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2 - Principles of radiofrequency and microwave tumor ablation

from Section II - Principles of image-guided therapies

Published online by Cambridge University Press:  05 September 2016

By
Anthony M. Esparaz ,
S. Nahum Goldberg  and
Muneeb Ahmed
Edited by
Jean-Francois H. Geschwind  and
Michael C. Soulen
Anthony M. Esparaz
Affiliation:
Department of Radiology
S. Nahum Goldberg
Affiliation:
Hadassah Hebrew University Medical Center
Muneeb Ahmed
Affiliation:
Department of Radiology
Jean-Francois H. Geschwind
Affiliation:
Yale University School of Medicine, Connecticut
Michael C. Soulen
Affiliation:
Department of Radiology, University of Pennsylvania Hospital, Philadelphia
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Summary

Key points

  1. • Radiofrequency (RF) ablation and/or microwave ablation are viable alternatives for the treatment of many solid focal malignancies, especially in the non-surgical candidate.

  2. • Benefits of image-guided, minimally invasive energy ablation include low morbidity and mortality, low cost, inclusion of non-surgical patients, and same-day discharge.

  3. • The basic principles of RF and microwave ablation can be divided into three main elements, including: (1) biology of heating; (2) RF and microwave technology; and (3) operator expertise and technique.

  4. • Successful treatment is obtained when balancing between complete tumor destruction and minimizing damage to surrounding normal parenchyma and adjacent structures.

  5. • Widespread adoption of RF and microwave ablation will rely upon improving and increasing tumor ablation volume. Adjuvant therapies such as chemotherapeutics, antiangiogenics, embolization, and radiation hold great promise in this capacity.

Introduction

Image-guided, minimally invasive tumor ablation aims to eradicate or substantially destroy focal tumors by inducing irreversible cellular injury through the application of thermal and non-thermal energy or chemical injection. Ablative modalities can be divided into energy-based ablation and chemical ablation. While chemical ablation uses agents such as ethanol or acetic acid to induce coagulation necrosis and tumor ablation, energy-based ablative techniques destroy a tumor via thermal (heat or cold) or non-thermal techniques. Two examples of energy-based modalities, RF ablation and microwave ablation, are the principal topic of this chapter. These therapies, initially RF ablation and now, to an ever-increasing extent, microwave, have gained widespread attention in the medical community and have become broadly accepted as methods for treating focal malignancies in a wide range of tumor types and tissues. These include primary and secondary malignancies of the liver, kidney, lung, and bone. Given the multiplicity of treatment types, complexity of paradigms in oncology, and diverse application of energy-based ablation techniques, a thorough understanding of the basic principles and recent advances in RF and microwave ablation is a necessary prerequisite for their effective clinical use (Figure 2.1).

The ultimate goal of minimally invasive, energy-based tumor ablation for focal malignancies is to completely eradicate all viable malignant cells within the target tumor. Based upon tumor recurrence patterns and pathologic analyses in long-term studies in patients who have undergone surgical resection or ablation, there are often viable persistent microscopic tumor foci in a rim of apparently normal surrounding parenchymal tissue beyond the visible tumor margin.

Type
Chapter
Information
Interventional Oncology
Principles and Practice of Image-Guided Cancer Therapy
 , pp. 3 - 12
Publisher: Cambridge University Press
Print publication year: 2016

