Effective palliative radiofrequency ablation for tumors causing pain, numbness and motor function disorders: case series
© Hamamoto et al.; licensee BioMed Central Ltd. 2014
Received: 8 November 2013
Accepted: 13 October 2014
Published: 28 October 2014
We present a case series of a palliative radiofrequency ablation (RFA) for the tumors that lead to the resolution of pain and motor function disorders. RFA is widely used on tumors in various organs and often reported in good outcome. There are some reports that RFA was performed as a palliative treatment but a few reports of RFA that performed for lung tumor as a palliative treatment. This case series includes two cases, palliative RFA for a sacrum and a lung tumor. The results of this case series presented that a palliative RFA is effective in improving the symptoms of patients.
Case 1. A 64-year-old Japanese woman with a chordoma at her sacrum presented with pain in her left leg and claudication. Though operations, radiation therapy and GS-TAE (gelatin sponge–transarterial embolization, via the L5 lumbar artery) were performed, the size of the tumor leading pain and claudication increased. RFA was performed for the sacral tumor, and these symptoms resolved one year after the procedure.
Case 2. A 68-year-old Japanese man with a leiomyosarcoma at the apex of left lung presented with pain and motor function disorders of the left upper limb. Dissemination in the pleura was appeared after the operation for a leiomyosarcoma at the mediastinum. Though radiation therapy and a second operation were performed, the tumor at the apex of the left lung increased and pain and numbness of the left upper limb were appeared after the second operation. RFA was performed for the left lung tumor, and the symptoms resolved 3 months after RFA.
RFA is effective as a palliative treatment and has a potential to salvage the patients from the symptoms of the tumors when conventional palliative treatments such as surgery, radiation therapy, and chemotherapy are difficult or contraindicated.
Radiofrequency ablation (RFA) is the treatment to malignant tumors by inserting an electrode into the tumor and causing the thermocoagulation necrosis of the tumor . RFA is a minimally invasive therapy and has a low risk of major complications . At present, RFA is widely used on tumors in various organs and results in good outcome [1, 3]. It has been reported that RFA is also effective for the palliative treatment . A palliative RFA is performed when conventional palliative treatments such as surgery, radiation therapy, and chemotherapy are difficult or contraindicated. It has not previously been well established in the literature if a palliative RFA for the pulmonary tumor is effective. These cases consist of two patients, a sacrum tumor and pulmonary tumor with pain and neuropathy that received palliative RFA. In both cases, the symptoms resolved after the procedure.
Palliative RFA was performed to relieve symptoms induced by tumor in two cases, leading to the resolution of pain and motor function disorders in both. Therefore, RFA was found to be an effective palliative treatment.
At present, surgery for reduction of tumor volume, radiation therapy and chemotherapy have been performed as palliative treatments for relief of symptoms induced by tumors that cannot be radically resected . However, these treatments have some limits. Surgical operation has a risk of bleeding and technical difficulties due to the size of tumors or adhesions. Radiation therapy is complicated by dose limitations in relation to re-irradiation, and it often takes several weeks before therapy is complete and relief of accompanying symptoms is achieved. Furthermore, radiation therapy has the risk of complications such as neuropathy and radiation pneumonitis .
Some reports have shown that ablation therapy is effective and safety palliative treatment for the relief of symptoms induced by tumor [4, 6]. Tumors can cause symptoms such as pain or motor function disorders in several ways. They can compress adjacent structures or nerves, increase intratumoral or interstitial pressure, or release cytotoxic substances . RFA can provide pain relief through thermal coagulation necrosis and reduction of tumor volume. These processes subsequently reduce tumor compression of surrounding internal organs and nerves. Furthermore, coagulation necrosis leads to decreased production of cytotoxic substances released from the tumor .
Palliative RFA has some advantages compared to other palliative treatments. First, RFA is completed in 1 day and often provides rapid pain relief. Effects of RFA are observed immediately after the procedure and may rapidly improve quality of life. Second, RFA is minimally invasive and can be performed under local anesthesia. It has also been reported to have a low risk of major complications . Furthermore, RFA can be performed repeatedly as long as the electrode puncturing procedure is technically possible. Repeat RFA has an opportunity to salvage tumors that progressed locally after the first RFA . RFA may promote neuropathy since the temperature around the electrode rises and heat may spread in the adjacent structures (such as nerves). Therefore, physicians must monitor the ongoing possibility of neuropathy development during ablation. When neuropathy does develop, ablation of a tumor has to be aborted. In the cases of RFA tumor ablation presented in this report, the relief of symptoms were obtained though incomplete tumor ablation. Since palliative RFA is a medical treatment aimed at symptom relief, careful attention must be paid to the procedure.
Palliative RFA is an effective treatment for the relief of pain or the improvement of motor function disorders. Palliative RFA has a potential to salvage the patients from the symptoms of the tumors when conventional palliative treatments such as surgery, radiation therapy, and chemotherapy are difficult or contraindicated.
Written informed consent was obtained from both patients for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We have no conflict of interest to disclose with respect to this case series.
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