Image guided radiofrequency ablation - alternative to surgery for some tumours

RFA involves the insertion of a fine probe through the skin into the centre of the tumour. This is guided by the most appropriate imaging modality for the tumour being targeted. For liver this is generally ultrasound, with or without CT, while for lung it is generally CT. Once in position high frequency radiofrequency energy is then passed through the probe, heating and destroying the surrounding tissue. This can be done in a very controlled manner to limit damage to healthy surrounding tissue. It can be done under a short and light general anaesthetic or under sedation, and often as a day stay procedure. 

 

RFA tumour ablation has been shown to be both safe and effective and has been approved by NICE.

 

Image guided RFA has also been shown to be safe and effective for the management of patients with secondary bone tumours (Fig. 3). Guidance of the RFA probe into the tumour is performed using CT, and the metastatic deposit is usually heated to around 100°C for up to 15 minutes. If the tumour is large the probe can be re-directed so several RFA treatment cycles can be delivered during one procedure. Tumours can also be treated in very delicate areas such as in the spine. These cannot be treated using conventional techniques because of the risks of nerve root or spinal cord injury. 

 

Image guided RFA is suitable not only for metastatic deposits. Osteoid osteomas are benign tumours of bone that tend to occur in young adults. They cause severe pain and conventional surgical treatment is destructive to surrounding tissue and bone. Image guided RFA has become the NICE approved treatment of choice for these rare tumours.