Radiofrequency ablation (RFA) has been used successfully in Japan to treat post-surgery recurrence of malignant pleural mesothelioma, according to a case study published recently by the Society of Thoracic Surgeons.
Although RFA has been utilized for several years to treat various thoracic lesions, the study authors believe this is the first time it worked effectively with mesothelioma cancer cells.
“It shows promising efficacy,” the authors wrote. “Radiofrequency should be considered an option for treating recurrence of MPM [malignant pleural mesothelioma].”
RFA is a minimally invasive medical procedure that utilizes the electrical energy of radiofrequency to generate enough heat to kill tumor cells without damaging surrounding tissue.
It has received considerable attention in recent years for its use on tiny, inoperable lung lesions, although many oncologists have been reluctant to recommend it.
There is considerable debate over its efficacy and safety.
Clinical Trials Testing Effectiveness of RFA
There are close to 100 clinical trials in the recruiting stage today that involve RFA in various combination treatments for a variety of malignancies.
The treatment is being monitored closely because recurrence with pleural mesothelioma is almost inevitable after first-line treatment, creating a demand for more effective adjuvant therapy.
Unfortunately, there currently is no FDA-approved second-line treatment when the recurrence happens with mesothelioma.
“The best therapy option for recurrence of MPM remains controversial,” the authors wrote. “Of particular note is the poor performance status often observed in patients after multimodality treatment.”
RFA Effective for Patient in Case Study
This case study involved a 55-year-old male who underwent multimodal treatment that included chemotherapy, an extrapleural pneumonectomy and radiation.
More than two years after major surgery, a distant focal recurrence was identified. The patient’s overall health discouraged more surgery.
He did not respond to additional chemotherapy, leaving him with few other options.
The unproven RFA was given as a last resort, and it worked well by significantly reducing the size of the recurrent tumor cells. Two years later, the patient had no signs of recurrence or tumor growth.
Different from Traditional Radiation
RFA is considerably different from traditional radiation treatment, although they are often compared.
RFA uses a high-frequency electric current to kill tumor cells. External beam radiation therapy uses high-energy x-rays to kill tumor cells.
One of the ongoing clinical trials is a study to determine the level of positive impact when RFA is used in combination with the more traditional external beam radiation.
A recently completed study at the University of Michigan compared the use of RFA with the use of stereotactic body radiation for the treatment of intrahepatic metastases over a 15-year period.
Researchers found comparable results, although the stereotactic radiation was the more effective treatment with larger tumors. RFA was slightly more effective with the smaller tumors.
RFA Is Easily Repeated
The authors of the current case study, published in June in The Annals of Thoracic Surgery, believe one benefit of RFA is the ability to repeat its use if necessary.
During the case-study procedure, the surgeon used real-time CT fluoroscopic guidance to accurately target the tumor cells. Local anesthesia and moderate sedation was used. No complications occurred.
With RFA, a catheter probe emits the electrodes that generate the heat to kill the nearby cells. The heat does not travel far, reducing the amount of healthy tissue being destroyed.
The duration of the procedure and the size of the probe being used helps determine the amount of tissue that will be heated and killed.
“Radiofrequency ablation is safe for thoracic lesions, with a low rate of complications, and it shows promising efficacy,” the authors wrote. “Our cancer board contemplated the most suitable approach. RFA was technically successful. Computed tomography revealed a significant reduction of the tumor.”