Radiofrequency Ablation
Dr. Damian Dupuy in the Department of Diagnostic Imaging at Rhode Island Hospital and Dr. Howard Safran in the Department of Medical Oncology, both active members of the Brown University Oncology Group, have officially opened a study protocol for the treatment of painful osseous metastatic disease using radiofrequency ablation. Dr. Damian Dupuy is the principal investigator and is currently accepting patients who may benefit from this novel therapy. Initial research has shown that radiofrequency ablation can provide local pain relief caused by metastatic disease. Patients with very localized disease who may not require more extensive radiation therapy or patients who have been previously unsuccessfully treated with radiation therapy are potential candidates.
Radiofrequency ablation is a percutaneously performed outpatient procedure whereby a small needle electrode is placed directly into the tumor using CT scan or ultrasound guidance. The high frequency radiowaves sent into the tumor cause heating and local necrosis of the tumor. The procedure takes between 45-90 minutes and can be performed with intravenous sedation. This technique is currently being applied to tumors involving the liver, kidneys, pancreas, adrenal gland and skeleton. Although this technique has only been FDA approved since December 1997 the early results are very encouraging.
More information regarding this new type of cancer treatment can be obtained by contacting Dr. Dupuy's nurse practicioner, Derek Tessier, in the Office of Minimally Invasive Therapy at dtessier@lifespan.org or telephoning him at 401-444-5707.
Furthermore, in conjunction with the departments of Oncology and Radiation Oncology, Dr. Dupuy has opened a Phase II lung cancer study, which is not completely funded by grants, which may require additional payments by patients and/or preapproval by insurers. The study is designed to provide substantial upfront reduction of live tumor with radiofrequency ablation (RFA) therapy in lung cancer patients who are not operative candidates due to poor lung or cardiac function. Patients undergo the most advanced staging with PET and CT scanning to determine if the cancers are confined to the lung. Patients are then treated with the most advanced radiation therapy called intensity modulation radiation therapy (IMRT) to minimize damage to normal tissues. Patients with larger tumors confined to the lung will receive radiation and chemotherapy after the RFA. For more information regarding this lung cancer treatment trial please contact Dr. Dupuy (Department of Diagnostic Imaging 401-444-5184) or Dr. Thomas DiPetrillo (Department of Radiation Oncology 401-444-8311).
| Sample Case 1: Treatment of Metastasis to Bone |
Figure 1:
Pretreatment axial CT scan image demonstrates a lytic osseous metastasis to the left iliac crest from renal cell carcinoma.
Figure 2:
Percutaneously placed radiofrequency probe within the lesion
Figure 3:
Follow-up CT scan obtained 14 months later shows complete healing
Radiofrequency ablation has recently been applied to the primary treatment of hepatocellular carcinomas at Rhode Island Hospital by Dr. Dupuy as well as other national centers such as M.D.Anderson Cancer Center and Mayo-Clinic. Utilizing the cool-tip RF electrodes ablation of liver cancer can be performed in cases where surgery is contraindicated due to underlying liver disease, lesion location, and high surgical mortality due to underlying medical conditions. Hepatocellular carcinomas as large as 6cm in size can be treated with RF ablation (see below). If you would like more information about RF ablation, Dr. Damian Dupuy can be contacted in the Department of Diagnostic Imaging at Rhode Island Hospital at 401-444-5184 or by e-mail at ddupuy@lifespan.org |
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| Sample Case 2: Treatment of Hepatocellular Carcinoma |
Figure 4:
Pretreatment CT scan of the liver in an 84 year old man shows a 6 cm biopsy proven hepatocellular carcinoma in the dome of the liver abutting the inferior vena cava and hepatic veins.
Figure 5:
RF ablation was perfomed with the trident array cool-tip electrode (Radionics Inc, Burlington, MA) under CT guidance. Four heat lesions were created using two tandem treatments on each side of the lesion. Note the peripheral positioning of the electrode to maximize the ablation volume.
Figure 6:
Two week post-treatment arterial phase spiral CT scan shows complete coagulation necrosis of the mass with no residual enhancement to suggest residual macroscopic disease.
Figure 7:
Close-up view of the three 18 gauge cool-tip electrodes which comprise the trident array system. These are placed under local anaesthesia. |
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| Sample Case 3: Treatment of Lung Carcinoma |
78 year old woman with known heart disease and a 3cm right upper lobe lung cancer. Thoracic surgery was not considered an option given her underlying heart disease.
Figure 1:
Initial RFA was performed and this CT image shows the electrode in the center of the mass.
Figure 2:
CT scan 3 months later and after completion of radiation therapy shows the mass with no significant change in size.
Figure 3:
One year later, CT scan shows shrinkage of the mass. The patient is currently well with no signs of active disease. |
80 year old man with severe heart disease and biopsy proven right upper lobe lung cancer. The patient was not a good candidate for surgery and was therefore a good candidate for the radiofrequency ablation-radiation therapy combination treatment.
Figure 4:
CT scan shows the RFA electrode in the lung cancer.
Figure 5:
Follow-up CT scan 3 months after completion of radiation therapy shows contraction of the tumor.
Figure 6:
The patient is currently well with signs no active disease at 6 months follow-up. |
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| Sample Case 4: Treatment of Renal Cell Carcinoma |
Figure 1:
(A) A CT image in an 84 year old man with cardiac disease shows the RF electrode within a biopsy proven renal cell carcinoma.
(B) Follow-up contrast-enhanced CT 6 months after RF ablation shows complete thermocoagulation of the mass. Note simple cyst in the opposite kidney. The patient continues to do well at over one year after RF ablation with no imaging evidence of recurrent renal cell cancer.
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In addition to the treatment of liver, lung and bone tumors. RF ablation can be applied to renal cell carcinomas. Many patients have small renal cancers incidentally discovered on imaging tests obtained for other reasons. Many of these masses are smaller than 2-3 inches in size and are located at the periphery of the kidney. The gold standard of therapy is complete or partial nephrectomy. However, many patients may have only one kidney, poor renal function or other medical conditions that make surgical removal too risky. In these patients RF ablation can provide a safe and simple method of tumor destruction. We have treated many patients with small renal cancers and thus far the results have been very promising.
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