The Ascension Crittenton Hospital Tumor Ablation Program is the most comprehensive, multi-organ ablation program in Michigan. Tumor ablation is a minimally invasive option for the thorough destruction of cancerous tumors in nearly any area of the body. Ablation is an outpatient procedure and is similar to a needle biopsy, however it’s performed under CT scan and/or ultrasound guidance for tumor visualization. Tumor ablation can be performed with either heat or cold, optimally using microwave or cryotechnology. Cryoablation, or freezing, can be used to treat benign tumors, such as breast fibroadenomas, chest/abdominal wall desmoids and endometriosis of the abdominal wall.
Image-guided tumor ablation can treat many cancerous tumors as thoroughly as other treatment options with less pain, less risk, faster recovery time and lower recurrence rates. Tumor ablation can also be an option for high-risk patients such as those with obesity, poor heart/lung status, or those with one kidney.
The program is led by Peter Littrup, MD, pioneering Interventional Radiologist and a globally recognized scientist in medical imaging. Dr. Littrup has treated over 1,000 patients with lung, liver, kidney and soft tissue tumors.
Dr. Peter Littrup
Ablation refers to the thorough destruction of a tumor by using cytotoxic (cell-killing) temperatures, or deadly heat/cold. It’s accurately delivered to a localized group of cancer cells and thoroughly covers all visible tumor margins. The “ablation zone” refers to the area of destruction intended to cover all tumor margins, usually extending approximately 1 cm beyond all tumor margins and mimicking a surgical resection margin.
The ablation zone is more visible when referring to cryoablation, or freezing, since ice involves a phase change and is easy to see using CT or ultrasound. Heat-based ablations, such as radiofrequency (RF) or microwave (MW), may require additional intravenous contrast during CT guidance to better see the ablation zone. MW is now routinely used due to its greater power, speed and predictability of the MW ablation zone compared to RF.
Image guidance refers mainly to the use of CT (computed tomography) to accurately guide the ablation needles to the appropriate tumor location. A recent (<6 weeks) CT scan and/or MRI scan is crucial to accurately plan the procedure. If a tumor can be better visualized by ultrasound, it may be used in combination with CT to better target the tumor for needle placement, while CT may provide better circumferential visualization of the ablation zones to cover all tumor margins. Ultrasound guidance alone is generally reserved for isolated, soft tissue tumors where the tumor and/or adjacent structures can be thoroughly seen for safety and efficacy, such as with some breast tumor ablations.
Cryoablation consists of placing at least 2 cryoprobes (needles that get cold) in order to generate lethal ice temperatures (e.g., <-20°C) to cover all visible tumor margins.
Cryoablation benefits include:
- Excellent visualization of the ice ablation zone extending beyond all tumor margins
- Potentially less procedural and post-procedural pain
- Thorough healing of the ablation zone
Cryoablation also allows “sculpting” of the ablation zone to the size of the tumor by placing sufficient probes to generate a large enough ice ball. Simplified as the “1-2 rule,” cryoprobes are placed less than 1 cm away from all tumor margins and no further than 2 cm apart. This translates into at least one cryoprobe per centimeter tumor diameter (i.e., 4 cm tumor requires at least 4 cryoprobes depending upon their diameter and freeze capacity). The cryoablation zones generally reduce by 90% in volume within 6-12 months, and with generally less scar tissue than heat-based ablations.
Microwave ablation has nearly replaced radiofrequency for heat-based ablations. The benefits over cryoablation include the speed of the procedure and potential greater safety for liver tumors. Multiple microwave ablations in the same procedure can cause less inflammation than cryoablation, especially for liver and lung tumors.
Tumor sites are generally considered by the organ groupings of liver, lung and kidney, as well as soft tissue. Soft tissue ablations are a growing group of ablations because cancer doesn’t only start or spread to the primary organ groups. Cryoablation has been highly effective for local control in numerous body sites, as well as being a cost effective addition to the care of patients with metastatic disease.
Indications are listed by body type in the five sections below. All patients are required to have a recent CT or MRI (within 6 weeks or less), as appropriate. Patients should not be on any major blood thinners (i.e. Coumadin, Xarelto, etc.) during the ablation procedure, and they should take appropriate time off the medication(s) to normalize bleeding risk.
Although Dr. Littrup and his medical support staff are not insurance experts, they are very willing to work with patients to obtain and/or provide sufficient documentation to support an initial evaluation or verbal consultation. Billing codes exist for image-guided ablation of liver, lung and kidney tumors which will be used to obtain authorization.
However, accepted billing codes for FDA-accepted ablation equipment does not ensure individual insurance companies will cover the procedure. In addition, Dr. Littrup has pioneered the use of cryoablation for soft tissue locations which may not fall under standard “organ-based” billing codes. This will likely require an appropriate appeal, and it may still not be approved for coverage.
Cryoablation for benign breast tumors, or fibroadenomas, has a specific billing code with excellent outcomes based on multicenter trials. However, the lack of ANY coverage for cryoablation of breast cancer is common due to many political/economic reasons, rather than the scientific integrity, as compared to nearly any other anatomic location.
Cryoablation for breast cancer at Ascension Crittenton Hospital is done with the highest scientific integrity under Dr. Littrup’s expert guidance, plus an industry-sponsored protocol for breast cancer is under way. For appropriate “off-protocol” breast cancer cases, Dr. Littrup will carefully consider potential cryoablation benefits as noted in the special breast section.
The Ascension Crittenton Tumor Ablation Program emphasizes years of evidence-based development and we continue the tradition of participation in clinical trials. Two clinical trials are described in the detailed ablation sections below. In the Soft Tissue Ablation section, learn more about the treatment of bone pain in the MOTION trial. In the Breast Ablation section, you’ll find details about the FROST trial for early breast cancer.
Learn more about each different type of ablation procedure, including access to published research papers on each topic.