<b>RFA & Cryoablation of Tumors

This is Dr Sewell's FAQs Sheet. </b>
<b>Patient Information Concerning Radio Frequency Tumor Ablation and Cryoablation of Tumors</b> 

Interventional radiologists at the University of Mississippi Medical Center are developing minimally invasive, image-guided methods of destroying primary and secondary tumors. Current therapies entail the use of thermal energy and are known formally as Percutaneous Magnetic Resonance (MR) - Guided Cryogenic Tumor Ablation or Percutaneous Computer Tomography (CT)- Guided Radio Frequency Tumor Ablation. Procedures are carried out with a radio frequency ablation probe or a cryoablation probe. Either instrument can be inserted through a small incision. Then the tip of the probe is secured in the target tumor under image guidance, such as CT or MRI, which assists the physician in his effort to destroy carcinomas by exposing the tumor to extreme fluctuations in temperature. Advantages of either technique include minimally invasive access to the defect without significant post-operative pain or discomfort related to the procedure as well as reduction of cost and recovery time in the hospital. Moreover, patients who do not qualify for conventional therapies because of unrelated but notable health problems may be suitable candidates for these innovative procedures. 

Cryoablation [sometimes called cryosurgery] is a theoretically sound therapeutic technique. It is performed with a machine that was developed in Tel Aviv, Israel, which uses pressurized argon and helium gases to regulate freezing and thawing processes. Visualization of the probe as it passes through the body allows for the introduction of the probe through a clear pathway and precise positioning of the probe. Once the probe is activated, freezing and thawing cycles are monitored with MRI. Multiple cycles are performed to obliterate as much of the tumor as possible. The procedure is performed under general anesthesia. After freezing, the probe is removed and the incision is closed with two or three sutures. Patients are awakened in the recovery room and transported to the general oncology ward for further observation. The oncology service as well as the interventional radiology service cares for the patient on the ward for the remainder of the patient's hospital stay. Recovery time ranges from two to eight days, depending on the location of the lesion and depth of treatment. Risks of the procedures include freezing of non-target tissues, internal bleeding, infection and damage to normal structures in the vicinity of the target tumor. 

Freezing tumor cells interrupts critical cell functions and results in cell death. Cells that remain within the body are absorbed along with scar tissue. The effectiveness of cryotherapy has been well documented as it is utilized in the treatment of numerous lesions throughout the body. Freezing and thawing cycles have been well studied; they are not experimental in nature. Accessing the tumor through a small incision under image guidance comprises the innovative aspect of this operation. 

Hospital stay after radio frequency tumor ablation is generally shorter than after cryoablation, in part because of the smaller probe that is used in the former procedure. Some lesions that could not be treated with conventional methods can be addressed and eliminated through modern technological advances. Patients with other significant health problems who are not candidates for conventional treatments might be eligible for these novel techniques. It is not uncommon for cryogenic or radio frequency treatments to be the only ones available to the patient who has additional health problems. Radio frequency ablation is less painful and takes less time than cryotherapy. 

<b>Frequently Asked Questions 

Am I a candidate for these procedures? What do I do to receive this treatment? </b>
Answer: Each procedure has benefits and risks unique to itself. The location of the tumor, the size of the tumor, the type of tumor as well as any previous chemotherapy or radiation all have bearing on which procedure would benefit you most. After obtaining pertinent clinical information and reviewing CAT scans and MRI's, I will be able to recommend which treatment would be your best option. The initial step in evaluation is to forward your most recent MRI and CAT scan images and reports, a medical history, a biopsy report, and a pathology slide to the University of Mississippi Medical Center for my review. Additionally, a phone consultation with your oncologist is usually very beneficial to me in obtaining more pertinent information. 

<b>What is the estimated time before I can receive any treatment?</b>
Answer: In general, it usually takes at least two weeks to complete the initial evaluation where I review the clinical information and the x-ray images. An appointment in the Oncology Clinic here at the University can then be scheduled if the procedure appears technically feasible based on the preliminary information I receive. That appointment can usually be obtained in approximately two to three weeks. Overall, some patients are treated within two to three weeks of my first becoming aware of their situation, but is more routine to have a patient treated four to six weeks after the initial contact. 

<b>Is this treatment offered anywhere else? </b>
Answer: Both of these treatments are new and thus there are very few people within the world who are experienced in these procedures. We are certainly one of the leading centers in the world with only a handful of other locations suited and capable of performing these procedures. In general, my personal experience places my rank as one of the top three people in the world performing these procedures. 

