Radiofrequency Ablation Therapy for Solid Tumors - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

Radiofrequency Ablation Therapy for Solid Tumors

Description:

Radiofrequency Ablation Therapy for Solid Tumors – PowerPoint PPT presentation

Number of Views:2699
Avg rating:3.0/5.0
Slides: 108
Provided by: akam
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Radiofrequency Ablation Therapy for Solid Tumors


1
Radiofrequency Ablation Therapy for Solid Tumors
  • Anthony Kam
  • Staff Clinician
  • Diagnostic Radiology Department
  • Warren G. Magnuson Clinical Center
  • National Institutes of Health

2
Agenda
  • Motivation for ablative therapy
  • History of RF in medicine
  • Effects of heat on tissue
  • Factors affecting coagulation volume
  • Monitoring therapeutic efficacy
  • RF ablation of tumors
  • Conclusion

3
Options for cancer treatment
  • Systemic
  • Chemotherapy
  • Biologic, immune, and hormonal therapy
  • Regional / local
  • Surgery
  • Radiation
  • Arterial infusion
  • Ablation

4
Team approach
Radiation Oncology

Medicine
Interventional Radiology
Surgery

5
Liver cancer
  • Primary hepatocellular carcinoma (HCC)
  • Worldwide
  • Most common solid tumor
  • 5th most common cancer in men
  • Incidence gt 1 million / yr
  • Median life expectancy 1-18 mo
  • Dependent on degree of cirrhosis
  • Male/female ratio 2-4
  • Regional variation
  • Highest in Southeast Asia and sub-Saharan Africa

Abeloff MD Clinical Oncology, 2nd ed., New
York, 2000, Churchill Livingstone, 1681-1721.
6
Age-adjusted incidence rates per 100,000 of
primary liver cancer in men
El-Serag HB. J Clin Gastro 2002 35(5)S72-S78
7
HCC
  • United States
  • 1999 estimate
  • 14,500 new cases of HCC
  • 13,600 deaths from HCC
  • Age-adjusted incidence increased by gt 100 last
    20 yrs
  • Age-adjusted HCC-related mortality rate increased
    by 40 last 10 yrs
  • Risk factors
  • Chronic hepatitis C
  • Chronic hepatitis B
  • Alcoholic cirrhosis

8
HCC
  • United States
  • 4 million people infected with hepatitis C
  • 20 will develop cirrhosis
  • 2-7 will develop HCC within 20 yrs of infection

McKean-Cowdin R et al. J Clin Oncol 2000
182258-2268.
9
Age-adjusted mortality rates for primary liver
cancer in US
El-Serag HB. J Clin Gastro 2002 35(5)S72-S78
10
Survival rate among all patients diagnosed with
HCC in SEER registries
El-Serag HB. J Clin Gastro 2002 35(5)S72-S78
11
Liver cancer
  • Secondary (metastases)
  • Liver is 2nd most common site of metastasis from
    other solid cancers
  • Lymph node 1st
  • Liver is most common site of metastasis from
    colorectal cancer
  • Stomach, pancreas, melanoma, lung, and breast
  • Liver metastases marker for disseminated disease
  • 30 of patients who die from cancer have liver
    metastases
  • Liver metastases are the cause of death in up to
    20 of patients who die from cancer


12
Treatment of liver cancer
  • Systemic
  • Chemotherapy palliative
  • Primary
  • Single agent no significant response (lt 20)
  • Combination agents controlled clinical trials
  • Secondary response reflects response of primary
    cancer
  • Colorectal mean response 26
  • Gastric mean response 34
  • Breast mean response 46
  • Minimal impact on survival
  • Biologic/hormonal therapy
  • Experimental interferon-alpha and tamoxifen for
    HCC

