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Semin intervent Radiol 2003; 20(4): 253-268
DOI: 10.1055/s-2004-828936
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

History, Principles, and Techniques of Radiofrequency Ablation

Clare Horkan, S. Nahum Goldberg
  • Minimally Invasive Tumor Therapy Laboratory, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Publication History

Publication Date:
20 July 2004 (online)

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ABSTRACT

Radiofrequency (RF) tumor ablation has been shown to be a useful method for creating thermally induced coagulation necrosis, using either a percutaneous approach with image-guidance, laparoscopic guidance, or direct surgical placement of thin electrodes into tissues to be treated. RF has gained widespread clinical use for the treatment of hepatic, renal, and bony malignancies. This article discusses the principles and technical considerations of RF ablation, with the goal of defining optimal parameters for the therapy of focal tumors. These parameters include innovations that permit large volume tumor ablation (i.e., multitined and internally cooled electrodes), as well as adjuvant therapies that can modulate tumor physiology to allow improved tumor destruction (i.e., altered tissue conductivity and blood flow). Recent adjuvant chemotherapy also will be reviewed. Finally, the principles governing the safe use of the system, including proper grounding pad placement, will be addressed.

KEYWORDS

Radiofrequency (RF) ablation - tumor therapy - electrode

REFERENCES

  • 1 McLean A. The Bovie electrosurgical current generator.  Arch Surg . 1929;  18 1863-1873
    PubMedGoogle Scholar
  • 2 Huang S K, Graham A R, Hoyt R H, Odell R C. Transcatheter desiccation of the canine left ventricle using radiofrequency energy: a pilot study.  Am Heart J . 1987;  114(1 Pt 1) 42-48
    CrossrefPubMedGoogle Scholar
  • 3 Patil A A, Andrews R, Torkelson R. Stereotactic volumetric radiofrequency lesioning of intracranial structures for control of intractable seizures.  Stereotact Funct Neurosurg . 1995;  64 123-133
    PubMedGoogle Scholar
  • 4 Taha J M, Tew Jr M J, Buncher C R. A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy.  J Neurosurg . 1995;  83 989-993
    PubMedGoogle Scholar
  • 5 Rossi S, Fornari F, Pathies C, Buscarini L. Thermal lesions induced by 480 KHz localized current field in guinea pig and pig liver.  Tumori . 1990;  76 54-57
    CrossrefPubMedGoogle Scholar
  • 6 McGahan J P, Browning P D, Brock J M, Tesluk H. Hepatic ablation using radiofrequency electrocautery.  Invest Radiol . 1990;  25 267-270
    CrossrefPubMedGoogle Scholar
  • 7 Cosman E R, Nashold B S, Ovelman-Levitt J. Theoretical aspects of radiofrequency lesions in the dorsal root entry zone.  Neurosurgery . 1984;  15 945-950
    CrossrefPubMedGoogle Scholar
  • 8 Pautler S E, Pavlovich C P, Mikityansky I. et al . Retroperitoneoscopic-guided radiofrequency ablation of renal tumors.  Can J Urol . 2001;  8 1330-1333
    PubMedGoogle Scholar
  • 9 Ahmed M, Weinstein J, Liu Z. et al . Image-guided percutaneous chemical and radiofrequency tumor ablation in an animal model.  J Vasc Interv Radiol . 2003;  14 1045-1052
    PubMedGoogle Scholar
  • 10 Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A. Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results.  Eur Radiol . 2001;  11 914-921
    CrossrefPubMedGoogle Scholar
  • 11 Kavolius J P, Mastorakos D P, Pavlovich C, Russo P, Burt M E, Brady M S. Resection of metastatic renal cell carcinoma.  J Clin Oncol . 1998;  16 2261-2266
    CrossrefPubMedGoogle Scholar
  • 12 Goldberg S N, Dupuy D E. Image-guided radiofrequency tumor ablation: challenges and opportunities-part I.  J Vasc Interv Radiol . 2001;  12 1021-1032
