What is Cancer Ablation?
This is a minimally invasive surgical method to treat solid cancers. More modern types of ablative style treatments may be described as non-invasive. With conventional ablation, special probes are used to “burn” or “freeze” cancers. Computed Tomography (CT), Ultrasound (US) or Magnetic Resonance Imaging (MRI) is used to guide and position the needle probe into the tumour. This requires only a tiny hole, usually less than 3 mm via which the probe is introduced. When the probe is within the cancer it is attached to a generator which “burns” or “freezes” the cancer. “Burning” refers to increasing the temperature of the tumour to such a level that cancer cells die. This is usually achieved by radio frequency probes, referring to the type of energy used to increase the temperature. “Freezing” refers to cryoablation which decreases the temperature to -40 C (-40 F) which also kills the cancer cells. Within the classification of tumour ablation, there are several modalities used worldwide: radiofrequency (RFA), microwave (MWA), laser, high-intensity focused ultrasound (HIFU), cryoablation, and irreversible electroporation (IRE). New kids on the block include Histotripsy. Each technique, although similar in purpose, has specific and optimal indications.
Tumor ablation is commonly used in the treatment of tumours of the liver, kidney, bone, and lung. It is an important option for people who need adjuvant/neoadjuvant treatment and/or are not surgical candidates.
The ones I see most in use for Neuroendocrine Cancer include the list below but I normally only see them used for lung and liver tumours. But read about pancreatic NET ablation below bearing in mind that only small tumours can be ablated and most guidelines suggest watch and wait for most small pancreatic NET (less than 2cm).
- Radiofrequency ablation (RFA) uses high-energy radio waves. A thin, needle-like probe is put through the skin and into the tumour. Placement of the probe is guided by an ultrasound or CT scan. The tip of the probe releases a high-frequency electric current which heats the tumour and destroys the cancer cells.
- Microwave Ablation (MWA) is similar to RFA, except it uses microwaves to heat and destroy the cancer cells.
- Cryotherapy (also known as cryosurgery or cryoablation) destroys a tumour by freezing it with a thin metal probe. The probe is guided through the skin and into the tumour using an ultrasound. Then very cold gasses are passed through the probe to freeze the tumour, killing the cancer cells. This method may be used to treat larger tumours than the other ablation techniques, but it sometimes requires general anaesthesia (where you are asleep).
Larger liver tumour ablation
As above, there are limitations are on size of the tumour to be ablated (normally up to 2cm). However, Cleveland Clinic recently announced they are the first hospital in the world to use a recently FDA-approved ablation technology that can destroy large liver tumours. The minimally invasive procedure uses a single needle connected to a powerful 150-watt microwave generator that can burn a malignant liver tumour as large as 2.4 inches, which is about the size of an egg. Click here to read more.
Ablation in the Pancreas remains controversial despite studies
Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is rapidly emerging as feasible therapy for patients with pancreatic neuroendocrine tumours (pNETs) in selected cases, as a result of its favourable safety profile. I think the key here is “selected cases”. This technology is not yet in the routinely available treatment domain. It appears to be something coming out of pancreatic cancer treatment research and most studies indicate further multicentre trials are needed.
I also wrote about the apparently controversial ablation of small pancreatic NETs where guidance is normally watch and wait. You can read that here
And there’s more ….. one study concluded EUS-guided RFA of pNETs is a minimally invasive, safe, and technically feasible procedure for selected patients. Read more about the study here. Another study followed up patients treated in this way concluding that EUS-RFA results for pancreatic NETs or PCNs appear to be stable during 42 months of follow-up. Read more about this study here. I also found a newspaper article from a hospital in San Antonia who is pioneering this approach. Read more here.
High intensity focused ultrasound (HIFU)
HIFU is a treatment that uses high frequency sound waves. You have HIFU from a machine. The machine gives off sound waves which deliver a strong beam to the cancer. In contrast to other methods of local ablation, it does not involve the use of needles, probes, or electrodes to unfold its effects, i.e. it’s non-invasive but as it uses soundwaves to heat, it must be considered a thermal approach.
Its use in NET remains isolated to a few case studies, I found one from Italy (abstract report only click here). Most information I can find is related to its use in Prostate and more recently for Pancreatic Adenocarcinoma. There are a few studies from Asia regarding the latter. However, there are case studies of successful use on pancreatic NETs.
It appears to be in early days of development and for example in UK, according to Cancer Research UK, the National Institute for Health and Care Excellence (NICE) recommends using HIFU for prostate cancer only in specific centres or as part of clinical trials. NICE also advised to limit treatment to local or locally advanced areas of the prostate but not metastatic prostate cancer.
This is not the same treatment as Histotripsy which is non-invasive and non-thermal (see below) but to the lay person, there are similarities.
Histotripsy – non-thermal ablation recently approved in US and UK
I also recently wrote about a clinical trial of Histotripsy which is the first non-invasive, non-ionizing, and non-thermal ablation technology. You can read that by clicking here.
Is Science bringing treatments together?
The boundaries between surgery, ablation and radiotherapy are getting closer as science advances. Take Stereotactic Radiosurgery (SRS) for example, it uses many precisely focused radiation beams to treat tumours and other problems in the brain, neck, lungs, liver, spine and other parts of the body. It is not surgery in the traditional sense because there’s no incision. When doctors use SRS to treat tumours in areas of the body other than the brain, it’s sometimes called stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR). I’ve covered this whole area in my treatment summary for patients blog post but I wrote separately about a Proof of Concept trial for NET – click here to read that.
Disclaimer
I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me.
Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional.
Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.
General Clinical Trials Disclaimer
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided in the clinical trials document. It’s very important to check the trial inclusion and exclusion criteria before making any contact. If you need questions, the articles here is very useful Questions to Ask About Clinical Trials | Cancer.Net
The inclusion of any trial within this blog should not be taken as a recommendation by Ronny Allan.
Finally
Whenever I post about a trial or study, some people get excited without understanding that these new treatments and capabilities can very often take years to come to fruition and it’s also possible that clinical trials can be halted, or that national approval agencies will not approve the final product. Plus, not everyone will be eligible, so always check the exclusion and inclusion criteria in the relevant clinical trials document. Please bear that in mind when reading studies/clinical trials posted on RonnyAllan.NET
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