every 6 months. There was no residual enhancement after a mean follow-up of 12 months (range 7-17). Both patients treated with laparotomic approach had a grade 2 complication according to the Clavien-Dindo classification. In our small series, RFA after relapse of surgically removed RCC was safe and effective. Percutaneous and laparotomic thermal ablation should be assessed as first line loco-regional treatment on a larger patient group.

Radiofrequency Thermal Ablation of Isolated Local Recurrence after Surgery for Renal Cell Carcinoma

Purpose To retrospectively assess safety and efficacy of radiofrequency thermal ablation (RFA) of retroperitoneal relapse after surgery for renal cell carcinoma (RCC). Material and Methods After open radical nephrectomy or nephron-sparing surgery, 4 patients were treated for retroperitoneal relapse and 2 for multiple pancreatic histologically proven metastasis of renal cell carcinoma with percutaneous RFA. Overall, 13 lesions were treated. Extensive staging showed no evidence of distant metastases. Results Disease progression after surgery occurred within a mean time of 27 months (range 12 to 84 months). Recurrent tumor size varied from 5 to 34 mm. Five patients previously had undergone surgical resection of retroperitoneal recurrent lesions. Five patients had neoadjuvant treatment and 2 patients had adjuvant treatment. After RFA all lesions were completely ablated with no residual enhancement. After a mean follow-up of 13 months (range 6 to 16 months) no recurrent or residual disease was evident. Conclusions Percutaneous RFA of surgical relapse of RCC is effective and should be assessed as first line loco-regional treatment on a larger patient group.

Quantitative measurement of radiofrequency volumetric tissue reduction by multidetector CT in patients with inferior turbinate hypertrophy

To objectively assess the efficacy of radiofrequency thermal ablation of inferior turbinate hypertrophy. Thirty-five patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. Radiofrequency energy was delivered to four sites in each inferior turbinate. Patients were evaluated before and 8 weeks after intervention. Subjective evaluation of nasal obstruction was performed using a visual analogue scale (VAS), and objective evaluation of the turbinate volume reduction was calculated using multidetector CT. Volumetric measurements of the preoperative inferior turbinate were compared with postoperative values on both sides. The great majority of patients (91.4%) exhibited subjective postoperative improvement. Mean obstruction (VAS) improved significantly from 7.45±1.48 to 3.54±1.96. Significant turbinate volume reduction was achieved by the surgery on both right and left sides [(preoperative vs. postoperative, right: 6.55±1.62cm(3) vs. 5.10±1.47cm(3), (P<0.01); left: 6.72±1.53cm(3) vs. 5.00±1.37cm(3), (P<0.01)] respectively. Radiofrequency is a safe and effective surgical procedure in reducing turbinate volume in patients with inferior turbinate hypertrophy. Multidetector CT is an objective method of assessment in detecting radiofrequency turbinate volume reduction.

Radiofrequency ablation treatment in the pelvic cancer relapses of rectal carcinoma

Background: To evaluate retrospectively the technical feasibility, safety and efficacy of radiofrequency thermal ablation (RFA) in the treatment of recurrent rectal cancer that is painful, non-resectable and no longer susceptible to radiotherapy and chemotherapy. Materials and Methods: Ten patients, average age 64 years, with pelvic recurrence of rectal carcinoma were treated with RFA to reduce pain and limit the progression of local disease. The lesion mean size was 4.7 cm(range of 3.2e9 cm). RFA was performed with computed tomography-guided percutaneous approach using local anaesthesia and conscious sedation in all patients. The therapeutic outcomes were evaluated by contrast- enhanced TC after 1, 3, 6 and 12 months. The absence of tumour enhancement on the TC image was considered to indicate complete tumour necrosis. Results: Complete tumour necrosis was found in 3 patients, sub-total in the remaining 7. Complete pain relief was obtained in 6 patients and a significant reduction of pain in the remaining patients (mean VAS score from7.4 before treatment to 1.5 after treatment). Abscess formation in the pre-sacral space and a bladder-rectal fistula after RF treatment was observed in 2 patients. The mean follow-up was 40 months (7–55months); 7 patients died of local tumour or distant progression. Three patients are still alive with 2 of them disease free. Conclusion: In selected cases, the RFA of pelvic recurrent rectal cancer can be considered a feasible and effective treatment in the control of pain and in the stabilisation of recidivism.