    PubMedGoogle Scholar
  • 13 Goldberg S N, Gazelle G S, Compton C C, Mueller P R, Tanabe K K. Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation.  Cancer . 2000;  88 2452-2463
    CrossrefPubMedGoogle Scholar
  • 14 Thomsen S. Pathologic analysis of photothermal and photomechanical effects of laser-tissue interactions.  Photochem Photobiol . 1991;  53 825-835
    CrossrefPubMedGoogle Scholar
  • 15 Seegenschmiedt M H, Brady L W, Sauer R. Interstitial thermoradiotherapy: review on technical and clinical aspects.  Am J Clin Oncol . 1990;  13 352-363
    PubMedGoogle Scholar
  • 16 Goldberg S N, Gazelle G S, Mueller P R. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance.  AJR Am J Roentgenol . 2000;  174 323-331
    CrossrefPubMedGoogle Scholar
  • 17 Dodd III D G, Soulen M C, Kane R A. et al . Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough.  Radiographics . 2000;  20 9-27
    PubMedGoogle Scholar
  • 18 Goldberg S N, Gazelle G S, Halpern E F, Rittman W J, Mueller P R, Rosenthal D I. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size.  Acad Radiol . 1996;  3 212-218
    CrossrefPubMedGoogle Scholar
  • 19 Lencioni R, Goletti O, Armillotta N. et al . Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial.  Eur Radiol . 1998;  8 1205-1211
    CrossrefPubMedGoogle Scholar
  • 20 Dupuy D E, Goldberg S N. Image-guided radiofrequency tumor ablation: challenges and opportunities-part II.  J Vasc Interv Radiol . 2001;  12 1135-1148
    CrossrefPubMedGoogle Scholar
  • 21 Liszczak T M, Hedley-Whyte E T, Adams J F. et al . Limitations of tetrazolium salts in delineating infarcted brain.  Acta Neuropathologica (Berl) . 1984;  65 150-157
    CrossrefPubMedGoogle Scholar
  • 22 Pennes H. Analysis of tissue and arterial blood temperatures in the resting human forearm.  J Appl Physiol . 1948;  1 93-122
    PubMedGoogle Scholar
  • 23 Goldberg S N, Gazelle G S, Dawson S L, Rittman W J, Mueller P R, Rosenthal D I. Tissue ablation with radiofrequency: effect of probe size, gauge, duration, and temperature on lesion volume.  Acad Radiol . 1995;  2 399-404
    CrossrefPubMedGoogle Scholar
  • 24 Rossi S, Di Stasi M, Buscarini E. et al . Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer.  AJR Am J Roentgenol . 1996;  167 759-768
    PubMedGoogle Scholar
  • 25 Rossi S, Buscarini E, Garbagnati F. et al . Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.  AJR Am J Roentgenol . 1998;  170 1015-1022
    PubMedGoogle Scholar
  • 26 Siperstein A E, Rogers S J, Hansen P D, Gitomirsky A. Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastases.  Surgery . 1997;  122 1147-1154
    CrossrefPubMedGoogle Scholar
  • 27 LeVeen R. Laser hyperthermia and radiofrequency ablation of hepatic lesions.  Semin Interv Radiol . 1997;  14 313-324
    PubMedGoogle Scholar
  • 28 de Baere T, Denys A, Wood B J. et al . Radiofrequency liver ablation: experimental comparative study of water-cooled versus expandable systems.  AJR Am J Roentgenol . 2001;  176 187-192
    CrossrefPubMedGoogle Scholar
  • 29 McGahan J P, Gu W Z, Brock J M, Tesluk H, Jones C D. Hepatic ablation using bipolar radiofrequency electrocautery.  Acad Radiol . 1996;  3 418-422
    CrossrefPubMedGoogle Scholar
  • 30 Lee Jr T F, Staelin S T, Haemmerich D ST, Johnson C D, Mahvi D M. Bipolar RF produces larger zones of necrosis than conventional monopolar RF in pig livers.  Radiology . 2000;  217 229
    PubMedGoogle Scholar
  • 31 Desinger K, Stein K, Muller G, Mack M, Vogl T. Interstitial bipolar RF-thermotherapy (REITT) therapy by planning by computer simulation and MRI-monitoring-a new concept for minimally invasive procedures.  Proceedings of the International Society for Optical Engineering . 1999;  3249 147-160