Abeloff MD Clinical Oncology, 2nd ed., New
York, 2000, Churchill Livingstone, 886-914 and
1681-1721.
13
Treatment of liver cancer
  • Regional/local
  • Surgical resection
  • Potentially curative
  • Primary
  • 5-year survival untreated 2-6
  • 5-year survival after partial hepatectomy 25-50
  • Survival better for
  • No vascular invasion
  • Tumor lt 5 cm
  • Solitary tumor
  • Negative resection margin of 1 cm
  • Second primary or local recurrence at 2 yr 50

Abeloff MD Clinical Oncology, 2nd ed., New
York, 2000, Churchill Livingstone, 1681-1721.
14
Resection for HCC
  • 10-15 HCC patients eligible for resection
  • Contraindications for resecting HCC
  • Extrahepatic disease
  • Insufficient hepatic reserve
  • Cirrhosis
  • Tumor burden
  • Previous resection
  • Multi-focal disease
  • Tumor in unresectable locations
  • Main portal vein involvement
  • Comorbid disease

15
Regional/local treatment
  • Surgical resection
  • Secondary
  • Colorectal cancer
  • 5-yr survival after resection of 1-3 metastases
    25-47
  • 5-yr survival lower for
  • Synchronous hepatic metastases
  • Duke stage C primary
  • Zero resection margin
  • Resection of 4 or more metastases not universally
    recommended
  • Recurrence of metastatic disease in liver after
    resection 40-50

Abeloff MD Clinical Oncology, 2nd ed., New
York, 2000, Churchill Livingstone, 886-914.
16
Resection for metastatic liver cancer
  • lt 15 of patients are eligible for resection
  • Contraindications for resecting liver metastases
  • Presence of extrahepatic disease
  • Except for resectable local recurrence of
    colorectal cancer
  • Insufficient hepatic reserve
  • gt 3 metastases
  • Except in investigational protocols
  • Proximity to major vascular and biliary
    structures
  • Comorbid conditions

17
Regional/local treatment
  • Surgical transplantation
  • Curative
  • Primary
  • For liver-only nonresectable disease or
    resectable disease with Child B/C cirrhosis
  • 5-yr survival rates 57-75
  • Survival better for
  • Single tumor lt 5 cm
  • 3 tumors, each 3-4 cm
  • No invasion of major blood vessels, lymph nodes
  • No extrahepatic disease
  • Survival with above criteria similar to
    transplantation without HCC

Patt CH et al. J Vasc Interv Radiol 2002
13S205-210.
18
Regional/local treatment
  • Surgical transplantation
  • Limited by organ availability and long waiting
    period
  • Living donor liver transplantation
  • Neoadjuvant transarterial chemoembolization being
    evaluated

19
Regional/local treatment
  • Radiation
  • Whole-liver radiation limited to 30 Gy because of
    radiation hepatitis
  • Sections of liver can receive more than 30 Gy
    with yttrium-90 microspheres or conformal
    external beam radiation
  • Intra-arterial 90Y microspheres (TheraSphere)
  • Phase II studies show utility in stabilizing HCC
  • Likely survival benefit at doses gt 100 Gy
  • 1-yr survival similar to surgical resection for
    HCC

Salem R et al. J Vasc Interv Radiol 2002
12S223-S229.
20
Regional/local treatment
  • Arterial infusion
  • Palliative
  • Transcatheter arterial chemoembolization (TACE)
  • Primary
  • 2 randomized controlled trials show increased
    survival
  • Hong Kong Trial 3-year survival
  • TACE 26
  • Supportive care 3
  • Spanish Trial 2-year survival
  • TACE 63
  • Supportive care 27

Lo CM et al. Hepatology 2002 351164-1171. Llove
t J et al. Lancet 2002 3591734-1739.
21
TACE
  • Secondary
  • Colorectal
  • Not surgical candidates and fail systemic
    chemotherapy
  • Median survival similar to historic controls on
    systemic chemotherapy (8-14 mo)
  • Increased survival with
  • Metastatic disease confined to liver
  • Homogeneous uptake of chemoembolic agents
  • Hypervascular tumor
  • Better performance status
  • Near normal liver function
  • Tumor shrinkage
  • Phase 3 trial comparing TACE and systemic
    chemotherapy with systemic chemotherapy alone in
    progress

