Radiofrequency ablation is a novel, new technology that uses energy from radio waves to destroy cancer. This procedure has been mostly used for liver cancer, and has allowed us to effectively rid the body of cancer without removing the liver. We are now curing some patients who were not curable ten years ago. This technique is a great adjunct and alternative to surgery, and is safe, rapid, and effective for the patient.

When surgical resection of liver cancers is not possible or advisable, radiofrequency ablation (RFA) or cryosurgery have been used to destroy these cancers. There are a number of reasons that this may be the chosen treatment. It is less invasive than open removal, and therefore it is less traumatic on the body and the patient recovers sooner and at less expense than a long hospital stay.

The liver is a solid organ that bleeds very easily. Therefore, when deciding whether or not a tumor should be cut out, location of the tumor is very important. If the tumor is near the surface of the liver it would be easy to cut it out. However, if it is located deep in the liver in order to reach it larger portions of the liver would have to be removed. This is of even more concern when there are multiple tumors involved. In some cases of multiple tumors in the past surgery was not done at all, because it would require removing too much liver tumor. Now radiofrequency ablation and cryosurgery allow the surgeon to kill the tumor and small amounts of surrounding tissue only, leaving most of the liver tissue intact.

Your surgeon is the best person to make this recommendation. However, radiofrequency ablation has essentially replaced cryosurgery for the destruction of hepatocellular cancers (hepatomas) and metastatic cancer to the liver.

The advantage of the radiofrequency ablation over cryosurgery is that a smaller probe is used which causes necrosis (heating to kill cells without breaking them). Cryosurgery breaks up the cells and therefore can cause changes in the body which result in a 1-2% death rate. The radiofrequency probe is smaller and therefore it can be placed in the body from the outside without having to do an operation, or it can be placed laparoscopically. There is also less bleeding after taking out the probe because of the small size. The equipment is less cumbersome and the procedure is performed in less time. Therefore, cryosurgery is not used very frequently. Cryosurgery could be used in order to fix a probe into the tumor so that the tumor can be handled better. This is an exceptional circumstance.

Radiofrequency ablation involves placing a needle less than 1/8 of an inch in diameter into the liver and advancing it through a plunger-like mechanism, making very tiny probes in a spherical pattern into the tumor in order to deliver a high frequency alternating current. The alternating current causes the ions of the local tissue to vibrate, causing heat up to 100 degrees centigrade. The heat is measured by temperature probes at the tip of the prongs. This heat causes coagulation and death of all the tumor cells.

The probe is placed using ultrasound control to guide the surgeon, and in this manner the surgeon can see the changes of the tumor as it becomes heated and destroyed. It is preferable to destroy half a centimeter to a centimeter of normal liver tissue around the tumor to ensure that the entire tumor is ablated.

Indications for radiofrequency ablation are:
· destruction of tumors which are not easily accessible for surgical excision
· destruction of tumors in patients who do not have adequate liver function to allow the liver to be removed
· destruction of multiple tumors
· destruction of tumors that are recurrent
· destruction of tumors in patient who do not have the stamina to undergo a major surgery

The results of radiofrequency ablation are not quite as good as that with surgery, and can only be employed in tumors up to 5 to 6 centimeters in size. It does, however, provide an excellent result for situations where excision of the tumor is not recommended.

In the follow up of the tumors that have been ablated by radiofrequency, the patient will need to have periodic CT scans to monitor the possible development of new tumors. The radiologist who reads the CT scan has to understand that the patient had radiofrequency ablation. The tumor area will look larger two weeks after surgery because of the larger area of tumor destruction. In addition, when the CT scan is performed with contrast, the contrast will not be taken up by the tumor. In half of the patients there may be a rim of high vascularity and high density pickup around the tumor where these is a chemical reaction. Eventually, these areas become cystic and they may shrink in size.

The surgeons at University Surgeons are among the first to make radiofrequency ablation available, and are experienced in the selection and performance of this procedure.

If you would like more information about this procedure, or if you would like to be evaluated to see if radiofrequency ablation can help you, we will be happy to see you. Call us at 312-942-6500 to make an appointment.