Radiofrequency Ablation for Recurrent Mesothelioma: A New Treatment Option?

A procedure normally used to help alleviate pain has been used to successfully stop a case of recurrent malignant pleural mesothelioma in Japan.

Radiofrequency ablation (RFA) uses electrical energy delivered through a thin, hollow needle to heat and destroy cancer cells.

Most of the time, this technology is used to destroy small tumors or a treat small area of cancer to alleviate symptoms such as pain or discomfort.

But thoracic surgeons at the Hyogo College of Medicine in Hyogo, Japan say their new case study suggests that the procedure should also be considered as a definitive treatment — especially for mesothelioma patients for whom surgery is not a viable option.

Complex Mesothelioma Case Drives RFA Decision

In a new report in the Annals of Thoracic Surgery, the researchers detail the case of a 55-year-old man with malignant pleural mesothelioma.

Like most mesothelioma patients, especially those who are younger and in overall good health, the subject was treated with a combination of several different types of mesothelioma therapies.

In this case, those therapies included chemotherapy to reduce the size of the mesothelioma tumor, radical EPP (extrapleural pneumonectomy) surgery to remove the diseased pleural lining and nearest lung, and radiotherapy to kill residual mesothelioma cells.

Although the multimodal approach did hold the cancer at bay for more than two-and-a-half years, when the patient’s mesothelioma recurred, the treatment options were limited.

“Surgery was considered a problem for the patient because of the previous extrapleural pneumonectomy and difficult tumor location,” writes thoracic surgeon Akifumi Nakamura, MD.

So Dr. Nakamura and his colleagues decided, instead, to treat the tumor with radiofrequency ablation.

Radiofrequency Ablation a Newer Cancer Option

Unlike open surgery, radiofrequency ablation is a minimally invasive procedure typically performed under local anesthetic.

With CT or ultrasound guidance, a small probe is inserted directly into the treatment area, which is heated to destroy the cells. Unlike other mesothelioma treatments, RFA has little effect on the surrounding healthy tissue.

While RFA has long been used to manage pain by destroying nerve cells, it’s utility as a cancer treatment is still evolving. Since the 1990s, it has been used in combination with other therapies to treat tumors in the liver, lung, kidneys, bone, pancreas, thyroid, and breast. RFA is considered a low-risk procedure that usually causes few side effects.

RFA Produces Promising Results for Mesothelioma Patient

There are few effective treatment options for pleural mesothelioma, but even fewer for recurrent pleural mesothelioma. The FDA has not yet approved any second-line treatment for mesothelioma.

In the case of the Japanese mesothelioma patient, the results of RFA treatment were excellent. There were no complications from the procedure, which significantly reduced the size of his tumor. Just as importantly, there was no further mesothelioma recurrence or tumor growth.

The research team concludes, “Radiofrequency ablation should be considered an option to treat recurrence of malignant pleural mesothelioma.”

A similar technology called microwave ablation is currently under evaluation at Mayo Clinic for the treatment of lung cancer in surgically high risk patients.

Source:

Nakamura, A, et al, “Radiofrequency Ablation Effectively Treated Focal Recurrence of Mesothelioma”, June 2018, Annals of Thoracic Surgery

Radiofrequency Ablation, Cancer Research UK