16.06.2014

Rfa treatment for liver cancer

Radiofrequency Ablation (RFA) is a medical procedure in which a tumor is destroyed by utilizing high frequency electrical currents to generate heat. This procedure is performed by experienced Interventional Radiologists and may be used to treat tumors in the lung, liver, kidney, abdomen, and bone. RFA is also utilized to provide relief when a tumor invades surrounding tissue causing pain. Talk with your oncologist, radiation oncologist or surgeon to refer you for a consultation. Make sure to let your doctor know if you have any allergies to medications or if you are on any blood thinners, including Coumadin (Warfarin), Heparin, Lovenox, Plavix or over-the-counter medications such as Aspirin, as these will need to be stopped prior to the procedure. You will need to have your blood tested in order to determine your liver and kidney function prior to the procedure. You will be positioned on the CT scanner and once under anesthesia a needle-like RFA probe will be placed inside the tumor. Radiofrequency waves will then be passed through the probe increasing the temperature within the tumor tissue resulting in destruction of the tumor. After the procedure, you will be admitted to the hospital overnight for observation and pain control.
You may feel relaxed or sleepy as you recover from the anesthesia and your throat may be sore from the breathing tube. You will need to return for a follow-up CT or MRI scan at one month to determine the success of the procedure. If you develop fever or severe pain contact our office at 352-333-7847 (7VIP) or call your referring physician. The procedure is typically used to treat hepatocellular carcinoma (primary liver cancer), or metastasis (secondary liver cancer) from other types of cancers.
The procedure itself is not painful, however light sedation medications may be administered through an IV in order to prevent any discomfort. You will be positioned on the table and a wire and catheter will be inserted into the large artery in the leg.
X-Ray images will be taken with contrast dye in order to visualize the artery that feeds the tumor. After injection is complete, the wire and catheter are removed, and a sterile dressing is applied. Once discharged home from the hospital you should be able to resume your normal activities within 1 week. Selective Internal Radiation Therapy or SIRT is a form of treatment for patients with either primary or metastatic liver tumors.
Currently, this is considered a “palliative” and not a “curative” therapy, however, it has been shown to be effective with extending and improving patient’s quality of life. The procedure is similar to an angiogram and is performed on an outpatient basis with rare need for overnight admission to the hospital.
Once the catheter is positioned appropriately the Y-90 particles will be painlessly injected into the vessel. After injection is complete the wire and catheter are removed, and a sterile dressing is applied.
Typically Y-90 therapy is delivered in two separate sessions and can be repeated as long as it remains technically possible and you remain healthy enough to tolerate the procedure. This website is intended to be used for information about Doctors Imaging Group, its services, and any affiliates that are retrieved from this site. Science, Technology and Medicine open access publisher.Publish, read and share novel research. 2.1The Licensed Material may not be used in any final materials distributed inside of your company or any materials distributed outside of your company or to the public, including, but not limited to, advertising and marketing materials or in any online or other electronic distribution system (except that you may transmit comps digitally or electronically to your clients for their review) and may not be distributed, sublicensed or made available for use or distribution separately or individually and no rights may be granted to the Licensed Material. 2.2One copy of the Licensed Material may be made for backup purposes only but may only be used if the original Licensed Material becomes defective, destroyed or otherwise irretrievably lost. Radiofrequency ablation (rfa) - radiofrequency denervation, Radiofrequency ablation (rfa) medical procedure radiofrequency denervation (rfd), radiofrequency thermolysis rhizolysis. Nih cc: radiofrequency thermal ablation tumor therapy, Liver cancer & rfa treatment for kidney cancer what are the complications? Radiofrequency ablation (rfa) liver tumors, Radiofrequency ablation (rfa) of liver tumors.
