Management of advanced abdominopelvic tumors with combined radiofrequency ablation and surgical debulking

AIM

Advanced abdominopelvic tumors due to rectal cancer, gynecological cancer or sarcomas are often unresectable using surgery alone. This study presents the combination of radiofrequency ablation (RFA) and surgical debulking for such tumors.

METHODS

Between November 2005 and June 2007 we treated 4 patients with tumor fixation to the pelvic side wall and to the sacroiliac joint. Two of these patients had recurrent gynecological cancer while the other 2 had rectal cancer. All 4 of them had received prior treatment. The radiofrequency probe was placed in the center of the tumor. A 5- to 8-cm tissue core was ablated and aspirated or curetted out. This was repeated centrifugally out to the tumor capsule.

RESULTS

Control of the tumor for more than 12 months was achieved in 3 patients. One patient died 14 months after the procedure due to tumor progression. Two patients are still alive 12 and 14 months after the operation without symptoms. The other patient is alive 6 months after the operation in a disease-free condition.

CONCLUSIONS

Combined RFA and surgical debulking is beneficial as an alternative palliative method in patients with inoperable abdominopelvic tumors.

Radiofrequency ablation in pancreatic cancer

INTRODUCTION AND AIM

Radiofrequency ablation (RFA) is effective in the treatment of unresectable hepatic tumors and promising results have also been described in tumors of kidney, lung, brain, prostate, and breast. The radiofrequency destruction of solid pancreatic tumors sounds logical but also seems risky due to the friable pancreatic parenchyma, the fear of pancreatitis and the prejudiced myth of 'the pancreas is not your friend'.

PATIENTS AND METHODS

We present our initial experience and we describe our technique during intraoperative RFA in four patients with locally advanced and unresectable pancreatic adenocarcinoma (head of pancreas, three; body-tail, one; diameter, 3-12 cm). In all the patients, the RFA was followed by bypass palliative procedures (cholecystojejunostomy and Brown's anastomosis and/or gastrojejunostomy). A drainage tube was left close to the ablated area. Serum amylase and fluid amylase (drain) were measured for 5-7 days postoperatively. Sandostatin was also administered prophylactically for 3-5 days.

RESULTS

The postoperative period was uneventful in all the patients, without complications or evidence of pancreatitis. The post RFA CT scan showed remarkable changes in the density and the characteristics of the tumors in all the patients. All the patients are alive, at 12, 8, 5 and 3 months postoperatively, respectively. In one patient (with cancer of the body of the pancreas) who was receiving morphine because of intolerable pain, significant pain relief has been observed.

CONCLUSIONS

From our initial results, RFA seems to be a feasible, potentially safe and promising option in patients with locally advanced and unresectable pancreatic cancer. Nevertheless, larger series of cases are needed to secure our encouraging results.