Sullivan KL. Semin Oncol 2002 29145-151.
22
Regional/local treatment
  • Ablation
  • Hypothesis Local control of tumor may improve
    survival
  • Numerous methods
  • Chemical
  • Ethanol, acetic acid
  • Thermal
  • RF
  • Microwave
  • Laser
  • Focused ultrasound
  • Cryotherapy

23
Why RF?
  • Ability to create a controlled focal thermal
    lesion
  • Minimal complications
  • Large necrosis volume
  • (vs. microwave, laser, focused ultrasound)
  • Useful for any solid tumor (vs. ethanol)
  • Minimally invasive (vs. cryotherapy)
  • Cost
  • Better marketing by RF manufacturers

24
History of RF in medicine
  • Caveman / Hippocrates / Hindu medics
  • 1891 dArsonval
  • RF heats tissue without neuromuscular excitation
  • 1910s Electrocautery
  • Beer bladder tumors
  • Clark superficial tumors
  • 1928 Cushing and Bovie
  • Bovie knife
  • Excise tissue
  • Cauterize bleeding tissue

25
Bovie knife
26
History
  • 1970s Percutaneous electrocoagulation for
    chronic pain
  • Gasserian ganglion or sensory nerve roots of CN 5
    for trigeminal neuralgia
  • Sensory nerves of lumbar facets for lumbar pain
  • Dorsal root ganglia for cervicobrachial and
    lumbar pain

27
History
  • Catheter ablation as treatment for cardiac
    arrhythmias
  • 1982 Scheinman and Gallagher DC
  • 1986 Hoyt RF
  • Advantages of RF vs. DC ablation
  • Greater control of thermal lesion because of
    longer duration of energy application (30-60 s)
  • Absence of barotrauma
  • Lower complication rate
  • No skeletal or cardiac muscle stimulation
  • Minimal discomfort during energy delivery

28
History
  • 1990 McGahan and Rossi
  • Independently proposed that RF ablation can be
    used to treat small liver cancers
  • 2000 RF endoluminal ablation of the greater
    saphenous vein for treatment of lower extremity
    venous insufficiency

29
Mechanism of RF heating in tissue
  • RF electric field drives translational motion of
    tissue ions
  • Resistive heating from ionic current around probe
    electrode or electrodes
  • Conductive heating into adjacent tissue

30
RF heating in tissue
Resistive heating
Conductive heating
More conduction
31
Effects of heat on tissue
Vaporization and carbonization
100
Irreversible damage
Instantaneous protein coagulation
Ideal ablation temperature
60
Tissue Temperature (C)
50
Nerve damage
45
Hyperthermia
42
40
Homeostasis
Rhim H et al. Radiographics 2001 21S17-S39.
32
Hyperthermia 42-45 C
  • Enhances cytotoxic effect of chemotherapy and
    radiation
  • Inhibits action potential
  • Increases tissue permeability
  • Increases blood vessel permeability
  • Upregulates certain gene expression
  • Heat shock proteins
  • Stimulates angiogenesis
  • Activates thermally sensitive encapsulations
  • Liposomes

33
Coagulation necrosis
34
Factors affecting coagulation volume
  • Probe electrode
  • Method of energy delivery
  • Tissue properties
  • Sensitivity of tumor tissue to heat

35
Single monopolar needle
  • Original electrode design
  • Coagulation necrosis diameter up to 1.6 cm in
    liver

McGahan JP et al. AJR 2001 1763-16.
36
Monopolar multiprobe arrays
  • Umbrella electrode with multiple hooked tines
  • Boston Scientific/Medi-Tech (formerly Radio
    Therapeutics)
  • LeVeen needle
  • 14-gauge cannula houses 10-12 retractable curved
    electrodes with array diameter up to 4 cm

