MEDICAL POLICY SUBJECT: RADIOFREQUENCY TUMOR ABLATION

Transcription

1 MEDICAL POLICY PAGE: 1 OF: 16 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied. Medical policies apply to commercial and Medicaid products only when a contract benefit for the specific service exists. Medical policies only apply to Medicare products when a contract benefit exists and where there are no National or Local Medicare coverage decisions for the specific service. POLICY STATEMENT: I. Based upon our criteria and assessment of peer-reviewed literature, radiofrequency ablation of malignant hepatic lesions (primary and metastatic) is considered a medically appropriate treatment option for selected patients meeting ALL of the following conditions: A. The patient has no evidence of uncontrolled extrahepatic systemic metastatic disease; and B. The lesions(s) treated by radiofrequency are not amenable to open surgical resection or the patient is considered at high risk for adverse outcomes (morbidity and mortality) during open surgical resection; and C. The lesion size is 5 cm or less. II. Based upon our criteria and assessment of peer-reviewed literature, radiofrequency ablation as a bridge to transplant is a medically appropriate treatment option in patients with hepatocellular carcinoma who meet liver transplant criteria and are waiting liver transplantation. III. Based upon our criteria and assessment of peer-reviewed literature, percutaneous radiofrequency ablation of an osteoid osteoma is a medically appropriate alternative to surgical excision for patients with ALL of the following indications: A. The patient can not be managed successfully with medical management; and B. There is sufficient clinical and imaging evidence that tumor is osteoid osteoma; and C. The tumor location allows for safe placement of the radiofrequency catheter (e.g., at least 1 cm away from vascular, neural or other anatomic structures which have the potential for damage,) IV. Based upon our criteria and assessment of peer-reviewed literature, radiofrequency ablation of renal tumors is considered a medically appropriate treatment option in the following circumstances: A. Patients with a solitary kidney; OR B. Patients with a contraindication to surgery (e.g., significant comorbidities location or number of tumors preclude surgical intervention); AND C. Tumor size is equal to or less than 4 cm. The comorbidities of patients unable to undergo surgery should not be so severe as to limit their life expectancy to less than one year. V. Based upon our criteria and assessment of peer-reviewed literature, radiofrequency ablation is considered medically appropriate when utilized for palliation of pain in patients with osteolytic bone metastases who have failed or are poor candidates for standard treatments such as opioids or radiation. VI. Based upon our criteria and assessment of peer-reviewed literature, radiofrequency ablation has been medically proven effective and therefore is considered medically appropriate to treat an isolated peripheral non-small cell lung cancer lesion that is no more than 3 cm in size when the following criteria are met: A. Surgical resection or radiation treatment with curative intent is considered appropriate based on stage of disease, however, medical co-morbidity renders the individual unfit for those interventions; AND B. Tumor is located at least 1 cm from the trachea, main bronchi, esophagus, aorta, aortic arch branches, pulmonary artery and the heart.

2 PAGE: 2 OF: 16 VII. Based upon our criteria and assessment of peer-reviewed literature, radiofrequency ablation has been medically proven effective and therefore is considered medically appropriate to treat malignant non-pulmonary tumor(s) metastatic to the lung that are no more than 3 cm in size when ALL the following criteria are met: A. The patient is not considered a surgical candidate or radiofrequency ablation is being performed in order to preserve lung function when surgical resection or radiation treatment is likely to substantially worsen pulmonary status; AND B. There is no evidence of extrapulmonary metastases; AND C. The tumor is located at least 1 cm from the trachea, main bronchi, esophagus, aorta, aortic arch branches, pulmonary artery and the heart; AND D. There are no more than 3 tumors per lung to be ablated; AND E. Tumors are amenable to complete ablation; AND F. Twelve months have elapsed since the last ablation. VIII. Based upon our criteria and assessment of peer-reviewed literature, radiofrequency ablation has not been medically proven to be effective and is considered investigational as a treatment method for other solid tumors, including, but not limited to pancreatic, thyroid, breast tumors and uterine fibroid tumors. Refer to Corporate Medical Policy # regarding Transurethral Radiofrequency Needle Ablation of the Prostate for Benign Prostatic Hyperplasia. Refer to Corporate Medical Policy # regarding Cryosurgical Tumor Ablations. Refer to Corporate Medical Policy # regarding Liver Transplantation. Refer to Corporate Medical Policy # regarding Selective Internal Radiation Therapy (SIRT). Refer to Corporate Medical Policy # regarding Peptide Receptor Radionuclide Therapy. Refer to Corporate Medical Policy # regarding Experimental and Investigational Services. POLICY GUIDELINES: The Federal Employee Health Benefit Program (FEHBP/FEP) requires that procedures, devices or laboratory tests approved by the U.S. Food and Drug Administration (FDA) may not be considered investigational and thus these procedures, devices or laboratory tests may be assessed only on the basis of their medical necessity. DESCRIPTION: Radiofrequency is an ablative technique that relies on heat to effect tumor killing. A radiofrequency electrode is passed into a tumor under sonographic, CT or MR-guidance. In radiofrequency ablation (RFA), tumors are destroyed in situ by thermal coagulation and protein denaturation. High frequency alternating current flows from un-insulated electrode tips into surrounding tissue. As the tissue ions attempt to follow the change in the direction of the alternating current, ionic agitation results in frictional heating. The tissue surrounding the electrode, rather than the electrode itself, is the primary source of heat. It is presumed that tissue heating drives extracellular and intracellular water out of the tissue, resulting in coagulative necrosis. RFA is usually used to treat inoperable tumors or to treat patients who are ineligible for surgery due to advanced age or co-morbidities. RFA was developed initially to treat inoperable tumors of the liver. RFA is now being proposed as a minimally invasive treatment alternative for other solid tumors such as breast, pancreas, pulmonary renal and bone. Radiofrequency ablation can be administered by open surgery, laparoscopic surgery or percutaneously.