Recently,minimally invasive interventional radiological therapies to be effective in both primary tumors & metastatic tumors. Most patients with HCC are diagnosed at intermediate to advanced stage, and there is no standard treatment for these patients. About 10-20% of patient of HCCs are eligible for resection & even after curative resection, post-operative recurrence is common. PRECISION TACE were 1st in the country to treat a patient of unresectable Hepatocellular Carcinoma by Intraarterial chemoembolization with newly introduced Drug Eluting beads (DC Beads). This drug eluting bead is specifically designed to be loaded with Doxorubicin (chemotherapy drug), This Drug Delivery Embolization System brings a new level of efficacy accuracy and convenience to trans-arterial chemo-embolization. Chemoembolization is a dual therapeutic approach involving Concomitant hepatic artery embolization and Infusion of a concentrated dose of chemotherapeutic drugs. It is a minimally invasive Interventional Radiological procedure, which means it requires only a tiny nick in the skin. The Interventional Radiologist makes a small nick in the skin at groin, insert a catheter, identifies arteries supplying to tumor(s) by using angiography with contrast media injection and then inject drug eluting bead loaded with chemotherapy drug (doxorubicin) that block the tiny vessels supplying the tumor (s). 5)Evaluation of patient by team specialist (Interventional Radiologist, cancer & Gastroenterology). Six month Follow-up case of Hepatic tumor: - Contrast enhanced CT scan shows significant reduction in size of liver tumor. As it is done by interventional Radiologist, he can see inside the body without opening it through CT scan, ultrasound, DSA thereby treating exact site of disease without effecting surrounding structures. Until recently, systemic treatment like chemotherapy was the only option for patients with inoperable liver cancer. RFA may be the only local treatment option for many cancers that cannot be surgically removed, and it does not have the unpleasant side effects of systemic options.
RFA may be used alone, or in combination with other treatments, including surgery, chemotherapy and chemoembolization. In general, RFA is used for cancers that cannot be removed by surgeons because of their size or location, or because the patient is not healthy enough to have open surgery. Lung tumour – If tumour is producing intolerable symptoms, RFA helps to reduce the size of tumor, thereby reducing the symptoms. Many patients have intolerable pain or other debilitating symptoms that can be relieved by RFA that shrink cancerous growth. Radiation therapy and in some cases, chemotherapy also may be recommended following surgery to destroy any cancer cells that have been left behind or that may have spread during the operation. A 71-year-old male patient, with known hepatitis C, came to the hospital for an annual follow-up.
All procedures were performed on a Miyabi system that consists of a CT sliding gantry (SOMATOM Definition AS) and an angiography system (Artis zee ceilingmounted system). The Miyabi system is an integrated system with an angiography unit and a CT sliding gantry unit.
SOMATOM Sessions Online is your source of the latest information from the world of CT scanning. The metal probe is guided into the tumor by using imaging guidance (CT scan and Ultrasound).
After hours or on weekends, go to the nearest emergency room or call North Florida Regional Medical Center at 352-333-4000 and ask for the Interventional Radiologist on call. During the procedure, small plastic particles impregnated with chemotherapy are injected directly into the artery that feeds the tumor(s). Some liver metastases treated include: neuroendocrine including carcinoid, gastrointestinal stromal tumors, melanoma, breast and colon. The procedure may be safely repeated many times over the course of many years as long as it remains technically possible and you remain healthy enough to tolerate the procedure.
Delivery of the radioactive microspheres (the radioisotope Yttrium-90 or Y-90) is through a small catheter that is advanced into the blood vessels feeding the tumors. There is ongoing research to determine its role as a “first-line” treatment option in certain patients.
There are minimal side effects, with the most common being fatigue for about one week following treatment. You will be monitored in the recovery area for a few hours to make sure you are feeling well prior to discharge. Information contained in this website is not intended to be used as medical advice, and should not be used as a substitute for professional medical advice. Except as specifically provided in this Agreement, the Licensed Material may not be shared or copied for example by including it in a disc library, image storage jukebox, network configuration or other similar arrangement.
Liver cancer is the fifth most common cancer in the world and third most common cause of cancer-related death. Definitive surgical intervention is not feasible in most cases due to extreme tumor extension, multiplicity of tumor foci & associated liver cirrhosis at the time of diagnosis.


