Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-07-07T16:35:44.936Z Has data issue: false hasContentIssue false

9 - Radiofrequency equipment and scientific basis for radiofrequency ablation

Published online by Cambridge University Press:  23 December 2009

Andy Adam
Affiliation:
University of London
Peter R. Mueller
Affiliation:
Massachussets General Hospital, Boston
Get access

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.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmed, M, Goldberg, SN. Thermal ablation therapy for hepatocellular carcinoma. J Vasc Interv Radiol 2002; 13 (9 Suppl): S231–44.CrossRefGoogle ScholarPubMed
Colella, G, Bottelli, R, Carlis, L, et al. Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection, and chemoembolization. Transpl Int 1998; 11 (Suppl 1): S193–6.CrossRefGoogle ScholarPubMed
Dodd, GD 3rd, 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.CrossRefGoogle ScholarPubMed
Goldberg, SN, Dupuy, . Image-guided radiofrequency tumor ablation: challenges and opportunities. Part I. J Vasc Interv Radiol 2001; 12: 1021–32.CrossRefGoogle Scholar
Goldberg, SN, Gazelle, GS, Mueller, PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000; 174: 323–31.CrossRefGoogle ScholarPubMed
Giorgio, A, Tarantino, L, Stefano, G, Coppola, C, Ferraioli, G. Complications after percutaneous saline-enhanced radiofrequency ablation of liver tumors: 3-year experience with 336 patients at a single center. AJR Am J Roentgenol 2005; 184: 207–11.CrossRefGoogle Scholar
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: 441–51.CrossRefGoogle Scholar
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: 961–7.CrossRefGoogle ScholarPubMed
Kim, YK, Kim, CS, Chung, GH, et al. Radiofrequency ablation of hepatocellular carcinoma in patients with decompensated cirrhosis: evaluation of therapeutic efficacy and safety. AJR Am J Roentgenol 2006; 186 (5 Suppl): S261–8.CrossRefGoogle ScholarPubMed
Clark, TW, Millward, SF, Gervais, DA, et al. Reporting standards for percutaneous thermal ablation of renal cell carcinoma. J Vasc Interv Radiol 2006; 17: 1563–70.CrossRefGoogle ScholarPubMed
Gazelle, GS, Goldberg, SN, Solbiati, L, Livraghi, T. Tumor ablation with radiofrequency energy. Radiology 2000; 217: 6333–46.CrossRefGoogle Scholar
McGahan, JP, Dodd, GD 3rd. Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol 2001; 176: 3–16.CrossRefGoogle Scholar
Cosman, E, Nashold, B, Ovelman-Levitt, J. Theoretical aspects of radiofrequency lesions in the dorsal root entry zone. Neurosurgery 1984; 15: 945–50.Google ScholarPubMed
Seegenschmiedt, M, Brady, L, Sauer, R. Interstitial thermoradiotherapy: review on technical and clinical aspects. Am J Clin Oncol 1990; 13: 352–63.CrossRefGoogle ScholarPubMed
Trembley, B, Ryan, T, Strohbehn, J.Interstitial hyperthermia: physics, biology, and clinical aspects. In: Hyperthermia and Oncology, Vol. 3. Utrecht: VSP, 1992: 11–98.Google Scholar
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: 463–9.CrossRefGoogle ScholarPubMed
Zevas, N, Kuwayama, A. Pathologic analysis of experimental thermal lesions: comparison of induction heating and radiofrequency electrocoagulation. J Neurosurg 1972; 37: 418–22.CrossRefGoogle Scholar
Thomsen, S. Pathologic analysis of photothermal and photomechanical effects of laser tissue interactions. Photochem Photobiol 1991; 53: 825–35.CrossRefGoogle ScholarPubMed
Goldberg, SN, Gazelle, GS, Compton, CC, Mueller, PR, Tanabe, KK. Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic–pathologic correlation. Cancer 2000; 88: 2452–63.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Goldberg, SN, Gazelle, GS, Halpern, EF, et al. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol 1996; 3: 212–8.CrossRefGoogle ScholarPubMed
Liu, Z, Lobo, SM, Humphries, S, et al. Radiofrequency tumor ablation: insight into improved efficacy using computer modeling. AJR Am J Roentgenol 2005; 184: 1347–52.CrossRefGoogle ScholarPubMed
Pennes, HH. Analysis of tissue and arterial blood temperatures in the resting human forearm. J Appl Physiol 1948; 1: 93–122.CrossRefGoogle ScholarPubMed
Rossi, S, Buscarini, E, Garbagnati, F. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol 1998; 170: 1015–22.CrossRefGoogle ScholarPubMed
Siperstein, AE, Rogers, SJ, Hansen, PD, Gitomirsky, A. Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastases. Surgery 1997; 122: 1147–55.CrossRefGoogle ScholarPubMed
Leveen, RF. Laser hyperthermia and radiofrequency ablation of hepatic lesions. Semin Interv Radiol 1997; 12: 313–24.Google Scholar
