Radiofrequency Ablation for Cancer: Current Indications, Techniques, and Outcomes

312 Pages·2004·5.267 MB·English

by  Lee M. Ellis MD, Steven A. Curley MD, Kenneth K. Tanabe MD (auth.)

Radiofrequency Ablation
for Cancer

Radiofrequency
Ablation for Cancer
Current Indications, Techniques,
and Outcomes
Lee M. Ellis, MD
Professor of Surgical Oncology and Cancer Biology
Department of Surgical Oncology
The University of Texas M.D. Anderson Cancer Center
Houston, Texas, USA
Steven A. Curley, MD
Professor, Department of Surgical Oncology
Chief of Gastrointestinal Tumor Surgery
The University of Texas M.D. Anderson Cancer Center
Houston, Texas, USA
Kenneth K. Tanabe, MD
Chief, Division of Surgical Oncology
Massachusetts General Hospital
Associate Professor of Surgery
Harvard Medical School
Boston, MA, USA
Editors
With 85 Illustrations
Lee M. Ellis, MD Steven A. Curley, MD Kenneth K. Tanabe, MD
Professor of Surgical Oncology Professor, Department of Chief, Division of Surgical
and Cancer Biology Surgical Oncology Oncology
Department of Surgical Oncology Chief of Gastrointestinal Massachusetts General
The University of Texas Tumor Surgery Hospital
M.D.Anderson Cancer Center The University of Texas Associate Professor of
Houston, TX 77030 M.D.Anderson Cancer Center Surgery
Houston, TX 77030 Harvard Medical School
Boston, MA02114-2167
Library of Congress Cataloging-in-Publication Data
Radiofrequency ablation for cancer : current indications, techniques, and outcomes
/ editors, Lee M. Ellis, Steven A. Curley, Kenneth K. Tanabe.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-387-95564-X (h/c : alk. paper)
1. Cancer—Thermotherapy. 2. Catheter ablation. I. Ellis, Lee M. II. Curley,
Steven A. III. Tanabe, Kenneth K.
[DNLM: 1. Cancer Ablation. 2. Neoplasms—therapy. QZ 266 R129 2003]
RC271.T5 R336 2003
616.99'40632—dc21 2002042727
Printed on acid-free paper.
© 2004 Springer-Verlag New York, Inc.
All rights reserved. This work may not be translated or copied in whole or in part
without the written permission of the publisher (Springer-Verlag New York, Inc., 175
Fifth Avenue, New York, NY10010, USA), except for brief excerpts in connection with
reviews or scholarly analysis. Use in connection with any form of information stor-
age and retrieval, electronic adaptation, computer software, or by similar or dissim-
ilar methodology now known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks and similar
terms, even if they are not identified as such, is not to be taken as an expression of
opinion as to whether or not they are subject to proprietary rights.
While the advice and information in this book are believed to be true and accurate
at the date of going to press, neither the authors nor the editors nor the publisher
can accept any legal responsibility for any errors or omissions that may be made. The
publisher makes no warranty, express or implied, with respect to the material con-
tained herein.
Printed in the United States of America.
9 8 7 6 5 4 3 2 1
ISBN 0-387-95564-X SPIN 10890910
Springer-Verlag New York Berlin Heidelberg
Amember of BertelsmannSpringer Science(cid:1)Business Media GmbH
Preface
Technologic advances have provided new methods for the sur-
gical treatment of malignant tumors. This minor revolution in
surgical therapy began with the widespread use of laparoscopy
for the diagnosis and treatment of various abdominal malignan-
cies. More recently, radiofrequency ablation (RFA) has been used
to treat malignant disease in the liver. Although prior ablative
therapies such as cryotherapy or ethanol injection have been used
for malignant liver tumors, the complication rates have been
moderately high and efficacy has been suboptimal. There has
been a great deal of enthusiasm for the increased use of RFAnot
only for liver tumors but also for tumors in other locations. It is
well established that the complication rate associated with RFA
for tumors in various anatomic locations is relatively low. Specif-
ically, when compared to cryoablation of liver tumors, RFA of
liver tumors is associated with reduced morbidity. However, RFA
is not yet in widespread use for malignant disease, and the long-
term outcome of this treatment modality has yet to be determined.