<b>Is this considered a major surgery? </b>
Answer: Yes. Both procedures usually require general anesthesia and one to several days within the hospital. There is the risk of significant complications such as bleeding or infection and even death with both of these procedures depending on the location of the tumor. 

<b>Are these procedures experimental? </b>
Answer: Some cryoablation procedures are investigational although cryoablation has a long history of successfully treating many malignancies. Technical advances such as utilizing the MRI for guidance are considered the experimental aspects. The radio frequency ablation is considered a very new procedure, however technically it is not experimental as the FDA has approved it here in the United States as off the shelf technology. In any event, the technology is so new that there are only a handful of people experienced with this equipment and procedure within the world. 

<b>Is this a cure for cancer? </b>
Answer: Not at this time. This has the potential to function as a cure (a surgical cure) if the tumor is caught in its early stage where it is localized and has not metastasized. Once it has spread to different locations (metastasis), the only chance for a cure is a systemic therapy such as a cancer vaccine or perhaps some form of chemotherapy. You may think of this procedure as the equivalent of surgically removing that tumor which is frozen because once it is frozen entirely, those tumor cells are dead and will no longer grow. Tumor cells that are left alone (not frozen) for whatever reason will continue to grow unless some form of therapy is administered to them as well. 

<b>What type of tumors/cancers are normally treated by these methods? </b>
Answer: Tumors in any organ in the abdomen or pelvis can be treated by both cryoablation and radio frequency ablation. Tumors in the lung are limited at this time to radio frequency ablation because of the breathing motion prohibiting visualization on MRI.

<b>What happens to the tumor during the procedure? </b>
Answer: During cryoablation, the tumor is frozen. The water within the cell freezes and expands which ruptures the cell membrane and in effect kills the tumor cell. During radio frequency ablation, heat is generated at the probe tip such that the tumor is essentially cooked. Both methods apply extreme temperature to the tumor in an effort to kill the tumor cell. 

<b>What effect will this have on my body? </b>
Answer: The goal is to halt the growth of the tumor being treated. Potential side effects include damage to structures adjacent to the area treated. These side effects can be temporary or permanent. They potentially include infection and bleeding as well as loss of function of certain organs. The procedure is planned such that these risks are minimized. However, there is always some degree of risk with all surgical procedures. 

<b>Compared to chemotherapy and radiation, is this a better treatment? </b>
Answer: Chemotherapy and radiation have their own merits and deficits. Which treatment is best for you and your tumor depends on a lot of individual variations which need to be addressed on a case-by-case basis. In general terms, this is a surgical treatment which can be used to augment chemotherapy or radiation and at this time is not planned as a substitute for either. When dealing with the tumor, one approach is to hit the tumor hard with all guns rather than just with one bullet. 

<b>What is the success rate? </b>
Answer: Cases performed so far have included those patients with few options and very large or extensive tumors. Regardless, the success rate has been quite dramatic in certain cases. It is too early to determine whether survival has been significantly improved in the patients whom I have treated. However, all patients seem to be satisfied with the results at this time, and I can certainly say that I have prolonged the survival in a hand full of patients treated. The preliminary data is encouraging. One definite and clear benefit is significant pain relief from metastasis to the bone treated with cryotherapy. 

<b>How much pain will I experience? </b>
Answer: The amount of pain the patient experiences is variable and depends on the size of the tumor treated as well as the location. Some patients have immediate pain relief whereas some patients have increased pain for the first couple of days which then returns to normal and begins to decrease. 

<b>How long will the procedure take? </b>
Answer: Cryotherapy usually takes several hours under general anesthesia. Radio frequency ablation is usually quicker because the tumors treated with the radio frequency ablation are generally smaller. In any case, the procedure usually lasts from two to five hours. 

<b>How long will I be in the hospital? </b>
Answer: A hospital stay can be as short as twenty-four hours and as long as seven to eight days depending on the lesion treated, the location, and the size of the tumor. 

<b>How much will this cost? </b>
Answer: The cost of the procedure is variable and depends on the method of ablation (cryotherapy versus radio frequency) as well as the location, size, and number of tumors. Each patient's case can be addressed individually, and our business manager will be happy to work with you in determining the expected cost of the procedure. 