Berber, E, Foroutani, A, Garland, AM, et al. Use of CT Hounsfield unit density to identify ablated tumor after laparoscopic radiofrequency ablation of hepatic tumors. Surg Endosc 2000; 14: 799–804.CrossRefGoogle ScholarPubMed
Baere, T, Denys, A, Wood, BJ, et al. Radiofrequency liver ablation: experimental comparative study of water-cooled versus expandable systems. AJR Am J Roentgenol 2001; 176: 187–92.CrossRefGoogle ScholarPubMed
Berber, E, Herceg, NL, Casto, KJ, Siperstein, AE. Laparoscopic radiofrequency ablation of hepatic tumors: prospective clinical evaluation of ablation size comparing two treatment algorithms. Surg Endosc 2004; 18: 390–6.CrossRefGoogle ScholarPubMed
Desinger, K, Stein, T, Muller, G, Mack, M, Vogl, T. Interstitial bipolar RF-thermotherapy (REITT) therapy planning by computer simulation and MRI-monitoring: a new concept for minimally invasive procedures. Proc SPIE 1999; 3249: 147–60.CrossRefGoogle Scholar
Haemmerich, DG, Lee, FT, Chachati, L, et al. A device that allows for multiple simultaneous radiofrequency (RF) ablations in separated areas of the liver with impedance-controlled cool-ip probes: an ex vivo feasibility study. Radiology 2002; 225(p): 242.Google Scholar
Haemmerich, DG, Lee, FT, Mahvi, DM, Wright, AS, Webster, JG. Multiple probe radiofrequency: rapid switching versus simultaneous power application in a computer model. Radiology 2002; 225(p): 639.Google Scholar
Terraz, S, Constantin, C, Majno, PE, et al. Image-guided multipolar radiofrequency ablation of liver tumours: initial clinical results. Eur Radiol 2007; 17: 2253–61.CrossRefGoogle ScholarPubMed
Clasen, S, Schmidt, D, Boss, A, et al. Multipolar radiofrequency ablation with internally cooled electrodes: experimental study in ex vivo bovine liver with mathematic modeling. Radiology 2006; 238: 881–90.CrossRefGoogle ScholarPubMed
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: 371–9.CrossRefGoogle ScholarPubMed
Hines-Peralta, A, Liu, ZJ, Horkan, C, Solazzo, S, Goldberg, SN. Chemical tumor ablation with use of a novel multiple-tine infusion system in a canine sarcoma model. J Vasc Interv Radiol 2006; 17: 351–8.CrossRefGoogle Scholar
Curley, MG, Hamilton, PS. Creation of large thermal lesions in liver using saline-enhanced RF ablation. Proc 19th International Conference IEEE/EMBS 1997: 2516–9.Google Scholar
Livraghi, T, Goldberg, SN, Monti, F, et al. Saline-enhanced radiofrequency tissue ablation in the treatment of liver metastases. Radiology 1997; 202: 205–10.CrossRefGoogle Scholar
Miao, Y, Ni, Y, Yu, J, Marchal, G. A comparative study on validation of a novel cooled-wet electrode for radiofrequency liver ablation. Invest Radiol 2000; 35: 438–44.CrossRefGoogle ScholarPubMed
Miao, Y, Ni, Y, Yu, J, Zhang, H, Baert, A, Marchal, G. An ex vivo study on radiofrequency tissue ablation: increased lesion size by using an “expandable-wet” electrode. Eur Radiol 2001; 11: 1841–7.CrossRefGoogle ScholarPubMed
Kettenbach, J, Kostler, W, Rucklinger, E, et al. Percutaneous saline-enhanced radiofrequency ablation of unresectable liver tumors: initial experience in 26 patients. AJR Am J Roentgenol 2003; 180: 1537–45.CrossRefGoogle ScholarPubMed
Leveillee, RJ, Hoey, MF. Radiofrequency interstitial tissue ablation: wet electrode. J Endourol 2003; 17: 563–77.CrossRefGoogle ScholarPubMed
Liu, Z, Ahmed, M, Weinstein, Y, et al. Characterization of the RF ablation-induced “oven effect”: the importance of background tissue thermal conductivity on tissue heating. Int J Hyperthermia 2006; 22: 327–42.CrossRefGoogle Scholar
Aube, C, Schmidt, D, Brieger, J, et al. Influence of NaCl concentrations on coagulation, temperature, and electrical conductivity using a perfusion radiofrequency ablation system: an ex vivo experimental study. Cardiovasc Intervent Radiol 2007; 30: 92–7.CrossRefGoogle Scholar
Lobo, SM, Afzal, KS, Ahmed, M, et al. Radiofrequency ablation: modeling the enhanced temperature response to adjuvant NaCl pretreatment. Radiology 2004; 230: 175–82.CrossRefGoogle ScholarPubMed
Brown, DB. Concepts, considerations, and concerns on the cutting edge of radiofrequency ablation. J Vasc Interv Radiol 2005; 16: 597–613.CrossRefGoogle Scholar
Lu, DS, Raman, SS, Vodopich, DJ, et al. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the “heat sink” effect. AJR Am J Roentgenol 2002; 178: 47–51.CrossRefGoogle ScholarPubMed
Patterson, EJ, Scudamore, CH, Owen, DA, Nagy, AG, Buczkowski, AK. Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size. Ann Surg 1998; 227: 559–65.CrossRefGoogle ScholarPubMed