Because of these reasons, transarterial chemoembolization has been aggressively tried to treat HCCs by Interventional Radiologist and it improves survival of patients with unresectable HCC and is likely to become the standard treatment. In addition there are other advantages like it requires lower dose of Doxorubicin in the system and allows higher doses of Doxorubicin in the tumor for longer time, and it is a consistent treatment.
It is performed under sedation and local anesthesia – feeling no pain and usually requires a short hospital stay. This blockade of blood supply to the tumor causes infarction and delivering a high concentration of drug to the target tumor (s) for longer time while reducing systemic toxicity.
These physicians specialize in the use of X-rays, Digital subtraction angiography (DSA) and other techniques such as ultrasound, computed tomography (CT) and magnetic resonance (MR) to see inside the body without surgery. Unfortunately, these medicines cannot be given in doses high enough to control most liver cancers because of their toxic effects, many of which are life-threatening.
Also concomitant use of RFA helps in reducing the dosage of chemotherapy and thus reducing the side effects.
The tumors themselves usually are not painful, but when they press against nerves, or interfere with vital organs, they can cause unbearable suffering. Depending on the patient and the type of cancer, the surgeon may remove the entire breast (mastectomy) or only the tumor and the tissue surrounding it (lumpectomy). A 4-phase liver CT examination revealed a hepatocellular carcinoma (HCC) with a diameter of 3 cm.
A 4-phase liver CT examination revealed a hepatocellular carcinoma (HCC) with a diameter of 3 cm. Both units share a common patient table, facilitating quick transportation of the patient from one unit to the other without risking dislodgment of the catheter. It is primarily aimed at physicians, physicists, researchers, and medical technical personnel in radiology.
The alternative to RFA may be surgery, radiation therapy, cryosurgery, chemotherapy, chemoembolization or no treatment at all. This treatment results in tumor destruction by eliminating its blood supply and administering high dose chemotherapy adjacent to the cancer cells. These particles are slightly larger than normal red blood cells and when injected into the blood vessels supplying the tumor they will lodge there and deliver the radiation dose directly to the tumor without subjecting the rest of the liver or the body to the radiation.
Smith2[1] Clinical Engineering Department, Faculty of Engineering and The Built Environment, Tshwane University of Technology, Pretoria, South Africa[2] Centurion Academy, Pretoria, South Africa1. Upon download of any film Licensed Material, you will be invoiced a non-refundable access service fee of one hundred fifty dollars ($150) USD or such other local currency amount as Getty Images may apply from time to time. The patient was scheduled for transarterial chemoembolization (TACE) to be followed by radiofrequency ablation (RFA). Whereas the angiography offers higher spatial resolution necessary for detailed imaging of the blood vessels, the CT offers better low contrast resolution which is necessary for imaging the extension of the tumor and to confirm the retention of the Lipiodol in the entire tumor after TACE. It offers reports on innovations and clinical applications in clinical fields such as neurology, cardiovascular disease, and acute care, and deals with topics such as low-dose and dual-energy CT scanning.
IntroductionIn recent times, different strategies for thermal ablation therapy have been in use. Helping the hepatic surgeon: Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumours. The Licensed Material may only be used in materials for personal, noncommercial use and test or sample use, including comps and layouts.
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The contrast media was injected through a catheter that was advanced into the superior mesenteric artery (SMA). They include radiofrequency ablation, cryoablation therapy, laser ablation therapy, microwave ablation and high intensity focused ultrasound ablation, among others.
The other challenge presented in this case was caused by the special location of the tumor – directly below the diaphragm and above the gallbladder.
Radiofrequency ablation (RFA) is used to destroy pathological tissue by inducing tissue necrosis through the heating of targeted tissue [1]. Create your slideshowBy using the code above and embedding this image, you consent to Getty Images' Terms of Use.
A critical decision had to be made regarding the access path of the RFA procedure, necessary to avoid potential complications occurring to the lung or to the gallbladder. While ablation is currently used in the treatment of different diseases, tumour ablation is considered here, i.e.
