What is RF Ablation? In which diseases is it used in Interventional Radiology?
RF Ablation (RFA, Radiofrequency Destruction method) is a treatment method used in cancer treatment that works on the principle of destroying cancer cells with heat. As with all other interventional radiology treatments, this treatment is performed with imaging guidance (such as Computed Tomography, MRI, Ultrasonography).
RF Ablation therapy is frequently used in the treatment of liver tumors in interventional radiology. The most common liver tumors are; primary tumors of the liver (e.g., hepatocellular cancer, HCC) and secondary (e.g., spread to the liver, metastatic) tumors (e.g., colon cancer, breast cancer, lung cancer, pancreatic cancer metastases, etc.) In addition, RF Ablation treatment can be used for cancers in other organs (e.g., lung). It is also effective.
Features that patients who are candidates for RF Ablation treatment should have
1. Surgery cannot be performed due to the location or characteristics of the cancer focus
2. The patient Surgery cannot be performed due to factors related to the disease
3. In case of surgery, there will not be enough healthy tissue left in the liver
4. Relapse despite surgery
5. The disease does not respond well to chemotherapy
6. Inside the liver
It can be listed as follows: there are many scattered cancer foci and therefore surgery cannot be performed.
RF Ablation treatment is also used to destroy these veins in varicose veins in the leg and thigh area.
What kind of treatment is RF Ablation? What Does It Do?
RF Ablation treatment is performed with imaging guidance. Ultrasonography and Computed Tomography devices are often used as a guide during the procedure. Rarely, this procedure is also performed with an MRI device. Since the treatment process is performed under imaging guidance, the risk of destroying the wrong tissue or destroying an unwanted area is very low and this situation is almost never observed.
RF Ablation treatment is performed by entering the skin with a small needle. Local anesthetic is applied to the patient before the procedure. For this reason, there is no or very little pain in the procedure. It is barely audible.
The RF Ablation needle is advanced to the center of the cancerous tissue under imaging guidance, and with this needle connected to the Radiofrequency generator, an area of the desired width (for example, 1 cm, 2 cm, 3 cm or larger cancer area) is removed. tissue, for example 7 cm) is burned with thermal energy resulting from radiofrequency energy. With the RF energy given from the needle tip advanced to the center of the cancerous tissue, the temperature in the cancerous tissue is increased and the cancer cells die. In addition, this increase in temperature ensures the occlusion of small vessels within the cancer focus, thus reducing the possibility of bleeding during the procedure. After the procedure, the cancerous focus becomes dead tissue and shrinks over time.
How Does RF Ablation Work?
In RF Ablation treatment, RF energy converted from electrical energy causes heating in the tissues and causes irreversible cell death. The amount of heat delivered to the tissue is monitored with a micro thermometer located at the tip of the RF ablation needle. The rise of the tissue to the desired temperature is monitored on the monitor. Generally, the destroyed tissue is heated to 60-100 degrees C. It takes 5-6 minutes to reach this temperature in the tissue where the RF Ablation needle is placed. The procedure is terminated when sufficient temperature is reached.
What Will Patients Experience Before and After the RF Ablation Procedure?
Patients go through a short preparation period before the treatment procedure. During this period, some blood tests are performed. In addition, before the procedure, examinations such as Ultrasonography, Tomography, MRI or PET/CT must be performed to precisely determine the location, size, extent and spread of the liver tumor to be ablated. This imaging performed before the procedure is very important as it will be used as the basis for determining the effectiveness of the treatment after the procedure.
The patient must be hungry on the day of the procedure. The procedure will be performed with local anesthesia. For this reason, patients do not experience serious pain during the procedure, but short-term temporary pain may be observed.
If there is no other reason that requires patients to stay in the hospital after the treatment, patients can be discharged on the same day. In some patients, rarely, one day. A hospital stay and follow-up is required. Although there may be mild pain after the procedure as the local anesthesia wears off, it can be controlled with simple painkillers.
How to Understand the Benefits of RF Ablation Treatment and How to Follow It?
Whether patients benefit from RF ablation treatment can be monitored with various clinical scores. A significant improvement can be observed in the general condition of patients who benefit from it. However, the actual follow-up is done with imaging findings.
CT, MRI, PET/CT or Ultrasonography results before the procedure are compared with the imaging results after the procedure. In patients who benefit from it, a decrease in the size of the cancer focus, a decrease in its prevalence, or a decrease in its vascularity (reduction in the retention of contrast material-tissue dyeing drug) is observed in Computed Tomography, Ultrasonography or MRI examinations, while the decrease in the metabolism and activity of the cancer tissue is monitored with PET/CT examination.
In order to better understand the shrinkage of the cancer focus, the decrease in its spread and the loss of activity, at least 3 months must pass after the RF Ablation procedure. It should be kept in mind that some errors may occur in the imaging performed before this period.
The optimal follow-up period in terms of imaging is periodic periods with short intervals (every 3 or 6 months) after the 3rd month. However, in patients with sudden deterioration in general condition after the procedure, these periods can be adjusted according to the clinical condition of the patient.
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