<b>RFA of Tumors in Lung, Liver, Bone, Adrenal or Kidney</b>
Perhaps the following websites will help you better understand Radio Frequency Ablation. I underwent RFA less than a month ago, for a liver met, and found it a whole lot easier than previous resections. Best of Luck, F

http://www.radweb.mc.duke.edu/info/rfa.html

http://www.uicc.org/publ/pr/archives/99050401.shtml

http://www.livertransplant.org/radiofrequencyablation.html

Spend some time here - see the series
http://rfa.ucsf.edu/patient/rita.html     

Another extensive site - from the NIH 
http://www.cc.nih.gov/drd/rfa/    

http://www.radiotherapeutics.com/patient.shtml 

http://www3.mdanderson.org/DEPARTMENTS/liver/ablation.htm 

University of Mississippi 
http://vir.umc.edu/      

RFA - How Does it Work?
http://www.livertransplant.org/radiofrequencyablation.html 


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Our decision to for Radio Frequency Ablation (RFA) of Bev's two ~5 cm lung tumors was based on our conclusion that there was very little downside risk and that avoiding a thoracotomy was highly desirable. Our rationale was as follows:
1) If the RFA fails surgery can still be done. Doing RFA closes the door to absolutely no other procedure.
2) The RFA procedure is 'trivial' in comparison to the major insult of a thoracotomy; the percutaneous puncture incision for RFA is only 3 mm (1/8").
3) Surgery is done under general anesthesia with its inherent risks of morbidity and mortality; recovery time is typically 3-4 months. RFA is most often done as an outpatient procedure under conscious sedation; you're up on your feet and out and around in a day or two and full recovery time is a week or so.
4) RFA can be done as many times as is necessary - it is not self-limiting in terms of scar tissue, etc. If part of the tumor is missed the first time (unlikely) it's no big deal to go in again for the remainder. If new nodules pop up in the same lung or in the other lung, it's easy to do them as they appear; that's not the case with surgery.
5) In my wife's case a thoracotomy and surgical wedge resection would have taken about 30% of her lung capacity; RFA took about 5%.
6) The journal-published results of RFA on liver/kidney tumors seems quite good - although there is no comparable long-term experience with lung tumors.
7) The new RadioTherapeutics Co-Access Electrode System (press release at http://radiotherapeutics.com/news-coaccess.html ) seems to solve many problems. It provides a cannula with a removable trochar for percutaneous insertion into the tumor. The RFA electrode is then inserted though the same cannula for the RFA procedure.
 Cordially, Neil December 2001
Do not limit your interest to RFA. Think in broader terms so as to include cryoablation, photodynamic therapy, laser ablation, VATS, etc. All of these minimally invasive procedures have the potential to accomplish some of the things that previously could only be done with the "gold standard" of open surgery. A good summary regarding RFA can be found at the U.S. Government National Institute of Health site http://www.cc.nih.gov/drd/rfa/ Information about the equipment used can be found at http://www.radiotherapeutics.com/coaccess.shtml 
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<b>What is Radio Frequency Ablation? </b>
Written by Beth C, November 2001
 
