Thermo Ablation with Radiofrequency RFA

RFA is based on thermic destruction of the tumour induced by the application of alternating current at radiofrequency frequency (350-500 kHz). The passage of the current causes ionic agitation of the tissue, which is converted into frictional heat. Electricity is supplied via an electrode needle inserted into the tumour. At present, many models of electrode-needle are used: single or multiple electrode internally cooled needles (Tyco Healthcare, Mansfield, MA, USA) or retractable multiple electrode non-cooled prongs (Radiotherapeutics and RITA Medical Systems, Mountain View, CA, USA). Experimental studies of comparison among the various models of equipment did not show significant differences in the extent of necrosis [65].

With the equipment used nowadays, the extent of necrosis after a single treatment is about 3-4 cm. For larger lesions multiple insertions of the needle are required. RFA treatment may be performed through percutaneous, laparoscopic and laparotomic approaches. Ultrasound is utilised for real-time monitoring of correct position of the probe into the tumour but also CT or MRI may be used (Fig. 4).

In colorectal metastases, indications for RFA are limited, because only surgical resection allows a radical treatment. RFA effectiveness has not been con

Table 9. Results of RFA Treatment

Authors No. patients Mean size Mean follow-up Local Intrahepatic or 1-2-3- years

(months) recurrences extrahepatic survival

Table 9. Results of RFA Treatment

Authors No. patients Mean size Mean follow-up Local Intrahepatic or 1-2-3- years

(months) recurrences extrahepatic survival

(%)

recurrences (%)

(%)

Curley et al. [70]

75

3.4

15

3

30

-

Wood et al. [71]

70

2

9

7

18

-

De Baere et al. [72]

68

2.5

14

10

50

94 ;-

Solbiati et al. [73]

69

4

36

10

58

90; 60; 34

Bowles et al. [69]

117

2.5

18

39

66

93; 69; 46

Pawlik et al. [74]

112

<2

21

2.3

57

98; 70; 50

Mutsaerts et al. [75]

48

2.5

11

7

56

-

firmed in randomised clinical trials and the use of this methodology should be reserved for selected patients. The indications of a mini-invasive treatment in the literature are not standardised and only patients with lesions that are not candidates for surgery are submitted to RFA. Therefore the use of this methodology in otherwise resectable patients should be limited as much as possible.

At the moment the role of RFA is not clear in patients with a non-resectable disease who are treated with combination therapy with RFA and new chemotherapeutic drugs. The use of RFA in association with surgical resection may allow a consensual treatment of multiple lesions in order to achieve the complete treatment of all lesions [66,67].

The use of RFA in the treatment of recurrences after surgical resection is still controversial, because, despite reiterated surgical resection having the best results, RFA might represent an alternative technique in selected patients. In non-randomised studies, RFA allowed results in these patients in terms of survival comparable with reiterated hepatic resections [63].

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