From Boston Scientific
37
Monopolar multiprobe arrays
  • RITA Medical Systems
  • StarBurst XL
  • 14-gauge cannula with 9 electrodes and a live
    trocar tip
  • 5 integrated thermocouples
  • Array diameter extends to 5 cm

From RITA Medical
38
(No Transcript)
39
Monopolar multiprobe arrays
  • Cluster array of electrodes
  • Radionics
  • 3 17-gauge electrodes arranged in a triangle with
    spacing 0.5 cm
  • With cooling and pulsed mode, coagulation
    diameters up to 7 cm can be achieved

From Radionics
40
Bipolar arrays
  • Heat is generated around both active and ground
    needle electrodes
  • Mack electrode
  • Active and ground electrodes on same 6-French
    probe
  • Coagulation diameters up to 3 cm
  • Not available in US (Celon, Berlin, Germany)

41
Internal cooling
  • Cooling an electrode
  • Reduces heating of tissue nearest electrode
  • Allows delivering a higher power without tissue
    charring
  • Radionics Cool-tip
  • Single electrode coagulation diameter 1.6 cm
  • Single electrode with cooling up to 3.6 cm

From Radionics
42
Method of energy delivery
  • Impedance control
  • Boston Scientific/Medi-Tech
  • Ramp power incrementally to peak power (200 W) to
    minimize tissue dessication and charring
  • Maintain peak power for 15 min or until impedance
    rises abruptly (impedes out)
  • If device does not impede out, restart at peak
    power for 15 min or until device impedes out
  • If device impedes out, restart at 70 of peak
    power for 15 min or until device impedes out
  • Two rises in impedance indicate a successful
    ablation

From Boston Scientific
43
Impedance control
44
Impedance control
  • Radionics
  • Ramp power to maximum (up to 200 W) over about 1
    min
  • Maintain maximum power until impedance rises 20 O
  • Reduce power to 10 W for 15 s
  • Return to maximum power until impedance rises
  • If power level cannot be maintained for 10 s,
    subsequent power level is reduced
  • Continue cycles for ablation time of 12 min
  • Tissue temperature gt 60 C at 3 min after peak
    temperature indicates successful ablations

From Radionics
45
Pulsing of energy
  • Allows higher energy deposition
  • Periods of low power allow preferential cooling
    of tissue adjacent to electrode
  • Single cooled electrode
  • No pulsing coagulation diameter up to 3.6 cm
  • With pulsing up to 4.2 cm

46
Method of energy delivery
  • Temperature control
  • RITA Medical
  • Increase to peak power (up to 250 W) over 0.5 -2
    min
  • Maintain peak power until temperature at
    electrode tips exceeds a target temperature
  • Deploy electrodes in stepped increments while
    maintaining target temperature
  • Regulate power to maintain target temperature for
    25 min
  • Temperatures of deployed electrodes gt 50 C at 1
    min after ablation indicate successful ablation

From RITA Medical
47
Tissue properties
Electrical conductivity at 100 -1000 kHz (S/m) Thermal conductivity, nonperfused (W/m K) Perfusion (ml/kg min) Heat capacity (J/kg K) Density (kg/m3)
Skin 0.01-0.2 0.266-0.498 120 3150-3710 1100
Lung (inflated) 0.10-0.17 (cat, in-vivo) N/A N/A N/A 260
Lung (deflated) 0.22-0.32 (cat, in-vivo)) N/A N/A N/A 1050
Liver 0.14-0.23 0.512 1000 3600 1050
Spleen 0.15-0.24 0.539 1200 3720 1054
Skeletal muscle 0.45-0.74 (cat, in-vivo) 0.449-0.546 38 3430-3810 1041
Blood 0.68-0.71 (rabbit) 0.484-0.491 N/A 3600-3720 1060
Kidney 0.33-0.49 0.513-0.564 4000 3890 1050
Duck FA. Physical Properties of Tissue.
Academic Press, San Diego, 1990.
48
Improving heat conduction
  • Infuse saline during RF ablation
  • Increases electrical conductivity
  • Increases thermal conductivity
  • RITA Medical
  • StarBurst XLi
  • Infuse 5 saline at 0.1-0.2 ml/min in each of 5
    active electrodes
  • Coagulation diameter 7 cm