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References

1. Ahmed, M, Solbiati, L, Brace, CL, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria – a 10-year update. Radiology 2014; 273: 241–260.Google Scholar
2. Solbiati, L, Ierace, T, Cova, L, et al. Ten-year experience in nonsurgical treatment of “intermediate” hepatocellular carcinoma in cirrhotic patients: Long-term survival and causes of death. Radiology 2006; 241: 359.Google Scholar
3. Livraghi, T, Solbiati, L, Meloni, MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226: 441–451.Google Scholar
4. Gillams, AR, Lees, WR. Five-year survival following radiofrequency ablation of small, solitary, hepatic colorectal metastases. J Vasc Interv Radiol 2008; 19: 712–717.Google Scholar
5. Gervais, DA, McGovern, FJ, Arellano, RS, et al. Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology 2003; 226: 417–424.Google Scholar
6. Dupuy, DE, DiPetrillo, T, Gandhi, S, et al. Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer. Chest 2006; 129: 738–745.Google Scholar
7. Callstrom, AR, Atwell, TD, Charboneau, JW, et al. Painful metastases involving bone: percutaneous image-guided cryoablation – prospective trial interim analysis. Radiology 2006; 241: 572–580.Google Scholar
8. 3rd, GD Dodd, Soulen, MC, Kane, RA, et al. Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough. Radiographics 2000; 20: 9–27.Google Scholar
9. Shimada, K, Sakamoto, Y, Esaki, M, et al. Role of the width of the surgical margin in a hepatectomy for small hepatocellular carcinomas eligible for percutaneous local ablative therapy. Am J Surg 2008; 195: 775–781.Google Scholar
10. Livraghi, T, Meloni, F, Goldberg, SN, et al. Hepatocellular carcinoma: radiofrequency ablation of medium and large lesions. Radiology 2000; 214: 761–768.Google Scholar
11. 3rd, GD Dodd, Frank, MS, Aribandi, M, et al. Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations. AJR Am J Roentgenol 2001; 177: 777–782.Google Scholar
12. Chen, MH, Yang, W, Yan, K, et al. Large liver tumors: protocol for radiofrequency ablation, and its clinical application in 110 patients – mathematical model, overlapping mode, and electrode placement process. Radiology 2004; 232: 260–271.Google Scholar
13. Gervais, DA, McGovern, FJ, Arellano, RS, et al. Radiofrequency ablation of renal cell carcinoma: part 1. Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005; 185: 64–71.Google Scholar
14. Lencioni, R, Crocetti, L, Cioni, R, et al. Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). Lancet Oncol 2008; 9: 621–628.Google Scholar
15. Schramm, W, Yang, D, Haemmerich, D. Contribution of direct heating, thermal conduction and perfusion during radiofrequency and microwave ablation. Conf Proc IEEE Eng Med Biol Soc 2006; 1: 5013–5016.Google Scholar
16. Seegenschmiedt, M, Brady, L, Sauer, R. Interstitial thermoradiotherapy: review on technical and clinical aspects. Am J Clin Oncol 1990; 13: 352–363.Google Scholar
17. Larson, T, Bostwick, D, Corcia, A. Temperature-correlated histopathologic changes following microwave thermoablation of obstructive tissues in patients with benign prostatic hyperplasia. Urology 1996; 47: 463–469.Google Scholar
18. Zevas, N, Kuwayama, A. Pathologic analysis of experimental thermal lesions: comparison of induction heating and radiofrequency electrocoagulation. J Neurosurg 1972; 37: 418–422.Google Scholar
19. Goldberg, SN, Gazelle, GS, Compton, CC, et al. Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic–pathologic correlation. Cancer 2000; 88: 2452–2463.Google Scholar
20. Mertyna, P, Dewhirst, MW, Halpern, E, et al. Radiofrequency ablation: the effect of distance and baseline temperature on thermal dose required for coagulation. Int J Hyperthermia 2008; 24: 550–559.Google Scholar
