Radiofrequency ablation (RFA) has been used for over 18 years for treatment of nerve-related chronic pain and cardiac arrhythmias. In the last 10 years, technical developments have increased ablation volumes in a controllable, versatile, and relatively inexpensive manner. The host of clinical applications for RFA have similarly expanded. Current RFA equipment, techniques, applications, results, complications, and research avenues for local tumor ablation are summarized.

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Percutaneous radiofrequency ablation (RFA) is a minimally invasive local therapy for cancer. Its efficacy is now becoming well documented in many different organs, including liver, kidney, and lung. The goal of RFA is typically complete eradication of a tumor in lieu of an invasive surgical procedure. However, RFA can also play an important role in the palliative care of cancer patients. Tumors which are surgically unresectable and incompatible for complete ablation present the opportunity for RFA to be used in a new paradigm. Cancer pain runs the gamut from minor discomfort relieved with mild pain medication to unrelenting suffering for the patient, poorly controlled by conventional means. RFA is a tool which can potentially palliate intractable cancer pain. We present here a case in which RFA provided pain relief in a patient with metastatic prostate cancer with pain uncontrolled by conventional methods.

A patient with renal cell carcinoma underwent external-beam radiation therapy (XRT) to treat a painful chest-wall metastasis. One month later, she underwent radiofrequency (RF) ablation of two metastatic deposits within the liver; one of the target lesions was in the recent irradiation zone and the other was outside of the radiation field. RF ablation within the irradiated liver produced a slightly larger ablation zone with prominent needle tract scarring, and required less energy input than treatment in the unirradiated liver. RF ablation and XRT may interact, possibly producing a synergistic effect. Further study of the potentially adjunctive relationship between these two modalities is warranted.Current treatment strategies for liver cancer frequently rely on a combination of modalities, including chemotherapy, radiation therapy, and surgery. This multifaceted approach may be more effective than any single therapy. Another tool in the arsenal of cancer therapy is radiofrequency (RF) ablation. RF ablation is a safe and effective technique to destroy focal cancer lesions in a variety of locations, including the liver, bone, and kidney (1-3). Clinical research is currently under way in cancers in the lung, breast, and adrenal gland as well (4-6). RF ablation also has the potential for synergism with traditional cancer treatments, as RF ablation and liposomal chemotherapy have been shown to considerably enhance ablation volumes (7). Although the additive effects of hyperthermia and radiation have been studied at low temperatures (40°C-44°C), there are few data about radiation and the high temperatures of RF ablation (60°C-100°C) (8). Herein we present a case in which the effects of externalbeam radiation treatment (XRT) in combination with RF ablation may account for treatment differences seen with RF ablation of liver metastases. The potential synergism between RF ablation and radiation therapy for local control warrants further investigation. CASE REPORTIn 1969, a 42-year-old woman presented with hematuria secondary to renal-cell carcinoma. She underwent right nephrectomy and XRT to the renal bed; there was no evidence of metastatic disease at that time. Twenty-seven years later, the woman, now 69 years of age, developed biopsy-proven metastases to the pelvis and liver. She was treated with abdominal resection of the pelvic mass followed by XRT, RF ablation of the liver lesion, and administration of interleukin-2, with good response. The following month, the patient developed a painful metastasis to the right chest wall, which was successfully treated with 2,100 cGy of radiation. On this hospital admission, the patient presented with two liver metastases and was referred for RF treatment. There was a 0.9-cm (transverse) by 0.8-cm (anteroposterior) lesion in the anterior section of the left lobe, and a 0.9-cm (transverse) by 0.8-cm (anteroposterior) in the posterior aspect of the right lobe. The region of the posterior