ablation (RFA) is a treatment technique that uses
high-frequency alternating electrical current to destroy tissue cells
by heating them.
Unfortunately, RFA is not helpful for the comprehensive treatment of
systemic blood cell cancers, or metastatic cancers of other types
... in most clinical circumstances. It might be used as part of
immunotherapy however, or as a palliative measure to treat
"RFA has a very low complication rate. Studies
of the technique report complications in only 1 percent to 4 percent
of patients, depending on the type of disease treated and the overall
health of the patient."
The safety and effectiveness of RFA is well known
and the technology has been approved by the Food and Drug
Administration (FDA). Countless patients with a variety of medical
problems have been treated with the technique. 2
Here we propose that RFA be applied to
investigational and compassionate use of lymphomas for
To safely manage the
disease in the palliative or watchful waiting setting;
To explore the
potential of RFA to induce immune responses against tumor
as described in the background section
within - possibly in combination with immune
Rationale: Patients diagnosed with indolent lymphomas are often advised to watch and wait (w&w) until symptoms, disease progression, or disease location makes treatment necessary. The rationale for monitoring is based on findings that overall survival is not improved by early use of standard chemotherapy (Horning et al).
However, many patients are unhappy with monitoring indolent lymphoma,
understanding that the disease could be progressing, even if slowly, and possibly accumulating dangerous
mutations. Furthermore lymphoid tumors that otherwise do not
require therapy can present in the face and neck, which can affect social and career functioning; and have a
significant impact on quality of life.
It should be noted that the main rationale for monitoring indolent
lymphomas is the toxicity of standard therapies - that can narrow the range of subsequent treatment
options - is rarely curative.
Importantly, RFA is unlikely to preclude optimal benefit from future standard treatments
when used to treat an unsightly or bothersome nodal lesion when
disease monitoring is otherwise indicated. Low-risk RFA could lead to fast-acting resolution on the tumor, with the added potential of inducing systemic immune activation against the disease.
In short, judicious use of RFA could improve quality of life and
well-being of people who live with this life-threatening disease.
For the patient there appears to be little to lose from RFA, except an unsightly/troubling nodal lesion. Radiotherapy can do the same, but patients have concerns about mutagenic risk to surrounding tissue. That treatment with RFA could lead to immune recognition of tumor antigens is an additional potential benefit.
Therefore we urge the investigational and
compassionate use of RFA for patients with lymphomas who are in
watchful waiting status or in need of safer palliative
"Ablation is a medical term that refers to
any procedure performed to destroy diseased or damaged tissue in the
body. Catheter ablation is a technique in which a thin tube, or
catheter, is inserted through the skin or threaded through the blood
vessels to the site of disease. Extreme heat or cold, alcohol,
chemotherapy drugs or other therapies are delivered through the
catheter to the diseased tissue." -
"An additional approach under investigation
by the Engleman lab involves intratumoral injections of naïve DCs
into tumors that have been treated with either radiofrequency ablation
or photodynamic therapy. The latter therapies are effective locally
but not systemically, and importantly, in tumor bearing mice the
combination of either treatment with intratumoral DCs can be curative."
Radiofrequency Ablation of Lymphoma - ASCO
"These cases of chemo resistance, pain palliation, and pending airway
compromise illustrate settings in which RFA may be a preferable
treatment to radiation or surgery, producing potentially less
morbidity than standard treatments. Previous studies have shown that
RFA produces a robust inflammatory response and could lead to a boost
in the immune response against lymphoma, especially when performed
with co stimulatory agents like vaccines or other immuno-stimulation.
This study exemplifies ways in which RFA may help manage patients with
lymphoma and few alternative therapies."
"Therefore, in addition to destroying tumor
tissue, RFA induces an immune response against tumor antigens that may
be exploited in multimodal antitumor strategies."