    PubMedGoogle Scholar
  • 32 Goldberg S N, Stein M C, Gazelle G S, Sheiman R G, Kruskal J B, Clouse M E. Percutaneous radiofrequency tissue ablation: optimization of pulsed-radiofrequency technique to increase coagulation necrosis.  J Vasc Interv Radiol . 1999;  10 907-916
    CrossrefPubMedGoogle Scholar
  • 33 Goldberg S N, Solbiati L, Hahn P F. et al . Large-volume tissue ablation with radio frequency by using a clustered, internally cooled electrode technique: laboratory and clinical experience in liver metastases.  Radiology . 1998;  209 371-379
    CrossrefPubMedGoogle Scholar
  • 34 Schmidt D, Trubenbach J, Brieger J. et al . Automated saline-enhanced radiofrequency thermal ablation: initial results in ex vivo bovine livers.  AJR Am J Roentgenol . 2003;  180 163-165
    PubMedGoogle Scholar
  • 35 Miao Y, Ni Y, Yu J, Zhang H, Baert A, Marchal G. An ex vivo study on radiofrequency tissue ablation: increased lesion size by using an “expandable-wet” electrode.  Eur Radiol . 2001;  11 1841-1847
    CrossrefPubMedGoogle Scholar
  • 36 Kettenbach J, Kostler W, Rucklinger E. et al . Percutaneous saline-enhanced radiofrequency ablation of unresectable hepatic tumors: initial experience in 26 patients.  AJR Am J Roentgenol . 2003;  180 1537-1545
    PubMedGoogle Scholar
  • 37 Goldberg S N, Gazelle G S, Solbiati L, Rittman W J, Mueller P R. Radiofrequency tissue ablation: increased lesion diameter with a perfusion electrode.  Acad Radiol . 1996;  3 636-644
    CrossrefPubMedGoogle Scholar
  • 38 Lorentzen T. A cooled needle electrode for radiofrequency tissue ablation: thermodynamic aspects of improved performance compared with conventional needle design.  Acad Radiol . 1996;  3 556-563
    CrossrefPubMedGoogle Scholar
  • 39 Haemmerich D, Lee Jr T F, Chachati L, Wright A S, Mahvi D M, Webster J G. A device that allows for multiple simultaneous radiofrequency (RF) ablations in separated areas of the liver with impedance-controlled cool-tip probes: an ex vivo feasibility study.  Radiology . 2002;  225(P) 242
    PubMedGoogle Scholar
  • 40 Arata M A, Nisenbaum H L, Clark T W, Soulen M C. Percutaneous radiofrequency ablation of liver tumors with the LeVeen probe: is roll-off predictive of response?.  J Vasc Interv Radiol . 2001;  12 455-458
    PubMedGoogle Scholar
  • 41 Berber E, Flesher N L, Siperstein A E. Initial clinical evaluation of the RITA 5-centimeter radiofrequency thermal ablation catheter in the treatment of liver tumors.  Cancer J . 2000;  6 S319-S329
    PubMedGoogle Scholar
  • 42 Gervais D A, McGovern F J, Arellano R S, McDougal W S, Mueller P R. Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors.  Radiology . 2003;  226 417-424
    CrossrefPubMedGoogle Scholar
  • 43 Kobayashi M, Ikeda K, Someya T. et al . Stepwise hook extension technique for radiofrequency ablation therapy of hepatocellular carcinoma.  Oncology . 2002;  63 139-144
    CrossrefPubMedGoogle Scholar
  • 44 Chung M H, Wood T F, Tsioulias G J, Rose D M, Bilchik A J. Laparoscopic radiofrequency ablation of unresectable hepatic malignancies. A phase 2 trial.  Surg Endosc . 2001;  15 1020-1026
    CrossrefPubMedGoogle Scholar
  • 45 Breiger J, Pereira P L, Trubenbach J. et al . In vivo efficiency of four commercial monopolar radio frequency ablation systems: a comparative study in pig liver.  Invest Radiol . 2003;  38 609-616.
    CrossrefPubMedGoogle Scholar
  • 46 Goldberg S N. Comparison of techniques for image-guided ablation of focal liver tumors.  Radiology . 2002;  223 304-307
    PubMedGoogle Scholar
  • 47 Merkle E M, Goldberg S N, Boll D T. et al . Effects of superparamagnetic iron oxide on radio-frequency-induced temperature distribution: in vitro measurements in polyacrylamide phantoms and in vivo results in a rabbit liver model.  Radiology . 1999;  212 459-466