21. Lubner, MG, Brace, CL, Hinshaw, JL, et al. Microwave tumor ablation: mechanism of action, clinical results and devices. J Vasc Interv Radiol 2010; 21: 192–203.Google Scholar
22. Brace, CL. Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences? Curr Probl Diagn Radiol 2009; 38: 135–143.Google Scholar
23. Yu, NC, Lu, DS, Raman, SS, et al. Hepatocellular carcinoma: microwave ablation with multiple straight and loop antenna clusters – pilot comparison with pathologic findings. Radiology 2006; 239: 269–275.Google Scholar
24. Lu, DS, Raman, SS, Limanond, P, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003; 14: 1267–1274.Google Scholar
25. Goldberg, SN, Hahn, PF, Halpern, EF, et al. Radiofrequency tissue ablation: effect of pharmacologic modulation of blood flow on coagulation diameter. Radiology 1998; 209: 761–769.Google Scholar
26. Horkan, C, Ahmed, M, Liu, Z, et al. Radiofrequency ablation: effect of pharmacologic modulation of hepatic and renal blood flow on coagulation diameter in a VX2 tumor model. J Vasc Interv Radiol 2004; 15: 269–274.Google Scholar
27. Hakime, A, Hines-Peralta, AU, Peddy, H. Combination of radiofrequency ablation with antiangiogenic therapy for tumor ablation efficacy: study in mice. Radiology 2007; 244: 464–470.Google Scholar
28. Mostafa, EM, Ganguli, S, Faintuch, S, et al. Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors. J Vasc Interv Radiol 2008; 19: 1740–1748.Google Scholar
29. Liu, Z, Lobo, SM, Humphries, S, et al. Radiofrequency tumor ablation: insight into improved efficacy using computer modeling. AJR Am J Roentgenol 2005; 184:1347–1352.Google Scholar
30. Goldberg, SN, Ahmed, M, Gazelle, GS, et al. Radiofrequency thermal ablation with adjuvant saline injection: effect of electrical conductivity on tissue heating and coagulation. Radiology 2001; 219: 157–165.Google Scholar
31. Miao, Y, Ni, Y, Yu, J, et al. A comparative study on validation of a novel cooled-wet electrode for radiofrequency liver ablation. Invest Radiol 2000; 35: 438–444.Google Scholar
32. Yang, D, Converse, MC, Mahvi, DM, et al. Measurement and analysis of tissue temperature during microwave liver ablation. IEEE Trans Biomed Eng 2007; 54: 150–155.Google Scholar
33. Brace, CL, Laeseke, PF, Sampson, LA, et al. Microwave ablation with a single small-gauge triaxial antenna: in vivo porcine liver model. Radiology 2007; 242: 435–440.Google Scholar
34. Wolf, EJ, Grand, DJ, Machan, JT, et al. Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology 2008; 247: 871–879.Google Scholar
35. Wright, AS, Sampson, LA, Warner, TF, et al. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology 2005; 236: 132–139.Google Scholar
36. Wang, Y, Sun, Y, Feng, L, et al. Internally cooled antenna for microwave ablation: results in ex vivo and in vivo porcine livers. Eur J Radiol 2008; 67: 357–361.Google Scholar
37. Haemmerich, DG, et al. A device that allows for multiple simultaneous radiofrequency (RF) ablations in separated areas of the liver with impedance-controlled cool-tip probes: an ex-vivo feasibility study. Radiology 2002; 225: 242.Google Scholar
38. Solbiati, L, Ierace, T, Goldberg, SN. Percutaneous US-guided RF tissue ablation of liver metastases: long-term follow-up. Radiology 1997; 202: 195–203.Google Scholar
39. Goldberg, SN, Gazelle, GS, Dawson, SL, et al. Tissue ablation with radiofrequency using multiprobe arrays. Acad Radiol 1995; 2: 670–674.Google Scholar
40. Baere, T de, Denys, A, Wood, BJ, et al. Radiofrequency liver ablation: experimental comparative study of water-cooled versus expandable systems. AJR Am J Roentgenol 2001; 176: 187–192.Google Scholar