This book on RFAfor cancer addresses mainly hepatic tumors.
The use of RFAfor malignant liver neoplasms is approved by the
Food and Drug Administration (FDA) and is now becoming more
widespread throughout the world. It is important to point out
that the indications for the use of RFA for liver tumors vary
among treating physicians. The gold standard for the treatment
of malignant liver tumors remains resection until such time as
long-term follow-up of patients treated with RFA demonstrates
equivalent or better results with respect to survival, morbidity,
v
vi Preface
and quality of life. The use of RFAfor malignant hepatic tumors
has increased the number of patients who are now surgical can-
didates because RFA can be used in combination with hepatic
resection for bilobar tumors that would otherwise be deemed un-
resectable. Experienced oncologists recognize that highly ag-
gressive tumors are infrequently affected by surgical therapy.
Therefore, the addition of chemotherapy to RFAof malignant he-
patic tumors is a natural strategy to explore, and this topic is care-
fully considered in this book. With the relatively low complica-
tion rate associated with RFA, surgeons now have the option of
“debulking” hepatic tumors. In the past this approach was not
considered to be beneficial because of the relatively high com-
plication rates of aggressive resections combined with the mini-
mal benefits (if any) in survival for patients with biologically ag-
gressive tumors. Despite the fact that some patients may have
small-volume extrahepatic disease, it is the opinion of most on-
cologists that the tumor in the liver is the ultimate cause of pa-
tient demise. Currently, it is unknown if resection and ablation
of the bulk of the tumor mass in the liver prolong survival or im-
prove quality of life. Furthermore, it should be recognized that
while the complications of RFAare uncommon, treatment-related
complications and deaths do occur. Issues pertinent to compli-
cations of RFAare addressed. As with any technical procedure,
there is a learning curve for RFA that affects the efficacy of the
therapy and the risk for adverse events.
Recognizing that RFAcan produce complete thermal tumor ne-
crosis and is associated with relatively low complication rates,
clinicians have investigated the use of RFA for benign and ma-
lignant tumors at other anatomic sites. Although one might an-
ticipate that the complication rate for RFAof pulmonary and thy-
roid tumors would be high, initial experience suggests that RFA
for lesions in these sites is feasible. The results reported in this
book are in a highly selective group of patients studied on clin-
ical protocols. Although the editors have selected such topics for
discussion here, further studies published in peer-reviewed jour-
nals and evaluated by the FDAare critical before widespread use
of these techniques for tumors at these extrahepatic sites can be
recommended.
Lastly, it is critically important to understand the role of ra-
diographic imaging in directing and monitoring the ablative pro-
cess. It is also necessary for radiologists and oncologists to un-
derstand the radiographic changes associated with successful
ablation versus recurrent disease. The use of radiographic imag-
ing for RFAis covered in a separate section in this book.
Although RFAis rapidly being adopted as a treatment modal-
ity, universally accepted guidelines for its use have not been es-
tablished. Even among the various authors in this book, there is
Preface vii
little consensus as to the appropriate patient population that
should be treated with this modality. Furthermore, some of the
data may be difficult to interpret because RFA equipment con-
tinues to evolve; more powerful and larger arrays are continu-
ally being developed. Thus the early results of RFAwhere the ar-
rays were relatively small with lower power generators may not
be applicable to the results obtained at the present time with ar-
rays that approach 7 cm and generators of 200 W. Therefore, cli-
nicians are encouraged to stay abreast of the current literature in
directing their practice.