From RITA Medical
49
Improving heat conduction
  • Berchtold
  • HiTT System
  • 14-16 gauge needles
  • Infuse 0.9 saline at 20-40 drops/min
  • Coagulation diameter up to 5 cm in 15 min

From Berchtold
50
Heat loss
  • Blood flow
  • Capillary level perfusion
  • Vessels seen on CT/MR (gt 1-2 mm) bulk flow

51
Heat loss from perfusion
Goldberg SN. Eur J Ultrasound 2001 13129-147.
52
Convective cooling with bulk flow
Adrenal cortical carcinoma metastasis
During
Immediate post
6 weeks
53
Convective cooling with bulk flow
Pre
6 months
12 months
54
Decreasing heat loss
  • Blood flow reduction
  • Embolize tumor prior to RFA
  • Clamp feeding vessels if RFA performed
    intra-operatively
  • Occlusion balloon
  • Vasoconstricting drugs

55
Intra-operative RFA with Pringle
Pre
Immediate post
56
Increasing sensitivity of tumor to heat
  • Combination therapies prior to RFA
  • Chemotherapy
  • Chemoembolization
  • Radiation
  • Targeted drug delivery

57
Chemoembolization and RFA
58
Monitoring therapeutic efficacy
  • During procedure
  • Guidance
  • US
  • CT
  • Combined US and CT
  • MR
  • Ablation adequacy
  • Thermometry
  • Extent of coagulation

59
(No Transcript)
60
(No Transcript)
61
Thermometry
  • Invasive
  • Integrated thermocouple in active electrode or
    dedicated tines (Radionics, RITA, optional for
    Berchtold)
  • Separate temperature sensors
  • Target T gt 60 C at 3 min after maximum
    temperature reached
  • Sampling errors

62
Thermocouples near sciatic nerve and rectum
63
Thermometry
  • Noninvasive MR thermometry
  • T1 relaxation of water protons
  • Sensitivity 1/C
  • Diffusion constant of water
  • Sensitivity 2/C
  • Water proton resonance frequency
  • Chemical shift about 0.01 ppm/C
  • Proton spectroscopic imaging (chemical shift
    imaging)
  • Water
  • Temperature-sensitive contrast agents

64
MR thermometry
  • Temperature-sensitive contrast agent TmDOTA-
  • Thulium-1,4,7,10-tetraazacyclododecane-1,4,7,10-te
    traacetate
  • Proton chemical shifts 1 ppm/C
  • Proton shifts independent of concentration, pH,
    or presence of plasma macromolecules and ions
  • In animal study phase

Hekmatyar SK et al. Int J Hyperthermia 2002
18165-179.
65
Comparison of MR thermometry methods
Absolute or relative Linearity Sensitivity Spatial resolution Temporal resolution Motion artifacts
T1 Relative Poor Poor Good Good Average
Diffusion Relative Poor Average Good Good Very poor
PRF Relative Excellent Good Good Excellent Average
Spectroscopy, water Absolute Excellent Excellent Very poor Very poor Poor
Spectroscopy, contrast agent Absolute Excellent Excellent Average Average Average
Quesson B et al. JMRI 2000 12525-533.
66
T1 subtraction overlay
5 min
10 min
Fiedler VU et al. JMRI 2001 13729-737.
20 min
67
MR thermometry
  • Not used widely
  • Lack of robust method
  • Interventional MR units not widely available
  • Need to switch between RF and imaging

68
Extent of coagulation
  • US
  • Area of hyperechogenity not reliable indicator of
    area of coagulation
  • CT with contrast
  • Enhancing hyperemic rim
  • Volume of coagulation may not peak till several
    days after ablation in combination therapies