Radio Frequency Ablation (RFA) is a procedure used to destroy undesirable tissue. Important to cancer patients, this procedure is being used to destroy tumors in the liver and lungs, and shows promise to destroy lesions in the breast, bone, kidney, pancreas, prostate and adrenal gland. 
RFA starts by passing radio frequency energy through the lesion. Heat is generated at the site of the lesion through agitation caused by this energy. This heat produces coagulation and cellular destruction --necrosis -- resulting in destruction of the lesion or tissue. 
Radio Frequency Ablation is a specialized technique, and should be carried out in a specialized treatment center. Celiotomy (abdominal incision) or laparoscopic approaches are preferred for RFA because they allow IOUS (intra-operative ultrasound), which may demonstrate hidden additional metastases. Operative RFA also allows concomitant resection, Cryosurgical Ablation, or in liver RFA, placement of a hepatic artery infusion pump, and isolation of the liver from adjacent organs. Laparoscopy and intraoperative ultrasound are essential in staging patients with hepatic malignant neoplasms. 
For liver metastases, the procedure can be used to treat the small residual tumor load in the contralateral lobe following liver resection in those considered unresectable at the first presentation. This new therapeutic strategy increases surgical resectability in patients previously judged unresectable. RFA can also be combined with cryosurgical ablation. 
How does it work? 
Using conventional imaging methods -- ultrasound, CT scan, or MRI -- an electrode is positioned strategically within the lesion. The electrode is then connected to a radiofrequency generator and the energy is delivered into the tissue. As the cells are heated, they are destroyed. The mechanism of RFA is similar to that of a microwave oven, heating from the inside out. The tissue reabsorbs the destroyed cells over a period of time. 
RFA can be carried out percutaneously --puncturing through the skin-- meaning without a classical surgical incision. Percutaneous RFA should be reserved for patients at high risk for anesthesia, those with recurrent or progressive lesions, and those with smaller lesions sufficiently isolated from adjacent organs. 
Radio frequency ablation when combined with Cryosurgical Ablation reduces the morbidity of multiple freezes. RFA is safer than Cryosurgical Ablation and can be performed via different approaches (percutaneously, laparoscopically, or at celiotomy).
The duration of the procedure depends on a number of factors, including the number of applications and the location of the lesions. RFA may be performed through an open incision or via laparoscopy -- through multiple, small skin incisions. RFA can also be done percutaneously -- through small skin punctures. 
Generally, patients will have IV access through which they will be given medication. The need for general anesthesia, sedation, or pain medication will be determined by the clinical intervention approach. Every effort is made to ensure that patients do not feel pain during the procedure. 
The length of hospitalization depends on how the procedure is performed, however, patients may only be in the hospital overnight. 
<b>Complications </b>
Complications of RFA can include bleeding into the chest or abdominal cavities or other structures, burns of vascular structures or skin or diaphragm, persistent pain, pleural effusions, cholecystitis, abcesses, trauma to the liver, and liver failure. Some of the RFA complications can be fatal. Another complication is increased temperature caused by tumor lysis syndrome. This condition results when the destroyed tumor releases enzymes that the body treats as a foreign substance. The body fights these enzymes like it would an infection, causing the elevated temperature, and less often, mild fatigue. However, within a couple of days the patient's temperature should return to normal. 
RFA is a safe and effective alternative for the attempted ablation of unresectable malignancies and when used adjunctively can reduce the morbidity of cryosurgery. Percutaneous and laparoscopic RFA can be performed effectively with less than 24 hours of hospitalization. Radio frequency ablation alone or combined with Surgical Resection or Cryosurgical Ablation resulted in reduced blood loss and shorter hospital stay. 
<b>Recurrence / Retreatment </b>
Some lesions, especially larger lesions, may require more than one treatment session to destroy the entire tumor. In some patients additional lesions will arise at a later date and these can also be retreated. As long as the lesions are visible via CT Scan or ultrasound, they can be treated using RFA, as many times as necessary. 
Tumors near a major blood vessel often recur locally since the blood vessel itself draws heat away from the area during the treatment in what is known as the "heat sink phenomenon." As a result, the tumor cells next to the blood vessel cannot get hot enough to achieve cellular death. 
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<b>RFA & Cryoablation of Tumors</b>
This is Dr SEWELLS FAQs Sheet.
<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 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 hand full 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. 
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<b>Lung RFA and Insurance Hassles</b>
Dear Madam Brimstone,
My insurance company is giving me hassles about paying for lung RFA. Do you have any corroboratory material I can use to convince them?
About To Be Burned Twice
...
Dear Twice,
Here are some citations for the insurance company.
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ASCO conferencevPublication Year: 2001 number 1342
http://www.asco.org/prof/me/html/01abstracts/0031/1342.htm
<b>Effect of Radio Frequency Ablation on Lung Cancer.</b>
Shijun Kang, Rongcheng Luo, et al

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 J Surg Res 2001 Aug;99(2):265-271
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11469896&dopt=Abstract 
<b>Radiofrequency ablation for eradication of pulmonary tumor in rabbits.</b>
Miao Y, Ni Y, Bosmans H, et al

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 ASCO Publication Year: 2001 number 2203
 http://www.asco.org/prof/me/html/01abstracts/0018/2203.htm
<b>Percutaneous Imaging-Guided Radio Frequency Ablation (RFA) of Secondary Colorectal Cancers (CRC) in Lung.</b>
Julie King, Jing Zhao, et al

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http://www.hemeonclinx.com/thearts.cfm?artid=489286&specid=17&ok=yes
Chest
<b>Radiofrequency thermal ablation of a metastatic lung nodule</b>
Adrian M. Highland1, Paul Mack2 and David J. Breen3, 
E-mail: david.breen@virgin.net 

Abstract. Pulmonary metastases are a common finding in patients with colonic adenocarcinoma. We report the treatment of a metastatic lung nodule with radiofrequency (RF) ablation under CT guidance. This case illustrates the use of RF ablation in a patient in whom surgical resection was no longer possible and where chemotherapy was unlikely to produce benefit. This technique may offer a viable method of cytoreduction when other treatments have not succeeded.

