Radiofrequency Ablation Reduces Head and Neck Tumor Volume, Pain

A team of New York surgical specialists have conducted research that evaluates the effectiveness of Radiofrequency Ablation (RFA) as an alternative treatment for patients unable or unwilling to undergo conventional treatment for advanced head and neck tumors. RFA causes the cellular destruction of soft tissue by heat, which is generated through agitation caused by alternating electrical current (radiofrequency energy) moving through tissue. The heat results in tissue coagulation: coagulated cells die and cannot continue to grow. This new technology has traditionally been used to attack malignant tumors in the liver, prostate, kidney, and spleen. Before this study, RFA had been only used to treat benign conditions of the head and neck.

The traditional management for local control of recurrent head and neck tumors consists of surgical resection (removal) and/or radiation therapy. However, there are cases when surgery is not feasible, due to the extent of the disease or close proximity to vital structures, or the possibility of a loss of vital function and/or disfigurement that leads the patient to decline standard treatment. When this occurs, patients are offered experimental chemotherapy or pain control alone, inevitably resulting in an undesirable outcome. Therefore, new treatments are needed for this advanced stage of cancer.

RFA has now been researched on a series of patients at a major cancer treatment center. The authors of "Techniques for Radiofrequency Ablation of Head and Neck Tumors" are Randall P. Owen MD, Carl E. Silver MD, Thanjavur S. Ravikumar MD, Alan Brook MD, and Jacquiline Bello MD, all from the Montefiore Medical Center of the Albert Einstein College of Medicine, Bronx, New York. Their findings are being presented at the annual meeting of the American Head and Neck Society, http://www.headandneckcancer.org/ being held May 2-6, 2003, at the Opryland Hotel, Nashville, TN.

Methodology: RFA tissue destruction of a head and neck tumor involves direct insertion of a metal probe into the tumor. Several prong-like tips of the probe are then pushed into the tumor in an umbrella-like pattern delivering alternating current. This action results in a spherical zone of destruction, generating tissue temperatures of 50"¢ to 100"¢. Cells within a zone of lethal temperatures of at least five minutes are usually killed.

To be included in this study patients had to demonstrate that they were ineligible for standard radiation and/or surgical intervention. These included: (1) patient refusal of standard therapies; (2) prior irradiation; (3) co-existing conditions precluding surgery; and (4) judgment from a tumor board that anticipated functional and cosmetic damage from traditional treatments would be severe enough to recommended alternative treatments.

A series of eleven patients was treated. Their response to this treatment was recorded and reviewed.

Results: The research team found that in the study's subjects, oral cavity and oropharyngeal tumors were receptive to transoral placement of the RFA probe by palpation of the lesion and visualization of the probe tips in the tumor. CAT scan guidance was used for tumors not readily visible.

Following set procedures, the researchers found RFA treatment for this set of patients produced tumor volume reduction, and relief from tumor-related pain, and/or inability to close the mouth.

Conclusions: Radiofrequency Ablation (RFA) has never been used to treat Squamous cell carcinoma of the Head and Neck (HNSCC) before. The currently reported study offers a new treatment to patients suffering from recurrent, advanced tumors. These patients often have no other effective treatment option. Finally, the treatment is quick, requires no incision and has minimal blood loss.

The sample is small, but growing steadily, and the results to date have been encouraging. Certainly more research is needed to determine the usefulness of RFA in additional patient populations.

Squamous cancers of the upper aerodigestive tract, consisting of malignant neoplasm derived from stratified squamous epithelium, constitute approximately six percent of new cancer cases in men and two percent of women. At all sites except the salivary glands, there is a significant preponderance of cases in men. Oral and pharyngeal cancer is more common in white males, but the incidence of laryngeal cancer is somewhat higher in black males.

The geographic distribution pattern for head and neck cancer shows considerable variation and is site-dependent. Past research has found that cancers of the nasal cavity and paranasal sinuses are slightly more common in the South than in the rest of the United States. Nasopharyngeal cancer is a very common disease in the Chinese, with age-specific incidence rates in males from Kwangtung Province (Cantonese) 40 times that of U.S. Caucasian males.