69
Evolution of echoes
70
Hyperemic rim after RFA of 4 cm HCC
Pre
15 min post
Goldberg SN et al. AJR 2000 174323-331.
71
Monitoring therapeutic efficacy
  • After procedure
  • Follow-up gt 1 year needed to document complete
    ablation of tumor
  • Order of sensitivity for detecting residual or
    recurrent tumor
  • PET/CT gt Dynamic MR gt MR gt CT

72
Fused PET/CT validates margin
Pre CT
Pre CT PET
Post CT PET
73
PET/CT detects recurrence
74
PET/CT identifies viable tumor
75
CT detects residual tumor
Residual tumor after first RFA
Post second RFA
Ahmed M et al. JVIR 2002 13S231-S243.
76
Shrinkage of thermal lesion with time
Pre
RFA
2 months
6 months
12 months
18 months
77
RFA of solid tumors
  • Liver
  • Kidney
  • Bone
  • Lung
  • Adrenal
  • Spleen
  • Pancreas
  • Lymph node
  • Head and neck
  • Breast
  • Prostate
  • Pelvis

78
RFA of liver tumors
Pre
Post
8 months
79
RFA of liver tumors
  • gt 3000 cases reported in literature
  • Tumor size is the most important predictor for
    local recurrence

Tumor diameter (cm) Complete ablation in
lt 2.5 90
2.5-3.5 70-90
3.5-5 50-70
gt 5 lt 50
Dupuy DE et al. J Vasc Interv Radiol 2001
121135-1148. Neeman Z et al. Tech Vasc Interv
Radiol, in press.
80
RFA of liver tumors
  • Other predictors of suboptimal ablation
  • Proximity of tumor to large vessels
  • Type of tumor
  • Lower success with infiltrative vs. encapsulated
    HCC
  • Lower success with colorectal metastases vs. HCC
    or breast metastases

81
RFA of liver tumors
  • Complications lt 5
  • Common
  • Focal pain
  • Pleural effusion
  • Regional hemorrhage
  • Rare
  • Hepatic abscess
  • Biliary fistula
  • Peritonitis

82
RFA of liver tumors
  • Results
  • Small ( 3.5 cm) HCC
  • 5-year survival 33
  • Local recurrence 14-29
  • Colorectal metastases (0.9-9.6 cm)
  • 3-year survival 46
  • Local recurrence 39
  • New metastases 66

Buscarini L et al. Eur Radiol 2001
11914-921. Solbiati L et al. Radiology 2001
221159-166.
83
RFA of renal tumors
Post 4 years
Pre
84
RFA of renal tumors
  • Renal cell carcinoma
  • Typically an incidental finding on imaging (2/3)
  • Tumors lt 3 cm
  • Slow growth rate (3-4 mm/year)
  • Rarely metastasize
  • Management
  • Observation
  • Partial nephrectomy
  • Experimental ablation
  • Tumors gt 3 cm
  • Partial or complete nephrectomy

85
RFA of renal tumors
  • Complete ablation more likely if tumor is
  • lt 3 cm
  • Exophytic
  • Complications
  • Minor
  • Transient hematuria
  • Transient psoas irritation
  • Flank pain numbness
  • Major
  • Ureteral stricture
  • Paranephric hematoma

86
Ureteral stricture after RFA
Pre
Post
6 months after stent
87
RFA of renal tumors
  • Potential indications for renal RFA
  • Contraindications to nephrectomy
  • Solitary kidney
  • Hereditary predisposition to renal tumors
  • Von Hippel-Lindau (RCC)
  • Hereditary papillary renal cancer
  • Intractable hematuria from renal tumor

88
RFA of renal tumors
  • Initial results
  • RFA of RCC lt 3cm has a radiologic success of 79
    at 2 months with 50 W generator
  • RFA of RCC lt 3 cm has a radiologic success near
    100 at 2 months with 200 W generator