Radiofrequency ablation for the treatment of HCC – Maybe much more than simple tumor destruction?

COMMENTARY ON Radiofrequency thermal ablation for hepatocellular carcinoma stimulates autologous NK-cell response. Zerbini A, Pilli M, Laccabue D, Pelosi G, Molinari A, Negri E, Cerioni S, Fagnoni F, Soliani P, Ferrari C, Missale G. Gastroenterology, 2010 May;138(5):1931–1942. Eup 2010 Jan 11. Copyright 2010. Abstract reprinted with permission from Elsevier Inc. www.ncbi.nlm.gov/pubmed/20060829 Abstract: Background & Aims Radiofrequency thermal ablation (RFA) is a minimally invasive technique used as standard local therapy of hepatocellular carcinoma and second-line treatment for metastatic liver tumors. Studies in preclinical models and in patients have shown that thermal destruction of tumor tissue can enhance anti-tumor cellular responses, but our knowledge of its impact on natural killer (NK) cells is still very limited. Methods Thirty-seven patients undergoing RFA for hepatocellular carcinoma were studied for peripheral blood lymphocytes counts followed by phenotypic and functional characterization of NK-cell population. Results Peripheral blood lymphocytes kinetics revealed an increased frequency and absolute number of NK-cells expressing higher levels of activatory along with reduced levels of inhibitory NK receptors, and increased functional NK-cell activity. A prevalent expansion of the CD3(−)CD56(dim) NK subset was observed compared to the CD3(−)CD56(bright) counterpart. Interferon-gamma production, anti-K562 cell-cytotoxicity, and antibody-dependent cell-cytotoxicity, appeared consistently increased in terms of both absolute activity and killing efficiency at 4weeks after RFA, as compared to baseline. Interestingly, when recurrence-free survival was assessed in two groups of patients separated according to higher vs lower enhancement of cytotoxicity and/or interferon-gamma production, a significant difference was observed, thus suggesting a potential predictive role of NK functional assays on efficacy of RFA. Conclusions RFA can lead to stimulation of NK-cells with a more differentiated and proactivatory phenotypic profile with general increase of functional activities. This observation may be relevant for development of adjuvant immunotherapeutic strategies aimed at enhancing NK-cell responses against primary and metastatic liver tumors. Copyright 2010 AGA Institute.

Radiofrequency Thermal Ablation of Hepatic Metastases of Adrenocortical Cancer – A Case Report and Review of the Literature

Radiofrequency thermal ablation (RFA) has shown promise as a technique for treating solid tumors. This method has been suggested as an alternative to surgery in patients with adrenocortical carcinoma (ACC). We reviewed the literature, and report the case of a patient with stage 4 ACC who received intraoperative and percutaneous RFA of two liver metastasis according to a standard ablation protocol. Post-interventional imaging in our patient demonstrated that after both interventions, a stellar-like structure of vital tumor tissue had remained within the coagulation necrosis. This was the starting point of a fast and progressive tumor recurrence. We suspect heat-sink effects of blood vessels in the highly vascularized metastasis to cause the tumor recurrence. In literature, there are only a few reports of RFA in ACC patients. In addition, there is no large randomized trial investigating the efficacy of RFA against surgery in those patients. Presently, RFA in ACC should be restricted to patients in whom surgery is contraindicated. It is necessary that strongly vascularized ACC metastases deserve a modified ablation protocol due to perfusion related cooling effects and to increase the efficacy of RFA.

Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

Objective The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); the second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

Experiences in US-Guided Percutaneous Radiofrequency Ablation of 44 Renal Tumors in 31 Patients: Analysis of Predictors for Complications and Technical Success

Preliminary clinical studies have shown the feasibility, safety, and efficacy of radiofrequency thermal ablation (RFA) of renal tumors, but only a few have analyzed the prognostic factors for technical success and there are no long-term results. Our objective was to statistically evaluate our mid-term results of percutaneous US-guided RFA in order to define predictors for complications and technical success. We selected for treatment 44 tumors in 31 patients (24 with renal cell carcinoma, 7 with hereditary tumors, 15 with a solitary kidney), up to 5 cm in diameter. Eight adverse events occurred; 3 (6.8%) were major complications, successfully treated with interventional radiology procedures in 2 cases. Exophytic extension of the tumor was protective against complications (p = 0.040). Technical success was obtained in 38 lesions after one RFA session and in 39 (89%) after one more session, when possible. At the end of treatment, central extension was the only negative predictor for technical success (p = 0.007), while neither size >3 cm (p = 0.091) nor other prognostic factors were statistically significant. US-guided percutaneous RFA can be proposed for non-central renal tumors up to 5 cm, also in patients without surgical contraindications, thanks to a low incidence of complications and a high success rate. Randomized controlled trials versus surgery are now needed to investigate long-term comparative results.

Percutaneous computed tomography-guided radiofrequency thermal ablation of small unresectable lung tumours

The aim of the current study was to evaluate the safety and the efficacy of radiofrequency thermal ablation (RFTA) for the treatment of nonsmall cell lung cancer (NSCLC) and isolated pulmonary metastases (METs) from colorectal cancer (CRC). A total of 31 patients (15 with NSCLCs and 16 with CRC lung METs), with 36 lung tumour nodules (mean+/-sd diameter: 22+/-8 mm, range: 10-35 mm) underwent computed tomography (CT)-guided RFTA using expandable electrodes. Contrast-enhanced CT was performed before and after (immediately and 30+/-5 days) each RFTA session to assess immediate results and complications and repeated 3 and 6 months post-RFTA, as well as every 6 months thereafter, to evaluate long-term results. Complete radiological necrosis was defined as a nonenhancing area at the tumour site that was equal to or larger than the treated tumour; persistence of enhancement at the tumour site indicated incomplete treatment. Local recurrence was defined as an increase in tumour size and/or enhancing tissue at the tumour site. Complete radiological necrosis of the 36 tumours was achieved with 39 RFTA sessions and 42 electrode insertions. No major complications or deaths were observed. Six patients experienced mild-to-moderate pain during the procedure. There were five cases of pneumothorax, none requiring drainage and four cases of pneumonia, which were successfully treated with antibiotics. After a mean follow-up of 11.4+/-7.7 months (range of 3-36 months), the overall local recurrence rate was 13.9% (20 and 9.5% for NSCLC and CRC-METs patients, respectively). Nineteen of the 31 (61.3%) patients were alive (15 apparently disease free) and 12 (38.7%) had died (three from causes unrelated to their cancer). Radiofrequency thermal ablation seems to be a safe, effective method for producing complete ablation of small nonsmall cell lung cancers and pulmonary colorectal cancer metastases.

