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• W2051549254 abstract "Editor: Radiofrequency (RF) ablation has attracted a great deal of interest as a method for the treatment of various malignancies (1Dupuy DE Goldberg NG Image-guided radiofrequency tumor ablation: challenges and opportunities-part II.J Vasc Interv Radiol. 2001; 12: 1135-1148Abstract Full Text Full Text PDF PubMed Scopus (418) Google Scholar, 2Akeboshi M Yamakado K Nakatsuka A et al.Percutaneous radiofrequency ablation of lung neoplasms: initial therapeutic response.J Vasc Interv Radiol. 2004; 15: 463-470Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar, 3Livraghi T Solbiati L Meloni MF et al.Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study.Radiology. 2003; 226: 441-451Crossref PubMed Scopus (1152) Google Scholar). In this report, we present a case of hemorrhagic vaginal cancer that was successfully treated by RF ablation. A 74-year-old woman visited our hospital with vaginal bleeding and severe anemia in April 2002. She had vaginal prolapse and a prominent hemorrhagic vaginal tumor with a maximum diameter of 15 cm. The vaginal tumor had invaded the urinary bladder and caused vesicovaginal fistula (Figure, part a). The vaginal tumor was proven by biopsy to be vaginal cancer of clinical stage IVA. The patient was judged to not be a candidate for surgical intervention because of her poor general condition. Although systemic chemotherapy and transarterial embolization of the internal iliac arteries were performed, the tumor became larger and tumor bleeding continued. Then, vaginal RF ablation was performed with epidural anesthesia five times during a 4-month period. The urinary bladder was continuously irrigated with cold saline solution via a three-channel urinary catheter to protect the bladder wall. A straight 17-gauge cooled-tip RF electrode (Radionics, Burlington, MA) was placed at three to six different sites during each RF session under computed tomographic fluoroscopic or ultrasound guidance. The first two RF procedures were performed in the supine position, but skin burns developed in the femoral region at the time of the second RF ablation session. The next three RF sessions were performed in the lithotomy position. To separate the vaginal tumor from the femoral skin, surgical gloves stuffed with gauze were placed between the tumor and the skin. Tumor bleeding ceased and the maximum tumor size was reduced from 15 cm to 4 cm after the fifth RF session (Figure, part b). The skin burns resolved with symptomatic treatment. The vesicovaginal fistula had become apparent as a result of shrinkage of the vaginal tumor, but the patient did not develop any complications such as urinary tract infection. The tumor did not grow and tumor bleeding was controlled until the patient died of multiple organ failure and cerebral infarction 6 months after the final RF session. Vaginal cancer is a rare disease, comprising less than 2% of all gynecologic cancers. The prognosis is still limited in patients with stage III/IV disease (4Goodman A Primary vaginal cancer.Surg Oncol Clin N Am. 1998; 7: 347-361PubMed Google Scholar). In addition to difficulty in controlling the vaginal tumor, tumor bleeding can be a life-threatening problem. In the present case, neither chemotherapy nor arterial embolization was effective in controlling tumor growth or tumor bleeding. We have shown that RF ablation can be useful not only in reducing the tumor size but also in controlling tumor bleeding. Because the vaginal cancer was associated with prolapse in the present case, the therapeutic effect was evaluated visually. Burns developed on the skin in contact with the tumor after the second RF session. In addition to ensuring that the exposed tip is embedded into the tumor, it is also important to position the tumor away from the patient's skin by interposing some sort of insulation to prevent skin burns (3Livraghi T Solbiati L Meloni MF et al.Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study.Radiology. 2003; 226: 441-451Crossref PubMed Scopus (1152) Google Scholar). As the vaginal tumor shrank, the vesicovaginal fistula became larger even though the urinary bladder was irrigated with cold saline solution. In patients with urinary bladder invasion, the risk of a vesicovaginal fistula after RF ablation seems to be greater because the tumor rapidly becomes smaller." @default.
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• W2051549254 date "2005-11-01" @default.
• W2051549254 modified "2023-09-27" @default.
• W2051549254 title "Radiofrequency Ablation for the Treatment of Hemorrhagic Vaginal Cancer" @default.
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• W2051549254 doi "https://doi.org/10.1097/01.rvi.0000188777.69563.aa" @default.
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