Tumor radiofrequency ablation (RFA) is a minimally invasive treatment technique that uses heat generated by high-frequency electric currents to directly destroy tumor tissue. Under precise imaging guidance, an electrode needle is inserted into the tumor, and local high temperatures cause coagulative necrosis of tumor cells, thereby inactivating the tumor. The following is a detailed introduction to this technology:

Technical Principles

* Energy Conversion: The RFA device releases high-frequency alternating current (typically 375–500 kHz) through an electrode needle. The current forms a circuit within the tumor tissue, causing ions inside the tissue to vibrate and rub intensely, generating heat (temperatures up to 60–100°C).

* Thermal Effect: The high temperature causes protein denaturation and cell membrane dissolution in tumor cells, leading to coagulative necrosis. Heat also conducts and diffuses to surrounding tissues, forming a controllable ablation zone.

* Selective Destruction: Normal tissues dissipate heat faster due to better blood circulation, whereas tumor tissues have disordered blood supply and poor heat dissipation, so high temperatures preferentially kill tumor cells.

Indications

RFA is primarily used to treat localized tumors in solid organs and is particularly suitable for patients who are not surgical candidates or who refuse surgery.

* Liver cancer: Early-stage hepatocellular carcinoma (≤3 cm), recurrent liver cancer, and liver metastases

* Lung cancer: Peripheral early-stage lung cancer (≤3 cm), and metastatic pulmonary nodules

* Kidney cancer: Small renal tumors (≤4 cm), patients with impaired renal function or a solitary kidney

* Others: Localized lesions such as bone tumors, thyroid cancer, breast cancer, and prostate cancer

Contraindications: Severe coagulopathy, tumors adjacent to major blood vessels or critical organs (e.g., bile ducts, intestines), and diffuse or multiple metastatic lesions

Procedure Workflow

* Preoperative Preparation:

 * Imaging assessment (CT, MRI, or ultrasound) to determine the tumor’s location, size, and surrounding structures

 * Local or general anesthesia, depending on the tumor site

* Image-Guided Puncture:

 * Under real-time guidance with ultrasound, CT, or MRI, the electrode needle is precisely inserted into the tumor center

* Ablation Treatment:

 * Adjust ablation time and power according to tumor size (typically 10–30 minutes), ensuring tumor coverage and a 5–10 mm safety margin

* Postoperative Management:

 * Monitor vital signs, perform follow-up imaging to evaluate ablation efficacy, and provide additional treatment if necessary

Advantages and Limitations

Advantages

* Minimally invasive: Percutaneous puncture, minimal trauma, fast recovery (1–3 days)

* Precision: Image-guided targeted tumor inactivation while sparing normal tissue

* Repeatable: Suitable for recurrent or multifocal tumor treatments

* Combinable: Can be integrated with surgery, chemotherapy, or radiotherapy

Limitations

* Size limitation: Effective range per session \~3–5 cm; larger tumors require multiple treatments

* Location sensitivity: Incomplete ablation risk near large vessels due to “heat sink effect”

* Risk of residual disease: Unclear margins or irregular tumor shapes may cause residuals

* Imaging-dependent: Outcome depends on imaging accuracy and operator experience

Complications

* Common: Local pain, thermal absorption-related fever, skin burns

* Severe (rare): Hemorrhage, infection, pneumothorax (lung ablation), injury to nearby organs (e.g., intestinal perforation)

Technological Advances and Future Prospects

* RFA combined with transarterial chemoembolization (TACE) enhances efficacy in liver cancer

* New electrode designs (multipolar, cooled-tip) expand ablation range

* AI algorithms assist with ablation path planning and temperature monitoring

* Integration with microwave ablation, cryoablation for synergistic therapy

Current Clinical Applications

RFA is included in several international cancer treatment guidelines (e.g., NCCN) as a first-line option for early-stage liver and lung cancers. For liver tumors ≤3 cm, RFA outcomes are comparable to surgery but with less trauma.

Conclusion

Radiofrequency ablation is a safe and effective local therapy, particularly suited for early-stage solid tumors and palliative care in selected advanced cases. Its key value lies in precise tumor destruction with minimal invasion. Strict indication selection and personalized planning by multidisciplinary teams are essential. With ongoing technological advancements, RFA is expected to play an increasingly important role in comprehensive cancer management.