**4.3. Radiofrequency ablation of pancreatic cancer**

150 Hyperthermia

**Figure 3.** RFA of osteoid osteoma in a 14-year-old girl. a MR images shows a small, well-defined lesion in the proximal tibial epiphysis. b CT during percutaneous RF ablation shows a radiolucent nidus with central calcification surrounded by a dense rim of sclerosis. Note markers for planning the skin entry point. c CT shows the bone biopsy probe tip at the margin of the nidus . d CT shows the tip of the RF electrode within the nidus after slight withdrawal of the penetrating cannula. e Control image obtained

Radiofrequency ablation has been advocated as an alternative to resection in persons with lung nodules who cannot be treated surgically because of medical problems, multiple tumors, or poor surgical risk. There are, however, no adequate prospective clinical studies that demonstrate that RFA of lung metastases is as effective as surgical (cold knife) resection in curative resection of malignant neoplasms. An important concern is that RFA does not allow for examination of surgical margins to ensure that cancer is completely resected. Le and Petrik considered RFA as a promising technique for the treatment of early states (state I and stage II) non-small cell lung cancer (13). An assessment by the National Institute for Health and Clinical Excellence (NICE, 2006) concluded: "Current evidence on the safety and efficacy of percutaneous radiofrequency ablation for primary and secondary lung cancers shows that there are no major safety concerns with this procedure. There is evidence that the treatment can reduce tumor bulk; however, this evidence is limited and is based on heterogeneous indications for treatment. The procedure should therefore be used only with special arrangements for consent, audit and clinical governance (14). "The Food and Drug Administration (FDA) has issued a Public Health Notification as clarification for healthcare providers that no RFA devices are specifically approved for use in partial or full ablation of lung tumors (15). Radiofrequency ablation devices are minimally invasive tools used for general removal of soft tissue, such as those that contain cancer cells. It is an image-guided technique that heats and destroys cancer cells. Imaging techniques such as ultrasound and computed tomography (CT) are used to help guide a needle electrode into a cancerous tumor. High-frequency electrical currents are then passed through the electrode, creating

immediately after the intervention shows the biopsy tract with no bleeding(12)

**4.2. Radiofrequency ablation of pulmonary tumors** 

heat that destroys the abnormal cells.

Radiofrequency ablation has been used as a treatment of pancreatic cancer for a number of years in Japan. Current evidence of effectiveness of RFA for pancreatic cancer consists of case reports and a phase II (safety) study; the latter concluded that RFA was a relatively safe treatment for pancreatic cancer. However, this evidence is insufficient to draw conclusions about the effectiveness of RFA for this indication. Girelli et al (2010) examined the feasibility and safety of RFA as a treatment option for locally advanced pancreatic cancer. A total of 50 patients with locally advanced pancreatic cancer were studied prospectively. Ultrasoundguided RFA was performed during laparotomy. The main outcome measures were shortterm morbidity and mortality. The tumor was located in the pancreatic head or uncinate process in 34 patients and in the body or tail in 16; median diameter was 40 (inter-quartile range [IQR] of 30 to 50) mm. Radiofrequency ablation was the only treatment in 19 patients; it was combined with biliary and gastric bypass in 19 patients, gastric bypass alone in 8, biliary bypass alone in 3 and pancreatico-jejunostomy in 1. The 30-day mortality rate was 2 %. Abdominal complications occurred in 24 % of patients; in half they were directly associated with RFA and treated conservatively. Three patients with surgery-related complications needed re-operation. Reduction of RFA temperature from 105 degrees C to 90 degrees C resulted in a significant reduction in complications (10 versus 2 of 25 patients; p = 0.028). Median post-operative hospital stay was 10 (range of 7 to 31) days. The authors concluded that RFA of locally advanced pancreatic cancer is feasible and relatively well tolerated, with a 24 % complication rate. This was a feasibility and safety study; it did not provide any data on the effectiveness of RFA in treating pancreatic cancer (16).