    PubMedGoogle Scholar
  • 48 Livraghi T, Goldberg S N, Monti F. et al . Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases.  Radiology . 1997;  202 205-210
    PubMedGoogle Scholar
  • 49 Miao Y, Ni Y, Mulier S. et al . Ex vivo experiment on radiofrequency liver ablation with saline infusion through a screw-tip cannulated electrode.  J Surg Res . 1997;  71 19-24
    CrossrefPubMedGoogle Scholar
  • 50 Goldberg S N, Ahmed M, Gazelle G S. et al . Radio-frequency thermal ablation with NaCl solution injection: effect of electrical conductivity on tissue heating and coagulation-phantom and porcine liver study.  Radiology . 2001;  219 157-165
    CrossrefPubMedGoogle Scholar
  • 51 Lobo S M, Afzal K, Kruskal J B, Lenkinski R E, Gazelle G S, Goldberg S N. Radiofrequency thermal ablation using an adjuvant NaCl gel: effect of electrical conductivity on tissue coagulation.  Radiology . 2001;  201(P) 398
    PubMedGoogle Scholar
  • 52 Goldberg S N, Hahn P F, Tanabe K K. et al . Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis?.  J Vasc Interv Radiol . 1998;  9(1 Pt 1) 101-111
    CrossrefPubMedGoogle Scholar
  • 53 Lu D S, Raman S S, Vodopich D J, Wang M, Sayre J, Lassman C. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the “heat sink” effect.  AJR Am J Roentgenol . 2002;  178 47-51
    CrossrefPubMedGoogle Scholar
  • 54 Chinn S B, Lee Jr T F, Kennedy G D. et al . Effect of vascular occlusion on radiofrequency ablation of the liver: results in a porcine model.  AJR Am J Roentgenol . 2001;  176 789-795
    CrossrefPubMedGoogle Scholar
  • 55 Goldberg S N, Hahn P F, Halpern E F, Fogle R M, Gazelle G S. Radio-frequency tissue ablation: effect of pharmacologic modulation of blood flow on coagulation diameter.  Radiology . 1998;  209 761-767
    CrossrefPubMedGoogle Scholar
  • 56 Patterson E J, Scudamore C H, Owen D A, Nagy A G, Buczkowski A K. Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size.  Ann Surg . 1998;  227 559-565
    CrossrefPubMedGoogle Scholar
  • 57 Horkan C, Ahmed M, Liu Z. et al . Radiofrequency Ablation: effect of pharmacologic modulation of hepatic and renal blood flow on coagulation diameter in a VX2 tumor model.  J Vasc Interv Radiol . 2004;  15 269-274
    PubMedGoogle Scholar
  • 58 Rossi S, Garbagnati F, Lencioni R. et al . Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply.  Radiology . 2000;  217 119-126
    CrossrefPubMedGoogle Scholar
  • 59 Goldberg S N, Kamel I R, Kruskal J B. et al . Radiofrequency ablation of hepatic tumors: increased tumor destruction with adjuvant liposomal doxorubicin therapy.  AJR Am J Roentgenol . 2002;  179 93-101
    CrossrefPubMedGoogle Scholar
  • 60 Ohnishi K, Yoshioka H, Ito S, Fujiwara K. Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma.  Hepatology . 1998;  27 67-72
    CrossrefPubMedGoogle Scholar
  • 61 Livraghi T, Giorgio A, Marin G. et al . Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection.  Radiology . 1995;  197 101-108
    CrossrefPubMedGoogle Scholar
  • 62 Giorgio A, Tarantino L, de Stefano G. et al . Ultrasound-guided percutaneous ethanol injection under general anesthesia for the treatment of hepatocellular carcinoma on cirrhosis: long-term results in 268 patients.  Eur J Ultrasound . 2000;  12 145-154
    CrossrefPubMedGoogle Scholar
  • 63 Shiina S, Tagawa K, Niwa Y. et al . Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients.  AJR Am J Roentgenol . 1993;  160 1023-1028
    CrossrefPubMedGoogle Scholar
  • 64 Ishii H, Okada S, Nose H. et al . Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection.  Cancer . 1996;  77 1792-1796
    CrossrefPubMedGoogle Scholar