Pavlovich CP et al. J Urol 2002 16710-15. Wood
BJ. Personal communication.
89
RFA of bone tumors
RCC metastasis
Pre
15 months
During
Dupuy DE et al. J Vasc Interv Radiol 2001
121135-1148.
90
RFA of bone tumors
Adenocarcinoma metastatic to the sternum
Pre
During
6 weeks
91
RFA of bone tumors
  • Metastatic cancer is the most common bone tumor
  • Lung, breast, and prostate cancer account for gt
    80 of bone metastases
  • Often painful
  • Conventional treatment is radiation
  • Average 4 weeks to respond
  • Pain relief poor (complete response 54)
  • Frequent relapse after initial response
  • Ongoing Phase I-II study of effects of RFA on
    bone metastases

92
RFA of lung tumors
Metastatic esophageal squamous cell carcinoma
During
9 months
Rose SC et al. J Vasc Interv Radiol 2002
131051-1054.
93
RFA of lung tumors
Primary squamous cell carcinoma
During
3 months post RFA 6 weeks post external radiation
27 months post RFA
Dupuy DE et al. RadioGraphics 2002 22S259-S269.
94
RFA of lung tumors
  • Most patients with primary or secondary lung
    cancer are not surgical candidates
  • Systemic chemotherapy and radiation do not
    significantly increase survival in nonsurgical
    patients
  • Possible adjuvant role of RFA in cytoreduction

95
RFA of lung tumors
  • Limited experience
  • Complications
  • Pleurisy
  • Pleural effusion
  • Pneumothorax (20)
  • Hemoptysis
  • Bronchopleural fistula
  • Infection
  • Bleeding 1 peri-procedural death
  • CVA 1 case

Neeman Z et al. Tech Vasc Interv Radiol, in
press. Dupuy DE et al. RadioGraphics 2002
22S259-269.
96
RFA of lung tumors
  • Microemboli to cerebral circulation have been
    detected during lung RFA
  • Clinical significance unknown
  • Need to evaluate neurologic status after lung RFA

Rose SC et al. J Vasc Interv Radiol 2002
131051-1054.
97
RFA of adrenal tumors
Adrenal cortical carcinoma
Pre
20 months
98
RFA of adrenal tumors
  • Primary adrenal cortical carcinoma
  • Surgical resection is the only effective
    treatment
  • Recurrence common, 40
  • Reoperation prolongs survival
  • 5-year survival 50 vs. 8

Bellantone R et a. Surgery 1997 1221212-1218.
99
RFA of adrenal tumors
  • Adrenal metastases
  • Surgical resection of isolated adrenal metastasis
    may improve survival
  • Controversial
  • Initial result
  • RFA of adrenal cortical tumors lt 5 cm has a
    short-term radiologic success of 67
  • Mean follow-up 10.3 months
  • Primary and metastatic

Beitler AL et al. J Surg Oncol 1998
6954-57. Wood BJ et al. Cancer 2003 in press.
100
RFA of splenic tumors
RCC metastasis
Pre
6 months
101
RFA of chordoma metastasis
Pre Painful
Immedidate post
6 months
102
RFA of fallopian tube carcinoma metastasis
Painful
Pre
Post
103
RFA of melanoma metastasis
Immediate post
6 months post with recurrence
104
RFA of ovarian cancer
Pre Painful
6 months post with recurrence
105
Conclusions
  • RF ablation is a recent promising development in
    cancer therapy
  • There is increased survival with RF ablation of
    limited small liver tumors
  • No long-term follow-up data on RF ablation of
    other tumors
  • Randomized controlled trials needed to assess
    efficacy of RF ablation versus surgical resection
    for various indications

106
Conclusions
  • Role of RF ablation in cancer therapy
  • Complete tumor eradication
  • Palliation
  • Part of combination therapy
  • Challenges
  • Real-time temperature mapping
  • Heat as a delivery enhancer for molecular or gene
    therapies
  • Cancer therapy requires a multidisciplinary
    approach

107
Credits
  • Dr. Bradford Wood
  • Dr. Ziv Neeman
  • Dr. Richard Chang
  • Julie Hvizda
About PowerShow.com