What is RFA radiofrequency heat treatment?
RFA · Radiofrequency Ablation
How local heat treatment with radiofrequency energy works
Not an actual procedure.
What RFA is
In RFA, a thin electrode needle is passed through the skin into a tumour, and radiofrequency current is applied. The heat it produces kills the tumour tissue.
It is not a systemic treatment that removes cancer from the whole body. It targets individual lesions that can be seen on imaging.
What “Radiofrequency Ablation” means
“Radiofrequency” refers to high-frequency electrical current, and “ablation” means destroying or removing tissue.
In Japan it is called Radiofrequency Radio wave (radiofrequency cauterization therapy), and the abbreviation RFA is used as well.
How RF current produces heat
Alternating current of about 400 to 500 kHz flows from the needle tip. Ions in the surrounding tissue vibrate rapidly and create frictional heat.
When tissue reaches roughly 60 to 100°C, cell proteins coagulate and the cells die. A grounding pad on the body completes the circuit. Only a limited area around the needle is heated.
The idea of image-guided access
Doctors insert the electrode needle while watching the tumour on ultrasound or CT. Ultrasound is common for the liver, and CT for the lung, kidney, and bone.
If the lesion is hard to see, contrast or image fusion may be used, and some ablations are done during open or laparoscopic surgery.
A typical procedure
This is a general outline. Actual steps differ by institution and organ.
Imaging and blood tests check whether the procedure is possible.
Local anaesthesia and sedation are given, or sometimes general anaesthesia.
The electrode needle is placed in the tumour under imaging.
Current is applied. One area takes from a few minutes to tens of minutes.
The needle track is ablated as the needle is withdrawn.
The patient is monitored and imaging checks the ablated area.
Clinical applications of RFA
These are the main areas where RFA is studied and used. Criteria and insurance coverage differ by country and institution.
Small hepatocellular carcinoma: the most studied area.
Some liver metastases, such as from colorectal cancer
Small lung tumours when surgery is difficult
Small kidney tumours
Pain relief for bone metastases
Non-cancer conditions such as benign thyroid nodules
Why lesion size and location matter
One ablation covers a limited zone around the needle. Results are generally reported to be better for small lesions of about 3 cm or less, and large lesions are hard to ablate completely.
Next to large vessels, flowing blood can carry heat away and leave the ablation incomplete (the heat-sink effect). Lesions near the bile ducts, bowel, diaphragm, heart, or major nerves carry a higher risk of heat injury.
Features of RFA
It is done through a needle puncture without an incision.
Hospital stay and recovery can be relatively short depending on the procedure.
More of the surrounding normal tissue can often be preserved.
It can sometimes be repeated for the same area or new lesions.
It may be considered as an option for patients for whom surgery is difficult.
Limitations of RFA
Large tumours are difficult to ablate completely.
Use is limited for lesions near large vessels or vital organs.
Microscopic cancer cells not visible on imaging can remain and cause local recurrence.
As a local treatment, it has limits for cancer that has spread through the body.
Long-term results depend on the cancer type, stage, and patient condition.
Possible complications
The type and frequency of complications depend on the organ and lesion location. Ask your medical team which risks apply to you before the procedure.
Bleeding
Bleeding can occur along the needle track or inside the organ.
Infection
An abscess or other infection can form in the ablated area.
Damage to nearby tissue
Nearby structures such as the bile ducts, bowel, or diaphragm can be injured.
Thermal injury
Heat can spread beyond the intended zone, or burns can occur at the grounding pad.
Pneumothorax
In lung procedures, air can collect between the lung and chest wall.
Post-ablation syndrome
Fever, fatigue, and pain can appear for several days afterward.
Needle-track seeding
Rarely, tumour cells can spread along the needle track.
Other organ-specific complications
These include reduced liver function, blood in urine after kidney procedures, and nerve injury after bone procedures.
Follow-up after treatment
Usually around one month after the procedure, contrast CT or MRI checks whether the tumour was sufficiently ablated.
After that, imaging and blood tests every few months look for recurrence at the same site or new lesions. Your medical team sets the specific schedule.
How RFA relates to IVR
Because RFA reaches the lesion directly with a needle under imaging, it is classified as a type of non-vascular IVR.
For liver cancer, RFA is sometimes combined with TACE, a vascular IVR. Besides radiologists, gastroenterologists and surgeons also perform it.
Frequently asked questions
Does RFA cure cancer?
A cure or longer survival cannot be guaranteed. Results depend on the cancer type, size, location, stage, and the patient’s condition.
Can RFA be used for every cancer?
No. RFA is mainly considered for relatively small lesions in certain organs. Qualified physicians decide whether it is suitable.
Is a hospital stay needed?
It depends on the country, institution, and organ. A short stay is common, but follow the institution’s guidance.
How is it different from microwave ablation?
Both destroy tissue with heat but use different energy. Doctors choose the method based on the lesion.