LEE M. ELLIS, MD
STEVENA. CURLEY, MD
KENNETH K. TANABE, MD
May 2003
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Principles of Radiofrequency Ablation
Chapter 1 Radiofrequency Tissue Ablation: Principles and
Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
MUNEEBAHMEDAND S. NAHUM GOLDBERG
Radiofrequency Ablation of Liver Malignancies
Chapter 2 Radiofrequency Ablation of Colon and Rectal
Carcinoma Liver Metastases . . . . . . . . . . . . . . . . . 31
MICHAELA. CHOTIAND KENNETH K. TANABE
Chapter 3 Combination of Radiofrequency Ablation and
Intraarterial Chemotherapy for Metastatic Cancer
in the Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
DOUGLAS L. FRAKER
Chapter 4 Deciding When to Use Resection or
Radiofrequency Ablation in the Treatment of
Hepatic Malignancies . . . . . . . . . . . . . . . . . . . . . . 67
MARK S. ROH
Chapter 5 Laparoscopic Radiofrequency Ablation of
Liver Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
EREN BERBERANDALLAN E. SIPERSTEIN
Chapter 6 Radiofrequency Ablation of Hepatocellular
Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
STEVENA. CURLEYAND FRANCESCO IZZO
ix
x Contents
Chapter 7 Radiofrequency Ablation of Carcinoid and
Sarcoma Liver Metastases . . . . . . . . . . . . . . . . . . 107
ALEXANDERA. PARIKH, BRUNO FORNAGE,
STEVENA. CURLEY,AND LEE M. ELLIS
Chapter 8 Complications of Hepatic Radiofrequency
Ablation: Lessons Learned . . . . . . . . . . . . . . . . . 121
RICHARD J. BLEICHERANDANTON J. BILCHIK
Radiofrequency Ablation of Solid Tumors at Various Sites
Chapter 9 Radiofrequency Ablation of Early-Stage
Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
MERRICK I. ROSSAND BRUNO D. FORNAGE
Chapter 10 Radiofrequency Ablation of Osteoid Osteoma . . 159
MARTIN TORRIANIAND DANIELI. ROSENTHAL
Chapter 11 Percutaneous Radiofrequency Ablation of
Osseous Metastases . . . . . . . . . . . . . . . . . . . . . . 173
DAMIAN E. DUPUY
Chapter 12 Radiofrequency Ablation of Solid Renal
Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
RAYMONDA. COSTABILEAND JACK R. WALTER
Chapter 13 Radiofrequency Ablation of Pulmonary
Malignancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
LUIS J. HERRARA, HIRAN C. FERNANDO,
AND JAMES D. LUKETICH
Chapter 14 Radiofrequency Ablation of Recurrent Thyroid
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
DAMIAN E. DUPUYAND JOHN M. MONCHIK
Imaging for Radiofrequency Ablation
Chapter 15 Sonographic Guidance for Radiofrequency
Ablation of Liver Tumors . . . . . . . . . . . . . . . . . . 227
BRUNO D. FORNAGEAND LEE M. ELLIS
Chapter 16 Radiographic Imaging Following Radiofrequency
Ablation of Liver Tumors . . . . . . . . . . . . . . . . . . 253
HAESUN CHOI, EVELYNE M. LOYER,
AND CHUSILPCHARNSANGAVEJ
Chapter 17 Magnetic Resonance Imaging–Guided
and -Monitored Radiofrequency Interstitial
Thermal Cancer Ablation . . . . . . . . . . . . . . . . . . 269
SHERIF GAMALNOURAND JONATHAN S. LEWIN
Contributors
MUNEEBAHMED, MD
Beth Israel Deaconess Medical Center, Harvard Medical School
Department of Radiology
Boston, Massachusetts 02215
USA
EREN BERBER, MD
The Cleveland Clinic Foundation
Department of General Surgery / A80
Cleveland, Ohio 44195
USA
ANTON BILCHIK, MD, PhD
John Wayne Cancer Institute
Department of Surgery
Santa Monica, California 90404
USA
RICHARD J. BLEICHER, MD
Attending Surgeon, Department of Surgery
The Palo Alto Medical Foundation and Clinic
795 El Camino Real
Palo Alto, California 94301
USA
CHUSILPCHARNSANGAVEJ, MD
The M.D. Anderson Cancer Center
Department of Radiology
Houston, Texas 77030
USA
xi