3 PAGE: 3 OF: 16 RATIONALE: Radiofrequency ablation of liver tumors is not subject to FDA approval. However, several devices/probes used to ablate tumors have received FDA marketing clearance. Current studies have demonstrated that RFA is most effective (causes tissue necrosis) in the treatment of small lesions confined to the liver. Studies of RFA of small liver tumors have provided similar outcomes in terms of local recurrence and overall survival for patients with unresectable hepatic malignancy compared to alternative therapies such as percutaneous ethanol injection (PEI). Overall, most studies of RFA for miscellaneous malignant solid tumors (other than liver) consist of case studies, which have reported only short-term outcomes such as tumor response and immediate tumor control. These studies have not determined RFA s effect on the overall survival and net health benefit of these patients compared to the well established local and systemic treatments currently available for these tumors. More rigorous scientific reviews, long-term follow-up and randomized prospective trials are needed to help better define the role of RFA in oncology. Renal tumors The majority of studies were small case series of individual institution experiences with this treatment modality. Patients in these case series had small renal tumors and were unsuitable for surgical management (e.g., severe co-morbidities, a solitary kidney, or multiple renal tumors). Outcomes of these case series have demonstrated that RFA for renal cell carcinoma is a promising treatment and creates tumor necrosis, but longer-term outcomes are needed to determine if RFA provides a durable survival benefit. RFA as an alternative to surgical intervention requires comparative studies to determine if it provides a similar survival benefit. Lung tumors In summary, while the available studies are limited by study design, accumulating evidence from case series suggests that RFA may be a treatment option in selected patients with primary, non-small cell lung cancer and metastatic pulmonary tumors. Evidence suggests RFA may have survival rates and have rates of procedure-related complications and mortality similar to surgery. Surgical resection remains the treatment of choice, but in patients unable to tolerate surgery due to medical comorbidities, RFA may be considered a treatment option. The December 2010 guidance from National Institute for Clinical Excellence (NICE) states: Current evidence on the efficacy of percutaneous radiofrequency ablation (RFA) for primary or secondary lung cancers is adequate in terms of tumor control. There is a small incidence of complications, specifically pneumothorax, which may have serious implications for these patients with already compromised respiratory reserve. This procedure may be used provided that normal arrangements are in place for clinical governance, consent and audit. Patient selection for percutaneous RFA for primary or secondary lung cancers should be carried out by a multidisciplinary team, which will usually include a thoracic surgeon, an oncologist and a radiologist. This procedure should only be carried out by radiologists who regularly undertake image guided interventional procedures The 2011 National Comprehensive Cancer Network (NCCN) Practice Guideline on NSCLC states RFA may be an option for node-negative patients who either refuse surgery or cannot tolerate surgery because of poor performance status, significant cardiovascular risk, poor pulmonary function, and/or comorbidities. Optimal candidates for RFA include patients with an isolated peripheral lesion less than 3 cm. RFA can be used for previously irradiated tissue for palliation. Transplant Setting The drop out rates of patients with hepatocellular carcinoma from liver transplant lists have been reported to range from 20-40% due to tumor progression. Recent studies utilizing radiofrequency ablation as a bridge to transplant have increased days on the transplant list considerably and decreased dropout rates to 12-15%. The evidence related to the use of RFA in patients with HCC to specifically downsize/downgrade tumors to meet priority transplant criteria is insufficient at this time due to inconsistent outcomes reported in the literature. Data related to tumor recurrence in this patient population requires longer-term follow-up.

