Radio Frequency Ablation,RF Ablation Surgery, RFA Osteoid Osteoma Treatment Gujarat, India

Benefits

    * Radiofrequency ablation can be an effective treatment for primary liver cancer and for cancers that have spread to the liver in select patients whose liver tumors are unsuitable for surgical resection.

    * In most studies, more than half of the liver tumors treated by radiofrequency ablation have not recurred. The success rate for completely eliminating small liver tumors is greater than 85 percent.

    * Treatment-related serious complications are infrequent and discomfort is minimal.

    * Radiofrequency ablation may be used repeatedly to treat recurrent liver tumors.

    * The percutaneous method of radiofrequency ablation, in which electrodes are inserted through the skin, is minimally invasive, produces few complications, and does not require hospital admission.

    * RFA is a relatively quick procedure and recovery is rapid so that chemotherapy may be resumed almost immediately in patients who need it.

    * Radiofrequency ablation is less expensive than other treatment options.

    * No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.

Risks

    * Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.

    * Depending on the site of treatment, radiofrequency ablation may cause brief or, rarely, long-lasting shoulder pain; inflammation of the gallbladder that subsides after a few weeks; damage to the bile ducts resulting in biliary obstruction; or thermal damage to the bowel.

    * Roughly one in four patients may develop a "post-ablation syndrome" with flu-like symptoms that appear three to five days after the procedure and usually last about five days. An occasional patient may remain ill for two to three weeks. Acetaminophen or ibuprofen taken by mouth is commonly used to control fever and other symptoms.

    * Some cases of bleeding have been reported but it usually stops on its own. If bleeding is severe, an additional procedure or surgery may be needed to control it.

    * Organs and tissues near the liver, such as the gallbladder, bile ducts, diaphragm and bowel loops, are at risk of being injured. Although this occurs only 3 to 5 percent of the time, it may require surgical correction. The risk of this complication is related to the location of the liver tumor that is treated.

    * Less than one percent of patients may develop a localized infection (abscess) at the site of the tumor ablation three to four weeks after the treatment. A liver abscess will require tube drainage and antibiotics to cure. Patients who have had a surgical procedure in which the liver bile duct has been connected to a loop of bowel are at much greater risk of developing a liver abscess after ablation.

    * Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.

    * This procedure may involve exposure to x-rays. However, radiation risk is not a major concern when compared to the benefits of the procedure.

    * Severe pain after RFA is uncommon, but may last a few days and require a narcotic to provide relief.

We first assess the tumor in detail, using CT scans and MRI, which are performed at our centre. However, if these investigations have already been done, we go through them carefully.

If the lesion is suitable for an RFA procedure from the treatment perspective, we assess the technical feasibility.

If the lesion is technically accessible, then a pre-procedure work-up is performed, which consists of a basic health assessment, and the coagulation profile.

If there is no contraindication, the procedure is then performed under deep sedation, with an anesthetist in attendance.

The procedure for an osteoid osteoma takes upto 30-45 minutes. For all other tumors, it may take from 30mins to 2 hours depending on the size of the tumor.

After the procedure, the patient is observed in the post-procedure room, until he/she is fully conscious. Usually within three hours, the patient leaves our centre. The patient is allowed light food four hours after the procedure. The patient will be on oral antibiotic coverage for another 3 days.

With most tumors including osteoid osteomas, the patient can go back to sedentary, non-strenuous work within 24-48 hours.

Follow-up CT scans or MRIs are performed at 48 hours, 30 days and 1 year and are part of the paid-up package.