Ultrasound-guided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches

Only 10% to 20% of patients with primary and colorectal metastatic liver tumors are candidates for curative surgical resection. Even after curative treatment, tumors recur commonly in the liver. As a less invasive therapy, radiofrequency thermal ablation (RFA) of primary, metastatic, and recurrent liver tumors was performed under percutaneous, laparoscopic, or open intraoperative ultrasound guidance. The safety and local control efficacy of RFA were investigated. RFA was performed mostly in patients with unresectable hepatomas or metastatic liver tumors. Patients with large tumors, major vessel or bile duct invasion, limited extrahepatic metastases, or liver dysfunction were not excluded. An RFA system with a 15-gauge electrode-cannula with four-pronged retractable needles was used. All patients were followed for more than 8 months to assess morbidity and mortality, and to determine tumor recurrence. Sixty RFA operations were performed in 46 patients: 11 patients underwent repeat RFA once or twice. A total of 204 tumors were treated: 70 hepatomas and 134 metastatic tumors. Tumor size ranged from 5 mm to 180 mm (mean 36 mm). RFA was performed in 29 operations for 81 tumors percutaneously, in seven operations for 14 tumors laparoscopically, and in 24 operations for 109 tumors by open surgery. Combined colorectal resection was carried out in five operations and combined hepatic resection was carried out in three operations. There was one death (1.7%) from liver failure, and there were three major complications (5%): one case of bile leakage and two biliary strictures due to thermal injury. There were no intra-abdominal infectious or bleeding complications. The length of hospital stay ranged from 0 to 2, 1 to 3, and 4 to 7 days for percutaneous, laparoscopic, and open surgical RFA, respectively. During a mean follow-up period of 20.5 months, local tumor recurrence at the RFA site was diagnosed in 18 (8.8%) of 204 tumors. The risk factors for local recurrence included large tumor size and major vessel invasion: recurrence rates for tumors less than 4 cm, 4 to 10 cm, and greater than 10 cm, and for those with vessel invasion were 3.3%, 14.7%, 50%, and 47.8%, respectively. Ten of 18 tumors recurring locally were retreated by RFA, and eight of them showed no further recurrence. Ultrasound-guided RFA is a relatively safe, well-tolerated, and versatile treatment option that offers excellent local control of primary and metastatic liver tumors. The appropriate use of percutaneous, laparoscopic, and open surgical RFA is beneficial in the management of patients with liver tumors in a variety of situations.

Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors.

Radiofrequency thermal ablation (RFA) can be performed safely and effectively to control local disease in patients with advanced, unresectable liver tumors. Prospective study of 76 patients with unresectable liver tumors who underwent RFA at a private tertiary referral hospital. Ninety-nine RFA operations were performed to ablate 328 tumors. Complications and local recurrence. There was 1 death (1%), major complications occurred in 7 operations (7%), and minor complications occurred in 10 operations (10%). Local recurrence was identified in 30 tumors (9%) at a mean follow-up of 15 months. Size (P<.001), vascular invasion (P<.001), and total volume ablated (P<.001) were associated with recurrence but the number of tumors was not (P =.39). Radiofrequency thermal ablation provides local control of advanced liver tumors with low recurrence and acceptable morbidity.

Radio frequency interstitial thermal ablation of metastatic liver tumours

Introduction: Radio frequency thermal ablation (RFA) of focal liver metastatic lesions has received much recent attention as minimally invasive treatment of such pathologic entities. The purpose of the study was to evaluate the efficacy of RFA in the treatment of liver metastases from different tumors. Methods: In the period October 1998–January 2001, 29 patients affected by 38 focal lesions, age range 31–86 years old, 16 males and 13 females were treated in our Institution by RFA. Sixteen patients had liver metastases from colorectal cancer, four from gastric cancer, three from breast, two from kidney, one from anal carcinoma, one from esophageal cancer, one from pancreas, and one undetermined. Average metastases size was 3.22 cm (range 1.7–6 cm). All patients, except three, had the primary tumor already resected before the treatment of liver metastases. In six cases, RFA was repeated to complete ablation for a total of 35 procedures. Eight treatments were performed under general anesthesia after laparotomy, 27 ultrasound-guided procedures were performed percutaneously, 6 of them in general and 21 under local anesthesia. Results: Mean follow up was 12.9±6.9 months (range 2–27 months). One patient who underwent liver resection plus RFA of a second lesion, had a subphrenic abscess treated by percutaneous computed tomography (CT)-guided drainage, another patient had left intra-hepatic portal branch thrombosis, which recovered spontaneously. One patient died 11 months after treatment, a second patient died after 6 months. A follow up CT scan was done in 25 of 29 patients. In those 25 patients, 31 focal lesions were treated. The amount of focal lesion necrosis based on CT scan was complete (100%) in 24 lesions, nearly complete (90–99%) in 1 lesion, and partial in 6 lesions (50–89%). Conclusion: RFA is an effective and safe treatment modality for metastatic liver tumors. Larger future studies and longer follow up will be needed to evaluate the impact on survival with respect to surgical resection.