Oncology/Surgery

 

An Overview of Treatment Options

 

What is Thermal Ablation?

 

Thermal ablation, or heat, has been used in medical procedures for over a decade. This method of destroying unwanted tissue has been used to ablate lesions or tumors in the liver and other soft tissue. Thermal ablation has also been used in cardiac and gynecological procedures. The most common methods of thermal ablation are Radiofrequency Ablation, Microwave Ablation and Laser Ablation.

 

Radiofrequency Ablation

 

What is Radiofrequency Ablation?

Quite simply, Radiofrequency Ablation is electrical energy used to create heat for the removal or destruction of tissue.

 

Until recently, people with cancer or other tumors have had traditional treatment options at the site of the tumor, such as surgical removal, radiation, freezing, and chemotherapy. Newer technologies include injecting medication directly into the tumor and cutting off the blood flow to the tumor. These methods all have their risks and drawbacks.

 

Radiofrequency Ablation (RFA) offers a valuable, groundbreaking option. RFA is a medical technology that destroys tumors in a much less invasive way. It can eliminate a tumor when surgical removal is not an option and without the side effects of other techniques.

 

How it works: Procedure overview

 

RFA is a very precise procedure that works to seek, heat and destroy unwanted tissue. 

 

SEEK

Using an imaging guidance system such as an ultrasound, computed tomography (CT), or magnetic resonance (MR), the doctor places a slender probe directly into the tumor. Once the probe is in position, a group of very thin, flexible electrodes are extended from the end of the probe into the tissue. This dispenses heat to a wider area.

 

HEAT

Using a radiofrequency generator, the doctor then allows a carefully controlled amount of energy to flow through the electrodes into the tissue, causing the tissue to heat up. Heating is sustained for a predetermined length of time, usually just a few minutes. Tiny thermometers at the tips of the electrodes constantly measure temperature.

 

DESTROY

Upon completion of the treatment, the tumor will be destroyed by the heat and will no longer enhance on CT imaging.

 

How it is administered: Techniques

There are three types of RFA treatment. Your doctor will determine the optimal treatment for you, depending on the size and severity of your tumor(s).

 

• Percutaneous

A needle-sized electrode is passed directly through the skin and guided into place. This requires only light sedation. You can usually go home the same day.

 

• Laparoscopic

Several tiny incisions are made, allowing the insertion of the RFA and imaging probes. This requires general anesthesia. You can usually go home the next day.

 

• Open Surgery

RFA can be used during open surgery, allowing the doctor to view the tumor before and during treatment. This requires general anesthesia and a slightly longer recovery.

 

The Benefits of Radiofrequency Ablation

Reduction of the size or elimination of tumors

• Minimally invasive—usually done on an outpatient basis

• Can be used on tumors up to 7 cm in size

• Can be used repeatedly for recurring or new tumors

• Few complications or side effects

 

What treatment is best for you?

Treatment choice depends on the type and size of tumors, their number and location, the severity of the disease, and your general health. Your doctor will help you decide if RFA is a good option for you.

 

Microwave Ablation

 

What is Microwave Ablation?

 

Unlike Radiofrequency Ablation, Microwave ablation uses microwave energy to create heat and destroy unwanted tissue.

 

Microwaves are a unique and rapid way of heating tissue. They are absorbed by the tissue creating heat by interacting with the water in the tissue. The microwaves decay away to nothing inside the area of tissue. This ensures that the area of heating is very controlled and precise.

 

How it works.

 

The MTA system uses a slender rod-shaped applicator that delivers a controlled amount of microwave energy into the target tissue. This takes approximately 2-4 minutes. The heat that is generated by the microwave applicator kills the cells within the target tissue.

 

About the procedure

Your doctor will use Ultrasound or CT guidance to accurately guide the microwave applicator into the center of the area of tissue to be treated.

 

Once satisfied with the applicator’s position into the target area, your doctor will start the microwave generator. The generator will deliver microwave energy to the applicator at the energy level selected by the doctor. The doctor will predetermine how long to apply this energy based on the size of the area that is to be destroyed. Usually only a few minutes are required to destroy the targeted tissue. If there are several areas of tissue to be targeted, the doctor will repeat this process for each area. Several areas of tissue can be treated during the same operation.

 

After the procedure, your doctor will discuss your post-operative care and outpatient follow-up. He/she will also want to perform follow-up CT scans every 3-6 months to check on your progress.

                  

Is Microwave Tissue Ablation the right choice for you?

 

Only your doctor can determine whether an ablative therapy is appropriate to treat your condition.

 

Learn more about Microwave Ablation:

PDF icon Microwave Ablation Patient Brochure (Arabic).pdf

 

Irreversible Electroporation

 

What is irreversible electroporation?

 

For over a decade, thermal ablation has been used to treat cancerous lesions and tumors in the liver, lung, kidney, prostate and bone, as well as in cardiac and gynecological procedures. Thermal ablation is minimally invasive and uses either extreme heat, extreme cold, radiation, or microwave energy. 

 

Irreversible electroporation, or IRE, represents the next generation in treatment. It does not use extreme heat or cold, thereby eliminating a major cause of treatment failure and possible tissue damage. This makes it especially useful for patients who are not candidates for traditional surgery because of the location or extent of the tissue to be ablated.

 

What is the procedure like?

 

IRE is a cutting-edge technology that uses the NanoKnife System. It is a highly targeted therapy that permits the ablation of soft tissue while leaving the surrounding structures viable.

 

Guided by ultrasound or CT images, a physician places small, IRE electrodes in or around the lesion. The electrodes then send out a series of short, intense electric pulses that irreversibly damage the cells in the ablation zone. The procedure is done under general anesthesia, and most patients experience little post-procedural pain or bleeding afterwards.

 

How does IRE compare to other therapies, like cryoablation, microwave or RFA?

 

IRE is a generation apart from the more common ablation therapies that use extreme heat (radiofrequency ablation, or RFA), extreme cold (cryoablation), radiation, or microwave energy. It is less damaging to blood vessels, ducts, and other delicate anatomical structures that lie within the ablation zone.    

 

How common is this procedure?

The NanoKnife System has been commercially available since September 2009 and is used by institutions to treat patients around the world.

 

Is IRE right for me?

 

Whether the IRE is appropriate for you is something that must be determined in consultation with your physician.

 

Are there any side effects?

 

There are few side effects or scarring that result from a NanoKnife procedure. The procedure is done under general anesthesia, which carries risk independent of the treatment. Most patients experience little post-procedural pain or bleeding afterwards. It is very important that prospective patients review all aspects of any proposed treatment with their physician to understand both the risks and possible benefits of treatment.

 

Will my insurance cover this?

 

Check with your insurance company and your doctor; coverage is on a policy-by-policy basis.

 

How long is recovery?

 

Patients are typically discharged from the hospital the day following the procedure.