4 PAGE: 4 OF: 16 Osteoid Osteomas Studies investigating the efficacy of radiofrequency ablation for osteoid osteomas provide evidence that RFA provides comparable outcomes to surgical excision in regards to tumor destruction and pain relief and allows for a decrease in hospital stay and quicker postoperative recovery. RFA treatment of osteoid osteoma is not appropriate for large lesions or for lesions whose location make it technically difficult to perform percutaneously. Breast Tumors There is insufficient evidence in the literature related to the effectiveness of RFA in the treatment of patients with breast cancer. The outcome data from current clinical trials is inconsistent and no conclusions can be drawn on the effect of RFA on recurrence or disease-free survival rates. Studies are also limited by small sample populations, short-term follow-up and a lack of comparative studies with already established breast conserving therapies. Bone Metastases The majority of literature consists of uncontrolled studies with only a limited number of cases. However, the patient populations comprised individuals with limited or no treatment options, for whom short-term pain relief is an appropriate outcome. Thyroid Tumors The evidence for RFA in thyroid tumors is primarily limited to case series and uncontrolled studies. While RFA has been shown to reduce thyroid tumor volume and improve clinical symptoms, complications can be common and available evidence is insufficient to determine the impact of RFA on net health outcomes. CODES: Number Description Eligibility for reimbursement is based upon the benefits set forth in the member s subscriber contract. CODES MAY NOT BE COVERED UNDER ALL CIRCUMSTANCES. PLEASE READ THE POLICY AND GUIDELINES STATEMENTS CAREFULLY Codes may not be all inclusive as the AMA and CMS code updates may occur more frequently than policy updates. Code Key: Experimental/Investigational = (E/I), Not medically necessary/ appropriate = (NMN). CPT: Ablation, bone tumor(s) (e.g., osteoid osteoma, metastasis), radiofrequency, percutaneous, including computed tomographic guidance Ablation therapy for reduction or eradication of one or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral Laparoscopy, surgical, ablation of one or more liver tumor(s); radiofrequency Ablation, open, of one or more liver tumor(s); radiofrequency Ablation, one or more liver tumor(s), percutaneous, radiofrequency Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency Ultrasound guidance for, and monitoring of, parenchymal tissue ablation Computerized axial tomographic guidance for, and monitoring of, parenchymal tissue ablation Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation 0336T (E/I) Laparoscopy, surgical, radiofrequency ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring Copyright 2016 American Medical Association, Chicago, IL

5 PAGE: 5 OF: 16 HCPCS: No specific code(s) ICD9: Malignant neoplasm of the liver Malignant neoplasm intrahepatic bile ducts Malignant neoplasm liver, NOS Malignant neoplasm of bronchus and lung Malignant neoplasm of kidney (code range) Malignant neoplasm liver, secondary Benign neoplasm of bone and articular cartilage (code range) ICD10: C22.0-C22.9 Malignancies of liver (code range) REFERENCES: C34.90-C34.92 C64.1-C64.9 C65.1- C65.9 C66.1-C66.9 Malignant neoplasm of unspecified part of bronchus or lung (code range) Malignant neoplasm kidney, except renal pelvis (code range) Malignant neoplasm renal pelvis (code range) Malignant neoplasm ureter (code range) C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct D16.00-D16.8 Benign neoplasm bones (code range) D16.9 Benign neoplasm bone and articular cartilage, unspecified Investigational diagnosis codes: Malignant neoplasm of female breast (code range) Uterine leiomyoma (code range) Fibroadenosis of breast C C Malignant neoplasm of breast (code range) D25.0-D25.9 N60.21-N60.29 Leiomyoma of uterus (code range) Fibroadenosis of breast (code range) *Abdellaoui A, et al. Radiofrequency ablation of renal tumors. Future Oncol 2008 Feb;4(1): *Abitabile P, et al. Radiofrequency ablation permits an effective treatment for colorectal liver metastasis. Eur J Surg Oncol 2007 Feb;33(1): *Adam R, et al. A comparison of percutaneous cryosurgery and percutaneous radiofrequency of unresectable hepatic malignancies. Arch Surg 2002 Dec;137(12): *Ahrar K, et al. Percutaneous radiofrequency ablation of renal tumors: technique, complications and outcomes. J Vasc Interv Radiol 2005 May;16(5): *Akeboshi M, et al. Percutaneous radiofrequency ablation of lung neoplasms; initial therapeutic response. J Vasc Interv Radiol 2004 May;15(5): *Ambrogi MC, et al. Percutaneous radiofrequency ablation of lung tumors: results in the mid-term. Eur J Cardiothorac Surg 2006 Jul;30(1):

