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2 - Principles of radiofrequency and microwave tumor ablation
- from Section II - Principles of image-guided therapies
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- By Anthony M. Esparaz, Department of Radiology, S. Nahum Goldberg, Hadassah Hebrew University Medical Center, Muneeb Ahmed, Department of Radiology
- Edited by Jean-Francois H. Geschwind, Michael C. Soulen
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- Book:
- Interventional Oncology
- Published online:
- 05 September 2016
- Print publication:
- 22 September 2016, pp 3-12
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Summary
Key points
• Radiofrequency (RF) ablation and/or microwave ablation are viable alternatives for the treatment of many solid focal malignancies, especially in the non-surgical candidate.
• Benefits of image-guided, minimally invasive energy ablation include low morbidity and mortality, low cost, inclusion of non-surgical patients, and same-day discharge.
• 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.
• Successful treatment is obtained when balancing between complete tumor destruction and minimizing damage to surrounding normal parenchyma and adjacent structures.
• 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.
9 - Radiofrequency equipment and scientific basis for radiofrequency ablation
- Edited by Andy Adam, University of London, Peter R. Mueller
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- Book:
- Interventional Radiological Treatment of Liver Tumors
- Published online:
- 23 December 2009
- Print publication:
- 11 December 2008, pp 167-180
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Summary
Introduction
Minimally invasive strategies for tumor ablation, such as radiofrequency (RF) thermal ablation, have now gained prominent attention for the focal destruction of hepatic malignancies and are considered mainline therapies for some focal malignancies. Advantages of minimally invasive therapies compared to surgical resection include the anticipated reduction in morbidity and mortality, lower cost, the ability to perform procedures on outpatients, and the potential application in a wider spectrum of patients, including non-surgical candidates.
Thermal ablation strategies utilize alterations in tissue temperature to induce cellular disruption and tissue coagulation necrosis. This chapter will provide a conceptual framework for the principles and theories that underlie focal thermal tumor therapy using radiofrequency ablation (RFA). Particular emphasis will be placed on design and current use of radiofrequency equipment. Furthermore, developing synergistic therapies that allow treatment design tailored to patient specific disease will be discussed, as it is anticipated that these will further increase long-term success rates.
Basic principles of radiofrequency ablation
Goals of minimally invasive tumor ablation
The ultimate strategy of RF thermal tumor ablation therapy for hepatic and other malignancies encompasses two specific objectives. First, through the application of energy, to attempt to completely eradicate all viable malignant cells within a designated area. Based upon studies examining tumor progression for patients undergoing surgical resection, and the demonstration of viable malignant cells beyond visible tumor boundaries, tumor ablation therapies attempt to include at least a 1.0 cm “ablative” margin of seemingly normal tissue for liver, but less may be needed for some tumors such as kidney.
5 - Image-guided Interventions: Fundamentals of Radiofrequency Tumor Ablation
- from PART II - PRINCIPLES OF IMAGE-GUIDED THERAPIES
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- By Andrew Hines-Peralta, Radiologist, Beth Israel Deaconess Medical Center Department of Radiology Boston, MA, S. Nahum Goldberg, Professor in Radiology, Department of Radiology Beth Israel Deaconess Medical Center Boston, MA
- Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
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- Book:
- Interventional Oncology
- Published online:
- 18 May 2010
- Print publication:
- 15 September 2008, pp 55-66
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Summary
KEY POINTS
Radiofrequency (RF) ablation is a viable alternative for the treatment of many solid focal malignancies, especially in the non-surgical candidate.
Benefits of RF ablation include low morbidity and mortality, low cost, non-surgical patient inclusion, and same-day discharge.
Successful treatment is a balance between complete tumor destruction and minimizing damage to surrounding normal parenchyma and adjacent structures.
The bio-heat equation states: coagulation necrosis = energy deposited × local tissue interactions – heat loss. This forms the foundation of RF ablation.
Widespread adoption of RF ablation will rely upon improving and increasing tumor ablation volume. Adjuvant therapies such as antiangiogenetics, chemotherapeutics, embolization, and radiation in this capacity hold great promise.
INTRODUCTION
Minimally invasive RF ablation continues to gain attention as a viable option for the treatment of multiple solid malignancies given continued favorable outcome studies coupled with scarce complications (1–4). Advantages of RF ablation include a wider spectrum of patients, including non-surgical candidates and outpatients, along with lower immediate morbidity and mortality, and lower cost (5–6). For these reasons and impressive initial outcomes, the indications continue to broaden to include multiple tumor types, multiple locations and ever-expanding patient selection criteria. Currently, the most commonly ablated tumor worldwide is focal hepatic cell carcinoma (HCC), but rapid acceptance of renal cell carcinoma (RCC) has been shown in many parts of the world, including the United States (7–12).