41. Miao, Y, Ni, Y, Yu, J, et al. An ex vivo study on radiofrequency tissue ablation: increased lesion size by using an “expandable-wet” electrode. Eur Radiol 2001; 11: 1841–1847.Google Scholar
42. Appelbaum, L, Sosna, J, Pearson, R, et al. Algorithm optimization for multitined radiofrequency ablation: comparative study in ex vivo and in vivo bovine liver. Radiology 2010; 254: 430–440.Google Scholar
43. Shibata, T, Shibata, T, Maetani, Y, et al. Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode. Radiology 2006; 238: 346–353.Google Scholar
44. Goldberg, SN, Solbiati, L, Hahn, PF, et al. Large-volume tissue ablation with radio frequency by using a clustered, internally cooled electrode technique: laboratory and clinical experience in liver metastases. Radiology 1998; 209: 371–379.Google Scholar
45. Shock, SA, Meredith, K, Warner, TF, et al. Microwave ablation with loop antenna: in vivo porcine liver model. Radiology 2004; 231: 143–149.Google Scholar
46. Desinger, K, Stein, T, Mueller, GJ, et al. Interstitial bipolar RF-thermotherapy therapy by planning by computer simulation and MRI-monitoring – a new concept for minimally invasive procedures. Proc SPIE 1999; 3249: 147–160.Google Scholar
47. Ritz, JP, Lehmann, KS, Isbert, C, et al. In-vivo evaluation of a novel bipolar radiofrequency device for interstitial thermotherapy of liver tumors during normal and interrupted hepatic perfusion. J Surg Res 2006; 133: 176–184.Google Scholar
48. McGahan, JP, Gu, WZ, Brock, JM, et al. Hepatic ablation using bipolar radiofrequency electrocautery. Acad Radiol 1996; 3: 418–422.Google Scholar
49. Hines-Peralta, A, Hollander, CY, Solazzo, S, et al. Hybrid radiofrequency and cryoablation device: preliminary results in an animal model. J Vasc Interv Radiol 2004; 15: 1111–1120.Google Scholar
50. Goldberg, SN, Gazelle, GS, Solbiati, L, et al. Radiofrequency tissue ablation: increased lesion diameter with a perfusion electrode. Acad Radiol 1996; 3: 636–644.Google Scholar
51. Lorentzen, T. A cooled needle electrode for radiofrequency tissue ablation: thermodynamic aspects of improved performance compared with conventional needle design. Acad Radiol 1996; 3: 556–563.Google Scholar
52. Livraghi, T, Goldberg, SN, Monti, F, et al. Saline-enhanced radiofrequency tissue ablation in the treatment of liver metastases. Radiology 1997; 202: 205–210.Google Scholar
53. Ahmed, M, Lobo, SM, Weinstein, J, et al. Improved coagulation with saline solution pretreatment during radiofrequency tumor ablation in a canine model. J Vasc Interv Radiol 2002; 12: 717–724.Google Scholar
54. Lencioni, R, Cioni, D, Crocetti, L, et al. Early stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 2005; 234: 961–967.Google Scholar
55. Dupuy, D, Goldberg, SN. Image-guided radiofrequency tumor ablation: challenges and opportunities – part II. J Vasc Interv Radiol 2001; 12: 1135–1148 Google Scholar
56. Goldberg, SN, Stein, M, Gazelle, GS, et al. Percutaneous radiofrequency tissue ablation: optimization of pulsed-RF technique to increase coagulation necrosis. J Vasc Interv Radiol 1999; 10: 907–916.Google Scholar
57. Jr., FT Lee, Haemmerich, D, Wright, AS, et al. Multiple probe radiofrequency ablation: pilot study in an animal model. J Vasc Interv Radiol 2003; 14: 1437–1442.Google Scholar
58. Wang, X, Sofocleous, CT, Erinjeri, JP, et al. Margin size is an independent predictor of local tumor progression after ablation of colon cancer liver metastases. Cardiovasc Interv Radiol 2013; 36: 166–175.Google Scholar
59. Goldberg, SN, Dupuy, EE. Image-guided radiofrequency tumor ablation: challenges and opportunities – part I. J Vasc Interv Radiol 2001; 12: 1021–1032.Google Scholar