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<b>Checking the FDA site for approvals.</b> On devices, they seem to be approved by what they are used for. The one for several of the RFA models say:
"...for the ablation and coagulation of soft tissue, including the partial or complete ablation of non-resectable liver lesions."
I think that mets in the lung would probably meet the approved category of "soft tissue."
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<b>Subject: lung RFA and FDA approval</b>
 
From: Been Burned
To: About to be Burned 2ce
Dear Burned:
Mme Brimstone is right when she indicates that the FDA approval for RFA is via its approval for the equipment. Dr. Sewell of U of Mississippi was very explicit about that when I asked him about the status of FDA approval for his treatment of lung tumors by RFA. He said that there will not be any additional approval for this specific procedure, that the FDA has approved the equipment for the treatment of cancer and that's it. He will write papers for professional meetings and publications, but acceptance of the procedure will come as it is done and the results become known. So, use the abstracts and texts that show that RFA kills cancer cells, there should be no doubt about that, and keep escalating, take to the State Insurance Commissioner if you need to.
Sincerely,
Been Burned and Ready to Be Burned Again if I Need to.
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 For more information about RFA and cryoablation, see the Metastatic Disease sites for liver and lung.
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Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases -

Cancer Volume 97, Issue 3, 2003. Pages: 554-560
Published Online: 17 Jan 2003
http://www.hemeonclinx.com/thearts.cfm?artid=495514&specid=17 

Conclusion: Percutaneous, image-guided RFA is a safe and well tolerated procedure for the treatment of unresectable primary or metastatic adrenocortical carcinoma. The procedure is effective for the short-term local control of small adrenal tumors, and is most effective for tumors less than 5 cm...
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<b>There is an ongoing clinical trial for lung RFA in California, Dr. Suh</b>

Phase II Study of Radiofrequency Ablation in Patients With Refractory or Advanced Pulmonary Malignancies   
Protocol IDs: UCLA-990802401a, NCI-G01-2011
Protocol Type: treatment
Sponsorship: NCI-sponsored, NCI-sponsored trial in cancer center
Status: Active
Age Range: Not specified

OBJECTIVES
I. Determine the safety and toxicity of radiofrequency ablation in patients with refractory or advanced pulmonary malignancies.

II. Determine the efficacy of this treatment, in terms of local control, in these patients.

III. Determine whether CT scan is a reasonable imaging assessment tool for treatment delivery and follow-up in these patients.

ENTRY CRITERIA
--Disease Characteristics--
Diagnosis of a primary or secondary intrathoracic malignancy
Any cell type or origin
Involving the intrapulmonary, mediastinal, or pleural/chest wall
Inoperable primary or metastatic cancer to the lung 
Refractory to or not amenable to conventional therapy (e.g., surgery,chemotherapy, or radiotherapy)
Single or multiple lesions that are non-contiguous with vital structures or organs such as:
 Trachea
 Heart
 Aorta
 Great vessels
 Esophagus
Less than 5 cm in largest dimension
Accessible via percutaneous transthoracic route

--Prior/Concurrent Therapy--
See Disease Characteristics

--Patient Characteristics--
Age: Not specified
Performance status: Not specified
Life expectancy: Not specified
Hematopoietic: Not specified
Hepatic: Coagulation profile normal
Renal:Not specified

OUTLINE
Patients undergo percutaneous CT-guided radiofrequency ablation directly to the tumor over 2 hours.
Patients are followed at 1, 3, 6, and 12 months.

STRATIFICATION Not abstracted
SPECIAL STUDY PARAMETERSNot abstracted
END POINTSNot abstracted
PROJECTED ACCRUALA total of 30 patients will be accrued for this study.

WARNING
The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer.  Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test.  The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment.  A responsible investigator associated with this clinical trial should be consulted before using this protocol.

PARTICIPATING ORGANIZATIONS/STUDY CONTACTS
Robert D. Suh, Chair Ph: 310-794-2168Jonsson Comprehensive Cancer Center, UCLA
STUDY CONTACTS  Robert D. Suh, Ph: 310-794-2168  Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, U.S.A.
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Updated March 2003 doctordee
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 The information on this site might very well be inaccurate, should be relied upon only for general information, is never intended to be medical advice, and is not a substitute for consulting your own physician.
Any listing of services or people is not complete, and is NOT a recommendation or guarantee. 

 
 
 