The views displayed on the CT monitor and the three dimensional imaging were helpful to ensure a minimally invasive procedure. A super-selective angiogram as well as an embolization was performed at the level of segment 4 in both arteries (Figs. Apart from RFA, thermal ablation therapy involves other strategies employed in the destruction of cancerous tumours. Cryoablation therapy (or cryotherapy) uses liquid nitrogen (or the expansion of argon gas) to freeze and kill abnormal tissue. The follow-up confirming angiogram was performed through the common hepatic artery (CHA, Figs. After numbing the tissue around the mass, a cryoprobe, which is shaped like a large needle, is inserted into the middle of the lesion. An ice ball forms at the tip of the probe and continues to grow until the images confirm that the entire tumour has been engulfed, killing the tissue [2], [3]. Mueller, Treatment of intrahepatic malignancy with radio-frequency ablation: radiologic-pathologic correlation in 16 patients” (abstr), American journal of roentgenology, 168. A non-contrast CT was performed to confirm the retention of the Lipiodol® in the entire tumor (Fig. The temperature and duration of freezing necessary to induce complete killing and necrosis are based on numerous in vivo and in vitro animal studies, some of which have been reviewed by Gage & Baust [4]. Generally, it has been accepted that a minimum freezing temperature of -40oC must be reached for at least 3 minutes for complete eradication of the tumour [5].
A rapid freeze followed by a slow thaw is the most damaging to cells, and a minimum of two freeze-thaw cycles (freeze-thaw-freeze-thaw) was necessary for effective cryonecrosis to take place than a single cycle [6]. The cost of a cryoablation unit ranges upwards from $190,000, and each multi-use cryoprobe costs approximately $3,750 [7]. Laser Ablation (or interstitial laser photocoagulation) uses a highly concentrated beam of light to penetrate the cancerous tissue. The laser energy is emitted from an optical fibre placed within a needle positioned at the centre of the tumour using either stereotactic guidance or Magnetic Resonance Imaging (MRI) [8], [9]. Two methods for delivery of light have been described to produce larger volumes of necrosis: multiple bare fibres in an array and cooled-tip diffuser fibres. The major drawback to this technique is its cost, requiring $30,000 to $75,000 for a portable, solid-state laser and $3,000 per set of multiple (50) user fibres [10]. Microwave ablation (MWA) or microwave coagulation uses microwave tissue coagulator for irradiation.
Ultra-high frequency (2450 MHz) microwaves are emitted from a percutaneously placed microwave electrode inserted into the target tissue under ultrasonographic guidance. Microwave irradiation is carried out for about 60 seconds at a power setting of 60W per pulse. During irradiation, the ultrasonographic probe is placed adjacent to the microwave electrode to monitor the effectiveness of the tumour coagulation [11], [12]. High Intensity Focused Ultrasound (HIFU) ablation is a non-invasive treatment modality that induces complete coagulative necrosis of a deep tumour through the intact skin.
HIFU treatments are usually carried out in a single session, often as a day case procedure in the doctor’s office, with the patient either fully conscious, lightly sedated or under light general anaesthesia. One major advantage of HIFU over other thermal ablation techniques is that the transcutaneous insertion of probes into the target tissue is not necessary. The high powered focused beams employed in the procedure are generated from sources placed either outside the body (for treatment of tumours of the liver, kidney, breast, uterus, pancreas and bone) or in the rectum (for treatment of the prostate), and are designed to enable rapid heating of a target tissue volume, while leaving tissue in the ultrasound propagation path relatively unaffected [17].
Numerous extra-corporeal, transrectal and interstitial devices have been designed to optimise application-specific treatment delivery for HIFU procedures. This chapter focuses on the discussion of principles and application of the radiofrequency ablation therapy system as a minimally invasive treatment modality for hyperthermia therapy. Detailed work completed in the use of radiofrequency (RF) energy in cancer management by developing and testing an economical and effective thermal probe that will effectively destroy volumes of pathological tumours by means of hyperthermia is presented. Radiofrequency energy and the RF ablation systemBasically, the term radio-frequency refers not to the emitted waves, but rather to the alternating electric current that oscillates in the high frequency range.
