Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
This is a minimally invasive method to treat solid cancers that utilizes special equipment to “burn” or “freeze” tumors without surgery. Computed Tomography (CT), Ultrasound (US) or Fluoroscopy is used to guide and position a needle probe into the tumor. This requires only a tiny hole, usually less than 3 mm via which the probe is introduced. When the probe is within the tumor it is attached to a generator which “burns” or “freezes” the cancer. The effectiveness of this new technique in treating cancer depends on two things: In general, for tumors 3 cm or less and easily accessible through the skin, the goal is to completely kill the cancer. The larger the tumor the more difficult it is to achieve complete cancer death, therefore early treatment is crucial to improving outcomes. Although surgery is a treatment option for most primary kidney tumors (renal cell carcinoma), some patients could benefit from a minimally invasive, kidney-sparing treatment option. This includes patients who are high surgical risks, have multiple medical problems, have multiple recurrent tumors (as with Von Hippel Landau), have borderline kidney function, or only have one kidney. RFA may also be used pre-operatively to decrease intraoperative blood loss.
Which tumors can be treated this way?
The most common cancers treated by this method are lung cancer, liver cancer and kidney (renal) cancer. Other cancers can also be treated provided they are accessible and of appropriate size.
Kidney (Renal) Cancer
Almost all tumors < 3cm and peripherally located can be successfully treated with RFA.
Radiofrequency ablation (RFA) is a useful alternative treatment for patients with small, early-stage lung cancer who wish to avoid conventional surgery or are too ill to undergo surgery. The same applies to patients who have a small number of metastases in their lungs, which are tumors that have spread from a cancer somewhere else in the body, such as the kidney, intestine or breast. RFA is not intended to replace surgery, radiation or chemotherapy in all patients. It may be effective when used alone or in conjunction with these treatments.
Radiofrequency ablation can be an effective means of relief when a tumor invades the chest wall and causes pain.Radiofrequency ablation may be used to debulk a lung tumor that is too large to remove surgically. In this way, the tumor is reduced in size so that the remaining tumor cells are more easily eliminated by chemotherapy or radiation therapy. It takes much less time to recover from RFA than it does from conventional surgery. Chemotherapy usually can resume after a shorter interval than when more invasive surgery is performed.
Two types of liver tumor have been the main targets of radiofrequency ablation: hepatocellular carcinoma, which is a primary liver cancer, and colon cancer that spreads (metastasizes) to the liver. Many patients with a malignant liver tumor are not good candidates for surgery, sometimes because their tumor is too widespread or inaccessible, or because of other medical conditions that make surgery especially risky. In other cases, so much liver tissue would have to be removed with the tumor that not enough would be left to provide adequate liver function. For many of these patients, radiofrequency ablation is a viable and effective treatment option.Some liver tumors that have failed to respond to chemotherapy or have recurred after initial surgery may be treated by radiofrequency ablation.
What does “burning” or “freezing” the cancer mean?
“Burning” refers to increasing the temperature of the tumor to such a level that cancer cells die. This is usually achieved by radio frequency probes, referring to the type of energy used to increase the temperature. “Freezing” refers to cryoablation which decreases the temperature to -400 C which also kills the cancer cells.
How do I prepare for the procedure?
You will be scheduled for a consultation with the Interventional Radiology Team. Bring a list of questions to ask your doctor. It is important that you understand exactly what procedure is planned, the risks, benefits and other options before your procedure.
What happens during the procedure?
is provided just prior to starting the procedure. You will be connected to several types of monitoring equipment.This procedure is generally done on the CT scan table. The Interventional Radiologist will position you in a way that will give him the shortest and safest pathway for the probe to reach the tumor.A technologist, nurse and physician will be in the room with you. You will have grounding pads placed on your thighs.It will be important for you to not move during the procedure and to follow the breathing instructions that are given to you.The procedure takes 2-3 hours.
What happens after the procedure?
You will go to the recovery area for a minimum of 2 hours. The Interventional Radiologists will assess your pain following the procedure and order medications as needed. The Interventional Radiologists reserve the option to keep you over night for observation. Your family will be able to join you in the recovery area. You may eat and drink after the procedure. An X-ray of you lung will be done 2 hours following the RFA to assure that your lung is not collapsed.
The Interventional Radiologist will assess you following the X-ray and determine if/when you can go home. More than 90% of patients are released from the hospital the day after the procedure. Possible complications depend on the organ treated and include bleeding, infection, and collapsed lung. The rate of serious complications from this procedure is below 5%.
Going home after a RFA:
In general, for tumors 3 cm or less and easily accessible through the skin, the goal is to completely kill the cancer. The larger the tumor the more difficult it is to achieve complete cancer death, therefore early treatment is crucial to improving outcomes.
Although surgery is a treatment option for most primary kidney tumors (renal cell carcinoma), some patients could benefit from a minimally invasive, kidney-sparing treatment option. This includes patients who are high surgical risks, have multiple medical problems, have multiple recurrent tumors (as with Von Hippel Landau), have borderline kidney function, or only have one kidney. RFA may also be used pre-operatively to decrease intraoperative blood loss.
1. Return home and rest quietly for the remainder of the day.
2. DO NOT drive or make legal decisions today as you may have received sedation medication for your procedure.
3. Have a responsible adult drive you and remain with you the rest of the day if possible. Depending on the time of your procedure, your activity will be restricted thus making it difficult to prepare meals etc. You may have also received medication that makes you groggy or sleepy.
4. You may resume your normal diet after the procedure. Avoid alcoholic beverages and depressant drugs for 24 hours.
5. DO NOT take aspirin-containing products, ibuprofen, vitamin E, or blood thinning products for 24 hours after the procedure. You may take Tylenol (1-2 tablets every 4-6 hours) for mild discomfort. Call the Radiology Department for pain, unrelieved by Tylenol for the first 24 hours following your procedure.
6. Call your physician immediately or go to the nearest Emergency Room if you develop any of the following:
- Rapid Heart Rate or Pulse
- Shortness of Breath
- Upper back or chest pain
- Sudden onset of anxiety
- Feeling Faint
- Skin color change
- Bloody Stool
- Saturation or the Band-Aid or dressing
- Check the dressing or Band-Aid throughout the day for any increase in drainage. Keep the Band-Aid or dressing dry for 24 hours. Replace the Band-Aid if necessary. If you notice brisk bleeding, apply pressure for 10 minutes and slowly release the pressure to see if the bleeding has stopped. If the bleeding does not stop, go to your Physician or the nearest Emergency Room.
Is there any follow up care?
Patients can expect blood work around 3- 4 weeks post procedure and an office visit. Long term follow up constitutes blood work, CT scans and office visits at 3 month intervals.
If you have any questions please feel free to contact the Interventional Radiology Office at 802-847-8359 Monday – Friday 8 a.m. to 5 p.m.If you need to reschedule an appointment please call the Interventional Radiology Department at (802) 847 3663.
This information is provided by the University of Vermont Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.