60. Kim, SK, Rhim, H, Kim, YS, et al. Radiofrequency thermal ablation of hepatic tumors: pitfalls and challenges. Abdom Imaging 2005; 30: 727–733.Google Scholar
61. Laeseke, PF, Sampson, LA, 3rd, TC Winter, et al. Use of dextrose 5% in water instead of saline to protect against inadvertent radiofrequency injuries. AJR Am J Roentgenol 2005; 184: 1026–1027.Google Scholar
62. Ahmed, M, Goldberg, SN. Combination radiofrequency thermal ablation and adjuvant IV liposomal doxorubicin increases tissue coagulation and intratumoural drug accumulation. Int J Hyperthermia 2004; 20: 781–802.Google Scholar
63. Horkan, C, Dalal, K, Coderre, JA, et al. Reduced tumor growth with combined radiofrequency ablation and radiation therapy in a rat breast tumor model. Radiology 2005; 235: 81–88.Google Scholar
64. Brace, CL, Sampson, LA, Hinshaw, JL, et al. Radiofrequency ablation: simultaneous application of multiple electrodes via switching creates larger, more confluent ablations than sequential application in a large animal model. J Vasc Interv Radiol 2009; 20: 118–124.Google Scholar
65. Yang, W, Chen, MH, Wang, MQ, et al. Combination therapy of radiofrequency ablation and transarterial chemoembolization in recurrent hepatocellular carcinoma after hepatectomy compared with single treatment. Hepatol Res 2009; 39: 231–240.Google Scholar
66. Wang, W, Shi, J, Xie, WF. Transarterial chemoembolization in combination with percutaneous ablation therapy in unresectable hepatocellular carcinoma: a meta-analysis. Liver Int 2010; 30: 741–749.Google Scholar
67. Wang, YB, Chen, MH, Yan, K, et al. Quality of life after radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma: comparison with transcatheter arterial chemoembolization alone. Qual Life Res 2007; 16: 389–397.Google Scholar
68. Goldberg, SN, Kamel, IR, Kruskal, JB, et al. Radiofrequency ablation of hepatic tumors: increased tumor destruction with adjuvant liposomal doxorubicin therapy. AJR Am J Roentgenol 2002; 179: 93–101.Google Scholar
69. Goldberg, SN, Giman, GD, Lukyanov, AN, et al. Percutaneous tumor ablation: increased necrosis with combined radio-frequency ablation and intravenous liposomal doxorubicin in a rat breast tumor model. Radiology 2002; 222: 797–804.Google Scholar
70. Chen, Q, Krol, A, Wright, A, et al. Tumor microvascular permeability is a key determinant for antivascular effects of doxorubicin encapsulated in a temperature sensitive liposome. Int J Hyperthermia 2008; 24: 475–482.Google Scholar
71. Solazzo, S, Ahmed, M, Schor-Bardach, R, et al. Liposomal doxorubicin increases radiofrequency ablation-induced tumor destruction by increasing cellular oxidative and nitrative stress and accelerating apoptotic pathways. Radiology 2010; 255: 62–74.Google Scholar
72. Bae, Y, Buresh, RA, Williamson, TP, et al. Intelligent biosynthetic nanobiomaterials for hyperthermic combination chemotherapy and thermal drug targeting of HSP90 inhibitor geldanamycin. J Control Release 2007; 122: 16–23.Google Scholar
73. Algan, O, Fosmire, H, Hynynen, K, et al. External beam radiotherapy and hyperthermia in the treatment of patients with locally advanced prostate carcinoma. Cancer 2000; 89: 399–403.Google Scholar
74. Solazzo, S, Mertyna, P, Peddi, H, et al. RF ablation with adjuvant therapy: comparison of external beam radiation and liposomal doxorubicin on ablation efficacy in an animal tumor model. Int J Hyperthermia 2008; 24: 560–567.Google Scholar
75. Mayer, R, Hamilton-Farrell, MR, der Kleij, AJ Van, et al. Hyperbaric oxygen and radiotherapy. Strahlenther Onkol 2005; 181: 113–123.Google Scholar

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