  • 65 Goldberg S N, Kruskal J B, Oliver B S, Clouse M E, Gazelle G S. Percutaneous tumor ablation: increased coagulation by combining radio- frequency ablation and ethanol instillation in a rat breast tumor model.  Radiology . 2000;  217 827-831
    PubMedGoogle Scholar
  • 66 Shankar S, VanSonneneberg E, Silverman S G, Tuncali K T, Morrison P R. Combined radiofrequency (RF) and direct alcohol infusion for percutaneous tumor ablation.  Radiology . 2002;  225(P) 447
    PubMedGoogle Scholar
  • 67 Kurokohchi K, Watanabe S, Masaki T. et al . Combined use of percutaneous ethanol injection and radiofrequency ablation for the effective treatment of hepatocelluar carcinoma.  Int J Oncol . 2002;  21 841-846
    PubMedGoogle Scholar
  • 68 Trembley B, Ryan T P, Strohbehn J. Interstitial hyperthermia: physics, biology, and clinical aspects. In: Urano M, Douple E, eds. Hyperthermia and Oncology, vol. 3 Utrecht, The Netherlands: VSP 1992: 11-98
    Google Scholar
  • 69 Larson T R, Bostwick D G, Corica A. Temperature-correlated histopathologic changes following microwave thermoablation of obstructive tissue in patients with benign prostatic hyperplasia.  Urology . 1996;  47 463-469
    CrossrefPubMedGoogle Scholar
  • 70 Christophi C, Winkworth A, Muralihdaran V, Evans P. The treatment of malignancy by hyperthermia.  Surg Oncol . 1998;  7 83-90
    CrossrefPubMedGoogle Scholar
  • 71 Goldberg S N, Saldinger P F, Gazelle G S. et al . Percutaneous tumor ablation: increased necrosis with combined radio- frequency ablation and intratumoral doxorubicin injection in a rat breast tumor model.  Radiology . 2001;  220 420-427
    PubMedGoogle Scholar
  • 72 Goldberg S N, Kamel I R, Reynolds K F, Stuart K E, Raptopoulos V D, Kruskal J B. Radiofrequency tumor ablation: increased coagulation of liver tumors with adjuvant liposomal doxorubicin monitored with 3D CT reconstruction techniques.  Radiology . 2001;  201(P) 627
    PubMedGoogle Scholar
  • 73 Monsky W L, Kruskal J B, Lukyanov A N. et al . Radio- frequency ablation increases intratumoral liposomal doxorubicin accumulation in a rat breast tumor model.  Radiology . 2002;  224 823-829
    CrossrefPubMedGoogle Scholar
  • 74 Kruskal J B, Oliver B, Huertas J C, Goldberg S N. Dynamic intrahepatic flow and cellular alterations during radiofrequency ablation of liver tissue in mice.  J Vasc Interv Radiol . 2001;  12 1193-1201
    PubMedGoogle Scholar
  • 75 Goldberg S N, Girnan G D, Lukyanov A N. et al . Percutaneous tumor ablation: increased necrosis with combined radio- frequency ablation and intravenous liposomal doxorubicin in a rat breast tumor model.  Radiology . 2002;  222 797-804
    PubMedGoogle Scholar
  • 76 Kong G, Anyarambhatla G, Petros W P. et al . Efficacy of liposomes and hyperthermia in a human tumor xenograft model: importance of triggered drug release.  Cancer Res . 2000;  60 6950-6957
    PubMedGoogle Scholar
  • 77 Livraghi T, Solbiati L, Meloni M F, Gazelle G S, Halpern E F, Goldberg S N. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study.  Radiology . 2003;  226 441-451
    CrossrefPubMedGoogle Scholar
  • 78 Goldberg S N, Solbiati L, Halpern E F, Gazelle G S. Variables affecting proper system grounding for radiofrequency ablation in an animal model.  J Vasc Interv Radiol . 2000;  11 1069-1075
    CrossrefPubMedGoogle Scholar
  • 79 de Baere T, Risse O, Kuoch V. et al . Adverse events during radiofrequency treatment of 582 hepatic tumors.  AJR Am J Roentgenol . 2003;  181 695-700
    CrossrefPubMedGoogle Scholar
  • 80 Meloni M F, Goldberg S N, Moser V, Piazza G, Livraghi T. Colonic perforation and abscess following radiofrequency ablation treatment of hepatoma.  Eur J Ultrasound . 2002;  15 73-76
    CrossrefPubMedGoogle Scholar
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