Purpose
Radiofrequency (RF) ablation for the treatment of refractory lymphoma is undocumented. We present three patients in whom RF ablation was used, for three different indications, to treat residual lymphomatous lesions unresponsive to conventional treatment.
Material and methods
Three patients with isolated lymphoma masses were treated with percutaneous image-guided RF ablation. In the first case, the patient had a rapidly enlarging B-cell lymphoma of the right neck causing impending airway compromise. The second patient had a residual hepatic mass after rituximab and EPOCH chemotherapy for polymorphic post-transplant lymphoproliferative disorder. The third patient had a progressively enlarging follicular lymphoma adjacent to the bladder wall following prior maximum radiation therapy and CHOP chemotherapy and was treated with RF ablation for pain palliation. The water-cooled Radionics generator ablation system was used with a cluster needle probe in all cases. Impedence, temperature, power, current, and time were monitored closely. Patients were followed both clinically and with CT, MRI, or PET to evaluate for treatment response and/or recurrence of their lesions.
Results
Although the first patient had short-term relief of his neck pain and respiratory compromise post-ablation, he expired five weeks later from his lymphoma. The second patient had complete radiological resolution of the hepatic masses and remains disease free at four years post-treatment. The third patient achieved a partial response to the pelvic mass, requiring a second ablation treatment for recurrent urinary symptoms. He remained with improved symptoms at most recent follow-up.
Conclusion
These cases of pending airway compromise, chemoresistance, and pain palliation illustrate settings in which RF ablation may be a preferable treatment to radiation or surgery, producing potentially less morbidity than standard treatments. Previous studies have shown that RF ablation produces a robust inflammatory response and could lead to a boost in the immune response against lymphoma, especially when performed with costimulatory agents like vaccines or other immunostimulation. This study exemplifies ways in which RF ablation may help manage patients with lymphoma and few alternative therapies.