© 2010 Physician’s Weekly, LLC January 2008 Vol. IV, No. 1  In My Opinion...  New Hope Emerging for Inoperable Cancer   "RFA has emerged as a viable alternative for small (less than 4 cm) inoperable liver cancer." Peter J. Julien, MD Chief, Thoracic Imaging Director, Radiofrequency Ablation Program   Cedars-Sinai Medical Center        Most physicians treat kidney and liver cancer with conventional surgical resection, and/or chemotherapy. However, non-surgical radiofrequency ablation (RFA) has proven to be an effective treatment option for patients with inoperable small liver, lung, and kidney cancer. A small needle is placed into a tumor site either under surgical control or using CT guidance. Radiofrequency energy, which is delivered to the needle tip, virtually cooks the tumor. The cancer cells shrink and die secondary to thermal coagulation. Healthy tissue is unaffected because of the controlled zone of heat delivery. This heat also closes up small blood vessels, minimizing the risk of bleeding similar to cauterization.        Typically, surgical removal of kidney tumors, the standard of care for kidney cancer, involves hospital stays of 3-to-5 days and postoperative recovery of up to 8 weeks. By contrast, RFA is minimally invasive and requires only local anesthesia. RFA also preserves the kidney (and therefore kidney function) and avoids surgical complications. Patients generally resume daily activities within 24 hours.        Candidates for RFA        RFA should be considered for elderly patients and patients with serious heart and lung diseases that preclude surgical intervention. My colleagues and I recommend RFA for patients with the following clinical problems:        • Stage I primary lung cancer where the patient is ineligible for surgery usually because of emphysema or severe heart disease.        • Limited metastatic disease to the lungs usually involving four or fewer lesions.        • Primary liver cancer (less than 4 cm) or limited metastatic disease with four or fewer liver lesions in patients who are not surgical candidates.        • Kidney cancers 4 cm or smaller on the peripheral margins of the kidney in patients who are not surgical candidates or with multi focal renal cell cancer.        • Treatment of painful bone metastasis in patients unresponsive to either chemotherapy or radiation therapy. In this situation, RFA is not a cure but significantly reduces pain (often within 24 hours) and the need for narcotic therapy.        • Primary therapy for osteoid osteoma.        A Bright Outlook for RFA        RFA has emerged as a viable alternative for small (less than 4 cm), inoperable liver cancer, particularly in patients with cirrhosis. Although more data is needed, patients with kidney cancer have demonstrated the greatest benefit from RFA, with cure rates equivalent to partial or radical nephrectomy. In a recent evaluation of 23 patients with kidney cancers who received RFA and were followed for up to 4.5 years, there has been no evidence of recurrent malignancy.        Unfortunately, many clinicians are unaware that RFA is effective. The procedure is available at most major medical centers. We are hopeful that the use of RFA will expand as an alternative treatment for patients who are not surgical candidates, including patients with limited primary liver cancer or metastatic liver disease—particularly those with cirrhosis or waiting for a liver transplant. In these circumstances, we encourage more physicians to consider RFA as a primary intervention.        Although we have performed the RFA procedure on over 50 pulmonary modules, in patients who are not surgical candidates, with stage I lung cancer or limited metastatic disease to the lungs. As of December 11, 2007, the FDA raised concerns over its safety and we will await the results of clinical trials to determine its efficacy.                Dr. Julien has indicated to Physician’s Weekly that he has been a consultant for ValleyLab.