New Procedure Kills Liver Tumors Without Surgery; Cures Some, Extends Life For Others
DURHAM, N.C. -- The week after Carlton Harris underwent a novel therapy at the Duke Comprehensive Cancer Center to destroy three cancerous liver tumors, he was back at the gym huffing, puffing, lifting and sweating. Not even a single stitch to show for his trouble, Harris wore only a small bandage to cover the three tiny holes -- the size of a snake-bite -- where wire probes entered his skin and literally burned away the cancerous tumors inside his liver.
So simple is the new procedure -- called radiofrequency ablation (RFA) -- that Harris says he will have it done as many times as necessary to maintain the good quality of life he now enjoys.
"I can't say I'm cured, but I am enjoying my life a great deal," said the 78-year-old, semi-retired physician from Greensboro, N.C. "I feel like as long as we catch the tumors as they arise, then I'll have years of good living to come."
The procedure is a last resort for patients who, like Harris, cannot endure surgery but require immediate removal of their potentially fatal tumors. For some, it is a cure; for others it extends the length and quality of life.
While surgery is still the accepted method for removing liver tumors, doctors say RFA is proving to be a successful alternative because it can be done quickly, with little pain and minimal recovery time, and as often as needed. In one extreme case, the patient had the procedure nine different times to destroy a total of 26 tumors.
Indeed, Harris has already undergone the procedure three times in two years. The treatment takes only an hour or two to perform in the radiology clinic, followed by four to six hours of resting in a recovery room. Then, Harris drives back home where he putters in the garden and kitchen in between his volunteer work at Duke and his position as medical director at the Wellspring retirement community in Greensboro.
Compare this to the months of painstaking recovery that he endured after two liver surgeries, and Harris has nothing but praise for the new procedure and the Duke physician who performs it.
"Radiofrequency ablation was so much better for me than surgery," said Harris, who suffered from two collapsed lungs and ventricular fibrillation after his second major surgery. "The difference between recoveries is like night and day."
Called radiofrequency ablation because it uses radio wave energy to heat the tumor and "ablate," or destroy it, the procedure has been used for nearly a decade to treat certain irregular heartbeats. Now, a handful of radiologists in North Carolina and nationwide are using RFA to treat primary tumors and metastases in the liver, kidneys, lungs and bones.
Harris was an ideal candidate for RFA because he was no longer eligible for surgery. During two previous operations, doctors had removed the entire left lobe of his liver along with the tumors. He simply didn't have enough liver tissue left for doctors to safely remove his new tumors and leave him with adequate liver function.
As an alternative, Harris' oncologist referred him to Rendon Nelson, M.D., a Duke radiologist who has performed more than 100 radiofrequency ablations on solid organs since May 1999. Within days, Harris was lying on a table as two separate scanners (computed tomography and ultrasound) were used to guide a small probe through a quarter-inch incision in his skin and directly to the site of the tumors. Once securely in place, the probe was hooked to an electronic device that delivered radiofrequency energy from the tip of several slender needles protruding from the probe. Multiple needle passes are often used for heating larger tumors, and different types of probes are selected depending on the type of thermal zone required to treat the tumor.
"The tissue that's being treated literally bubbles because it is heated to boiling temperature -- 100 degrees Celsius," said Nelson. "Since heat is concentrated around the tip of the probe, we can generally limit tissue destruction to the region of the tumor without damaging the surrounding tissue."
After the heating session, the needles are slowly withdrawn at a slightly lower temperature in order to cauterize the wound and minimize bleeding. All the patient needs is a small bandage on the skin and a half-day of rest before leaving the hospital. Side effects tend to be minimal but include pain, malaise, fever, nausea and the potential for infection, although all patients receive a course of antibiotics to decrease the risk.
"The procedure is better tolerated than surgery, there is no large abdominal wound to heal, and we can do the procedure as often as necessary," said Nelson. "And the survival rate may end up being the same as with surgery, although it is too soon to tell yet."
How well a patient fares after RFA or surgery depends on many factors, Nelson said. It matters where the primary cancer originated and what type of cancer it is, where in the body the cancer has "metastasized" or spread, how well the cancer responds to chemotherapy, and how aggressive the tumors are, to name a few factors.
Both techniques work best if the tumors are isolated to the liver. Still, RFA can be used in patients whose cancers have spread elsewhere in the body, especially if the tumors are slow growing, said Nelson.
Nancy Emerson is just such a patient. Having lived with breast cancer for 20 years, Emerson's most recent metastasis appeared in her liver. Although her tumors will surely recur, they tend to be slow growing and not aggressive. This makes Emerson a suitable candidate for RFA, said Nelson.
"For Nancy, like many others, radiofrequency ablation is palliative -- it's meant to control symptoms, reduce pain, or simply decrease the bulk of tumors that secrete noxious hormones, rather than to eradicate all of the cancer," said Nelson.
Indeed, Emerson has a slow-growing malignancy in her bones, but she sees no reason to tolerate new tumors elsewhere if they can be destroyed. "I approach it from a common-sense perspective," she said. "If they're not there, they can't grow larger."
Adds Harris' daughter, Ross, "RFA gives you another way to have hope, which is what we're all looking for in this fight against cancer."