Doctors
from Japan have successfully treated post surgery recurrence of
Malignant Pleural Mesothelioma (MPM). They used Radiofrequency ablation
(RFA) to kill the recurrent tumor cells. The report of the case study
was published on the journal “The Annals of Thoracic Surgery”. The
doctors involved in the treatment were Akifumi Nakamura, Teruhisa
Takuwa, Masaki Hashimoto, Nobuyuki Kondo, Haruyuki Takaki, Masayuki
Fujiwara, Koichiro Yamakado and Seiki Hasegawa from Hyogo College of
Medicine, Japan.
RFA is an effective
and minimally invasive electrosurgical technique involving the use of
heat to kill cancer cells. Doctors had to choose RFA due to difficult
location of cancer but the result that showed up was promising. “It
shows promising efficacy,” the authors wrote. “Radiofrequency should be
considered an option for treating recurrence of Malignant Pleural
Mesothelioma”.
Malignant Pleural
Mesothelioma is an aggressive tumor with limited treatment options,
often linked to asbestos exposure. Pleural Mesothelioma has
poor prognosis and minimal life expectancy
due to chemo-resistance. Mesothelioma recurrence after surgery and lack
of response to other modalities of treatment often poses clinical
challenges in decision making.
RFA
has been considerably utilized over several years for the treatment of
inoperable thoracic lesions and hepatic tumors. However, the authors of
the study believe this to be the first time it worked effectively with
mesothelioma cancer cells. In RFA, high-frequency electrical currents
are passed through an electrode in the needle, creating a small region
of heat to kill cancer cells.
Patient Profile & Treatment Summary
A
55-year-old man, known case of malignant pleural mesothelioma with
right sided pleural effusion came for a follow up 2 years back. He had
already undergone variety of treatment options including surgery,
chemotherapy and radiation. During the follow up, Contrast Enhanced CT
(CECT) of the chest was advised. The CECT film revealed a new tumor in
left hemithorax suggestive of focal distant metastasis. Chemotherapy was
then administered intravenously with pemetrexed and cisplatin regimen.
However, there was no response to treatment even after completing four
cycles.
Team of doctors in the Cancer
Board of Hyogo College of Medicine therefore had to think of the most
suitable approach. The board contemplated that surgery could be a
problematic procedure due to poor performance status of patient, past
history of treatment failures and difficult location of recurrent tumor.
Radiofrequency Ablation (RFA) was then the most suitable option on the
list with its safety, effectiveness and low rate of complications. The
advantageous ability of RFA to be repeated with recurrent tumors was
also considered in the decision making process.
Doctors
performed RFA under CT fluoroscopic guidance. Prior to exposing the
tumor with an electrode, the internal mammary artery was embolized to
prevent risk of bleeding. After exposing the electrode into the center
of tumor cells, the energy of radiofrequency was applied for 10 minutes
to kill recurrent tumor cells. The procedure was successful with no
complications. Post procedure course was uneventful. There was no
evidence of Mesothelioma recurrence in the patient even after two years
of procedure.
REFERENCES
1.
Nakamura A, Takuwa T, Hashimoto M, et al. Radiofrequency Ablation Effectively Treated Focal Recurrence of Mesothelioma. Ann Thorac Surg. 2018;105(6):e265-e267.
2.
Gomez
D, Hong D, Allen P, et al. Patterns of failure, toxicity, and survival
after extrapleural pneumonectomy and hemithoracic intensity-modulated
radiation therapy for malignant pleural mesothelioma. J Thorac Oncol. 2013;8(2):238-245.
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