For Alveolar Soft Part Sarcoms patients the use of aggressive surgery, appropriate diagnostic imaging, and long-term surveillance for metastases are critical to achieve long-term survival (Kayton et al 2006). When surgery is not possible, then local treatment like tumor ablation may be considered. In the past we discussed the benefits of Stereotactic Radiosurgery (SRS).
There are different ablation techniques that can be used to treat tumor locally: cryoablation (cryosurgery), radiofrequency ablation (RFA), laser-induced thermal therapy (LITT), microwave ablation, and focused ultrasound (FUS). Some of them are widely available – like RFA, and some are not avail. everywhere (like cryo and LITT) and some are only started to get used by a few doctors. The medical specialist that performs local tumor ablations is called Interventional Radiologist. Local tumor ablations are used when there is a need/reason to avoid the open surgery and have the advantage of the minimal pain, scarring, and cost.
1. Cryoablation (formerly known as Cryosurgery) is the application of extreme cold to destroy abnormal or diseased tissue. It can be used percutaneously (as a minimally invasive procedure) and during the open surgery as an additional tool in case when resection is complicated. The most common method of freezing tumors is by using liquid nitrogen as the cooling solution. Other freezing agents are carbon dioxide and argon gas to drive ice formation. The cryoablation has the advantage of the continued direct visualization of the ablation quality during the ablation process using CT-scanner.
Click the following link and read about Cryosurgery in Cancer on the National cancer Institute website
Few ASPS patients had their tumors cryoablated at the Karmanos Cancer Institute with Dr. Peter Littrup
Click the following link to read a scientific article that supports cryosurgery over other tumor ablation methods
2. Radio frequency ablation (RFA) is the application of the heat that is produced by the current and used to locally destroy a tumor. It can be used percutaneously (as a minimally invasive procedure) and during the open surgery as an additional tool in case when resection is complicated. Tumors in Lung, liver and kidney are the main tumors treated with RFA. The procedure is done by placing a needle-like RFA probe inside the tumor.
Click the following link and read about Radio frequency ablation in Cancer on the National cancer Institute website
Few ASPS patients had their tumors RFA-ablated.
3. Laser-induced thermal therapy (LITT) is the application of the high temperatures generated by the local absorption of laser energy. It can be used percutaneously (as a minimally invasive procedure) and during the open surgery as an additional tool in case when resection is complicated. Organs or tissues in which LITT has been used for this purpose include brain, head and neck, liver, kidneys, and prostate. Laser applicators for LITT may be inserted into target tissue using a number of image-guided techniques including x-ray fluoroscopy, ultrasound imaging, magnetic resonance imaging, or stereotaxic approaches. LITT has the advantage of the tiniest applicator possible between the all ablative techniques, but it is rarely available technology.
One ASPS patient had her brain metastasis ablated by using LITT technology at the Dana Farber clinics in Boston, but the most experienced intervenional radiologist in using LITT is located in Europe in Frankfurt University Hospital, Dr.T.J.Vogl.
Click the following link to read about Lasers in Cancer on the National cancer Institute website
4. Focused ultrasound (FUS) and microwave ablation are currently under development technologies. They use a microwave or focused ultrasound medical devices to heat and destroy tissue. Among the tumors destroyed by FUS are solid tumors of the bone, brain, breast, liver, pancreas, rectum, kidney, testes and prostate. When the procedure is done by MRI guidance it may be called Magnetic Resonance-guided Focused Ultrasound, or MRgFUS.
Click the following link to read about Focused ultrasound on the Focused Ultrasound Surgery Foundation website
The insurance coverage for the locally ablative procedures varies, consult your insurance guides for the up-to-date information as whether it is covered for your specific case as the coverage of these procedures is evolving as more data about its efficacy became available. Some of our patients had to pay out of pocket to have their tumors ablated in order to get an access to the technology that is able to locally destroy the tumors not treatable otherwise.
Yosef Landesman, Ph.D.
President & Cancer Research Director
Cure Alveolar Soft Part Sarcoma International (iCureASPS)