Frich, L, Mala, T, Gladhaug, IP. Hepatic radiofrequency ablation using perfusion electrodes in a pig model: effect of the Pringle manoeuvre. Eur J Surg Oncol 2006; 32: 527–32.CrossRefGoogle Scholar
Chinn, SB, Lee, FT, Kennedy, GD, et al. Effect of vascular occlusion on radiofrequency ablation of the liver: results in a porcine model. AJR Am J Roentgenol 2001; 176: 789–95.CrossRefGoogle Scholar
Goldberg, SN, Hahn, PF, Halpern, EF, Fogle, R, Gazelle, GS. Radiofrequency tissue ablation: effect of pharmacologic modulation of blood flow on coagulation diameter. Radiology 1998; 209: 761–9.CrossRefGoogle Scholar
Murgo, AJ. Clinical trials of arsenic trioxide in hematologic and solid tumors: overview of the National Cancer Institute Cooperative Research and Development Studies. Oncologist 2001; 6 (Suppl 2): 22–8.CrossRefGoogle ScholarPubMed
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: 269–74.CrossRefGoogle Scholar
Ratain, MJ, Eisen, T, Stadler, WM, et al. Phase II placebo-controlled randomized discontinuation trial of sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol 2006; 24: 2505–12.CrossRefGoogle ScholarPubMed
Pautler, SE, Pavlovich, CP, Mikityansky, I, et al. Retroperitoneoscopic-guided radiofrequency ablation of renal tumors. Can J Urol 2001; 8: 1330–3.Google ScholarPubMed
Pavlovich, CP, Walther, MM, Choyke, PL, et al. Percutaneous radio frequency ablation of small renal tumors: initial results. J Urol 2002; 167: 10–15.CrossRefGoogle ScholarPubMed
Christophi, C, Muralidharan, V. Treatment of hepatocellular carcinoma by percutaneous laser hyperthermia. J Gastroenterol Hepatol 2001; 16: 548–52.CrossRefGoogle ScholarPubMed
Ahmed, M, Liu, Z, Lukyanov, AN, et al. Combination radiofrequency ablation with intratumoral liposomal doxorubicin: effect on drug accumulation and coagulation in multiple tissues and tumor types in animals. Radiology 2005; 235: 469–77.CrossRefGoogle ScholarPubMed
Ahmed, M, Lukyanov, AN, Torchilin, V, et al. Combined radiofrequency ablation and adjuvant liposomal chemotherapy: effect of chemotherapeutic agent, nanoparticle size, and circulation time. J Vasc Interv Radiol 2005; 16: 1365–71.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Watanabe, S, Kurokohchi, K, Masaki, T, et al. Enlargement of thermal ablation zone by the combination of ethanol injection and radiofrequency ablation in excised bovine liver. Int J Oncol 2004; 24: 279–84.Google ScholarPubMed
Kurokohchi, K, Watanabe, S, Masaki, T, et al. Comparison between combination therapy of percutaneous ethanol injection and radiofrequency ablation and radiofrequency ablation alone for patients with hepatocellular carcinoma. World J Gastroenterol 2005; 11: 1426–32.CrossRefGoogle ScholarPubMed
Kitamoto, M, Imagawa, M, Yamada, H, et al. Radiofrequency ablation in the treatment of small hepatocellular carcinomas: comparison of the radiofrequency effect with and without chemoembolization. AJR Am J Roentgenol 2003; 181: 997–1003.CrossRefGoogle ScholarPubMed
Xia, T, Sun, Q, Shi, X, Fan, N, Hiraoka, M.Relationship between thermal parameters and tumor response in hyperthermia combined with radiation therapy. Int J Clin Oncol 2001; 6: 138–42.CrossRefGoogle ScholarPubMed
Kalapurakal, JA, Pierce, M, Chen, A, Sathiaseelan, V. Efficacy of irradiation and external hyperthermia in locally advanced, hormone-refractory or radiation recurrent prostate cancer: a preliminary report. Int J Radiat Oncol Biol Phys 2003; 57: 654–64.CrossRefGoogle ScholarPubMed
Sakurai, H, Hayakawa, K, Mitsuhashi, N, et al. Effect of hyperthermia combined with external radiation therapy in primary non-small cell lung cancer with direct bony invasion. Int J Hyperthermia 2002; 18: 472–83.CrossRefGoogle ScholarPubMed
Zee, J, Gonzalez, Gonzalez D, Rhoon, GC, et al. Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial. Dutch Deep Hyperthermia Group. Lancet 2000; 355: 1119–25.Google ScholarPubMed
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: 81–8.CrossRefGoogle Scholar
Rhamanuddin, S, Solazzo, S, Mahadevan, A, et al. Combined radiofrequency (RF) thermal ablation and radiation therapy (XRT) increases parameters indicative of oxidative and nitrosative stress as well as increasing tumor coagulation. Annual Meeting of the Radiological Society of North America, Chicago, 2007.Google Scholar
Dupuy, , 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: 738–45.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×