This energy is formed from waves of electromagnetic energy moving together (or radiating) through space at the speed of light. This means that it is not strong enough to ionize atoms and molecules in cells or alter their genetic makeup. Radiofrequency energy is safer than many cancer therapies because it is absorbed by living tissue as simple heat. The main tumoricidal effect of RF ablation occurs because the absorption of electromagnetic energy induces thermal injury to the tissue.
But RF energy and the heat it generates does not alter the basic chemical structure of cells.


The system comprises of a closed circuit consisting of a radiofrequency generator circuit, a power amplifier circuit, and the control circuit. A power supply circuit is also included to meet the power supply requirements of the system.
The energy generated by the system is delivered to the tissue by the active electrode, whereas a dispersive electrode that acts as a patient plate provides a return part to complete the circuit.
Hyperthermic (thermal) coagulation necrosisCoagulation necrosis denotes “irreversible thermal damage to cells even if the ultimate manifestations of cell death do not fulfill the strict histological criteria of coagulative necrosis” [18]. The nature of the thermal damage caused by radiofrequency heating is dependent on both the tissue temperature achieved and the duration of heating. For successful ablation, the tissue temperature should be maintained in the ideal range (50 – 100oC) to ablate tumour adequately and avoid carbonization around the tip of the electrode due to excessive heating. For adequate destruction of tumour tissue, the entire volume of a lesion must be subjected to cytotoxic temperatures. Thus, the main objective of radiofrequency ablation therapy is to reach and maintain a temperature range of 50o – 100oC throughout the entire target volume for at least 4 – 6 minutes. Principles of radiofrequency ablation Radiofrequency ablation is physically based on radiofrequency current (about 460 kHz) that passes through the target tissue from the tip of an active electrode (RF thermal probe) towards a dispersive electrode which serves as the grounding pad. The active electrode has a very small cross-sectional area (a few square millimetres) with respect to the passive electrode. The active electrode is usually fashioned into the form of a needle-like probe that is inserted into the tumour. The dispersive electrode has a much larger area than the active electrode, on the order of 100cm2 or larger, and is usually placed firmly behind the right shoulder or the thigh of the subject, depending on the location of the tumour in the body. Current flowing into the dispersive electrode is the same as the current flowing into the active electrode. As a result of the difference in current density between the two electrodes, the energy at the tip of the probe leads to ionic agitation with subsequent conversion of friction into heat.
The tissue ions are agitated as they attempt to follow the changes in direction of alternating electric current as shown in figure 4 below. Figure 4.Ionic agitation by alternating electric currentThe agitation results in frictional heat around the electrode.
The marked discrepancy between the surface area of the needle electrode and the dispersive electrode causes the generated heat to be tightly focused and concentrated around the needle electrode.
The use of a large grounding pad ensures maximum surface area for dispersion of current from the needle electrode.
The grounding pad also maximizes dispersion of equal amounts of energy and heat at the grounding pad sites, thereby minimizes the risk of burns. The tissue underneath the passive electrode heats up only slightly, while the tissue in contact with the active electrode is resistively heated to elevated temperatures sufficient for tumour ablation (coagulative necrosis). The strategy of RF ablation is to create a closed-loop circuit including the RF generator, the needle electrode, the patient (tissue) and the passive electrode (grounding pad) in series. Appreciable advances have been made over the past decade to produce application devices for RFA. The Radionics probe is an internally cooled device that also uses pulsing sequences to improve heating. It has a thermocouple at the tip of the probe that registers the tissue temperature, and that is used to monitor its effect.
The LeVeen needle electrode is designed to deliver a consistent pattern of heat throughout the lesion [21]. These and other application devices for RFA are available for use in the USA and some parts of Europe. In spite of technical progress in the development of various application devices for radiofrequency ablation therapy, most patients with malignant tumours, especially in Sub-Saharan Africa, have not yet benefitted from this technology due to their limited availability and exhorbitant cost. A typical RF generator costs $25,000 and each single use probe costs approximately $800 to $1200 [22]. This paper presents the structure and experimental results of a low cost minimally invasive radiofrequency thermal probe developed for hyperthermia therapy.