This technique has many similarities to CT-guided lung biopsy procedures. Throughout the world, lung RFA is commonly performed in a CT scanner suite. Patients undergo this procedure either under moderate sedation with pain relief or under general anesthesia. General anesthesia has the advantage of complete control over patient's breathing pattern and motion that helps to accurately place the RFA electrode within the tumor.
                            Radio frequency Ablation (RFA) Needle

One study comparing conscious sedation to general anesthesia did not show any major difference in tumor control or procedure related complication rates, however the number of patients in both groups was small . A survey of centers performing RFA for lung tumors indicated that conscious sedation is used more commonly than general anesthesia . During the procedure, tumor cells are destroyed by placing a needle (RFA electrode) within the center of the tumor. The RFA electrodes come in various shapes, length and thickness, depending on the manufacturer . The RFA electrodes are carefully placed into the center of the tumor undergoing ablation using the guidance of images in the CT suite. Multiple CT images are taken to confirm the safe placement of RFA electrodes, and to avoid adjacent vital organs.
 Following placement, RFA electrodes are connected to an external RF generator. High-frequency alternating energy is then applied through the RF electrodes. This causes ionic agitation in tumor cells which raises tissue temperature. As the temperature increases above 45-50 degrees centigrade within the tumor, cellular proteins denature and cell structure disintegrates. This results in thermal coagulation in tumor cells, ultimately leading to tumor destruction. The entire RFA procedure session usually takes 3-4 hours or less. Following completion of therapy, RFA probes are withdrawn from the patient. Subsequently, patients are closely observed for any post procedural complications such as lung collapse. Following an uncomplicated RFA procedure, patients are discharged home mostly after overnight observation or rarely the same day.

Lung tissue characteristics may play a role in the effectiveness of RFA. The normal lung tissue surrounding the tumor is relatively resistant to heating due to its high electrical impedance (20, 21). Therefore, the heat energy created by RFA is preferentially deposited in the tumor facilitating higher temperatures. Also, large blood vessels (> 3 mm) near a tumor constantly cool the tissue due to the flowing blood that takes heat away from the area being treated, commonly known as the heat sink effect (14, 20). As a result, tumors in continuity with large blood vessels may be suboptimally treated with RFA. Some electrodes are believed to produce necrosis measuring up to 4-5 cm in diameter. This allows for the treatment of a 3 cm lesion and a 1 cm margin of normal lung. Tumors larger than 3 cm may require multiple electrodes to create overlapping tissue RFA zones.

Patients with tumors that are 3 cm or smaller are best suited for RFA treatment. A typical patient undergoing RFA is an adult who cannot undergo lung cancer surgery despite having a tumor that is at an early stage.

Examples of patients who may not be able to undergo surgery include those with poor lung function, other coexisting other diseases, poor general performance status which might deteriorate further following lung surgery, and patients with lung tumors that either do not respond to maximum conventional therapy, including radiation therapy, or recur after treatment. In other words, these patients have tumors that can be potentially removed by surgery, but the presence of other additional diseases in these patients prevent them from undergoing surgery.

Also in this group are patients who cannot afford to lose any more lung tissue. Although few studies report that RFA can be safely performed in tumors close to vital organs such as the heart, generally tumors that are close to the lung hilum (where the airtubes and blood vessels enter the lung) are not amenable to RFA (17, 18).

RFA stands for Radio Frequency Ablation. RFA is successfully used to treat certain tumors of lung, liver, kidney, and bone. Radiofrequency energy oscillation agitates cells thereby increasing the frictional heating with in tissues resulting in cell death. The feasibility of lung RFA has been demonstrated in animals, and the feasibility, safety and long term efficacy of lung RFA to treat tumors have been reported in humans, both in the United States and internationally . During the RFA procedure, rapidly alternating current is applied with a frequency in the range of 460-500 kHz through the RFA electrode . The alternating current causes movement of ions in the tissue resulting in tissue heating. Applying a temperature greater than 50 degrees centigrade for five minutes results in tumor cell death. Too high a temperature is not desirable as it will cause charring and gas formation immediately adjacent to the electrode and prevent the homogeneous heating of the entire tumor. During RFA, reaching a temperature of 60-100 degrees centigrade within the tumor is generally desired, as charring and gas formation occur at approximately 105-115 degrees centigrade. Ideally, the goal is to achieve complete cell death within the tumor, as well as in a 1 cm margin of the adjacent normal lung .