The probe developed is effective and economical, and represents more than 70% in cost reduction compared to commercially available reusable RF thermal probes reviewed. Materials and methodsThe RF thermal probe developed was designed on a SolidWorks platform and manufactured according to design specifications.
The shaft of the needle is also insulated except for the tip which makes physical contact with the tumour or volume to be treated. The stainless steel needle is insulated, except for the exposed 20 mm tip that makes direct contact with tissue.
The insulation prevents normal tissue from being destroyed along with cancerous tissue during thermal ablation treatment. The probe (as shown in figure 5) is reusable and is made of epoxy-resin material that can be easily steam-cleaned. An essential objective of radiofrequency ablation therapy is to achieve and maintain a temperature range of 50 – 100oC throughout the entire target volume for at least 4 – 6 minutes [23-25]. This means that the outer limit of critical cell temperature where cell necrosis takes place is reasonably well-defined by the applied power and will be spherical around a point source if the impedance remains constant.
In practice, we have a short cylindrical contact volume in the tumour with non linear impedances. Liver, lung, brain, kidney and soft tissue were tested at different power settings to determine which power setting gives the best results with each tissue type in terms of the minimum time to reach the ideal temperature range, and the maximum time to remain within this range without charring or vapourizing. An RF generator (460 KHz) was connected in a closed circuit with the RF thermal probe, tissue sample, and dispersive electrode in series. Each tissue type was tested with different power settings, and each test was done for about 15 minutes. Results and discussionThe extent of coagulation necrosis is dependent on the energy deposited, local tissue interaction minus the heat lost.
Therefore, effective ablation can be achieved by optimizing heat production and minimizing heat loss within the area to be ablated. The relationship between these factors has been well characterized as the “bio-heat equation.” Heat production is correlated with the intensity and duration of the radio-frequency energy deposited. Heat conduction or diffusion is usually explained as a factor of heat loss in regard to the electrode tip.
Therefore, the cooling tissue by perfusion can limit the reproducible size of the ablation lesion in vivo. Macroscopic and microscopic examination of tissue samples tested show clear evidence of coagulation necrosis.
The best result was achieved with 2 watts, which showed a steady rise in temperature maintained within the ideal ablation temperature range.The plot in figure 7 shows that, while 2 watts was below the ideal temperature range, and therefore inadequate for effective tissue necrosis, 4 watts was too high and showed evidence of carbonization, resulting in a drop in temperature due to inhibition in conduction.
This means that the ideal temperature range for treatment will be reached quicker with 20 watts.
The 10 watts power setting produces temperature below the ideal range, and was therefore inadequate for ablating soft tissue.5.
Summary of resultsThe above results have been summarized in table 2 below showing the different tissue types, the best power settings suitable for each tissue type, the minimum and maximum time required to keep the temperature within the ideal ablation range of 50 to 1000C, and the total duration.
The total duration is the difference between the maximum time and minimum time.Tissue TypePower (w)Min.
ConclusionThe search for less morbid and less invasive techniques for cancer treatment has led to a strong drive within the global oncology community to develop and implement even more minimally invasive diagnostic and therapeutic procedures.
With several ablation techniques available, the ablation characteristics and method of application will differentiate one ablation method from another. Most thermo-ablative procedures could be performed in the doctor’s office as an outpatient procedure with mild or no sedation.
With RF ablation, it requires an increase in temperature to induce necrosis (tissue death). The heat needed for this necrosis requires that large amount of local anaesthetic be infused around the treatment site. This excess fluid blurs the ultrasound visualization of RFA and other heat-based ablation techniques.
Though all the available literature agree that thermal ablation therapy is relatively safe and much less traumatic than radical surgical procedures, some complications and side effects have been reported. Some of these complications and side effects have been associated with probe design, probe placement, or the use of multiple probes. Though multiple probes appear to be more successful in destroying larger tissue volumes, their use increases the risk of complications in the procedure. Finally, the high cost of RF ablation equipment, coupled with their limited availability has placed these treatment procedures above the reach of most patients and physicians in Sub-Saharan Africa.




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