6 PAGE: 6 OF: 16 Atwell TD, et al. percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol 2013 Feb;200(2): Baek JH, et al. Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology 2012 Jan;262(1): *Baldan A, et al. Percutaneous radiofrequency thermal ablation for hepatocellular carcinoma. Aliment Pharmacol Ther 2006 Nov 15;24(10): *Bandi G, et al. Comparison of postoperative pain, convalescence, and patient satisfaction after laparoscopic and percutaneous ablation of small renal masses. J Endourol 2008 May;22(5): *Belfiore G, et al. CT-guided radiofrequency ablation: a potential complementary therapy for patients with unresectable primary lung cancer- a preliminary report of 33 patients. Am J Roentgenol 2004 Oct;183(4): Belfiore G, et al. CT-guided radiofrequency ablation in the treatment of recurrent rectal cancer. AJR Am J Roentgenol 2009 Jan;192(1): *Berber E, et al. Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. J Clin Oncol 2005 Mar 1;23(7): Berman JM, et al. Three years Outcome from the halt trial: a prospective analysis of radiofrequency volumetric thermal ablation of myomas. J Min Invasive Gynecol Feb 2014 [Epub ahead of print]. Bilal H, et al. Is radiofrequency ablation more effective than stereotactic ablative radiotherapy in patients with early stage medically inoperable non-small cell lung cancer? Interact Cardiovasc Thorac Surg 2012 Aug;15(2): *Bilchik AJ, et al. Cryosurgical ablation and radiofrequency ablation for unresectable hepatic malignant neoplasms. A proposed algorithm. Arch Surg 2000 Jun;(135): Bouza C, et al. Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol 2009 May 11;9:13. Brouquet A, et al. Hepatectomy for recurrent colorectal liver metastases after radiofrequency ablation. Br J Surg 2011 Jul;98(7): Brucker SY, et al. laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy. Int J Gynecol Obstet Feb 2014 [Epub ahead of print]. *Chan RP, et al. Radiofrequency ablation of malignant hepatic neoplasms. Can Assoc Radiol J 2002 Dec;53(5): Chan VO, et al. percutaneous radiofrequency ablation of lung tumors: evaluation of the literature using evidence-based techniques. J Thorac Imaging 2011 Feb;26(1): *Cheng BQ, et al. Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm: a randomized controlled trial. JAMA 2008 Apr 9;299(14): Cho YK, et al. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology 2009 Feb;49(2): Cho YK, et al. Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: a systematic review. J Gastroenterol Hepatol 2011 Sep;26(9): *Choi D, et al. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol 2007 Mar;17(3): *Chow DH, et al. Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a comparative study. J Surg Oncol 2006 Dec 1;94(7):

7 PAGE: 7 OF: 16 Chua TC, et al. Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases. Cancer 2010 May 1;116(9): *Chung MH, et al. Laparoscopic radiofrequency ablation of unresectable hepatic malignancies. A phase 2 trial. Surg Endosc 2001 Sep;15(9): *Cioni R, et al. CT-guided radiofrequency ablation of osteoid ostetoma: long-term results. Eur Radiol 2004 Jul;14(7): Cirocchi R, et al. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev 2012 Jun 13;6:CD *de Baere T, et al. Midterm local efficacy and survival after radiofrequency ablation of lung tumors with minimum follow-up of 1-year: prospective evaluation. Radiology 2006 Aug;240(2): *de Baere T, et al. Hepatic malignancies: percutaneous radiofrequency during percutaneous portal or hepatic vein occlusion. Radiology 2008 Sep;248(3): De Jong MC, et al. Therapeutic efficacy of combined intraoperative ablation and resection for colorectal liver metastases: an international, multi-institutional analysis. J Gastrointest Surg 2011 Feb;15(2): Donington J, et al. American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest 2012 Dec;142(6): Duan C, et al. Radiofrequency ablation versus hepatic resection for the treatment of early-stage hepatocellular carcinoma meeting Milan criteria: a systematic review and meta-analysis. World J Surg Oncol 2013 Aug 13;11(1):190. Dupuy DE, et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer 2010 Feb 15;116(4): El Dib R, et al. Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 2012 Aug;110(4): Elias D, et al. Combined liver surgery and RFA for patients with gastroenteropancreatic endocrine tumors presenting with more than 15 metastases to the liver. Eur J Surg Oncol 2009 Oct;35(10): *Earashi M, et al. Radiofrequency ablation therapy for small breast cancer followed by immediate surgical resection or delayed mammotone excision. Breast Cancer 2007;14(1): *Farrell MA, et al. Imaging-guided radiofrequency ablation of solid renal tumors. AJR 2003 Jun;180(6): Fegrachi S, et al. Radiofrequency ablation for unresectable locally advanced pancreatic cancer: a systematic review. HPB (Oxford) 2013 Apr 18 [Epub ahead of print]. Feng K, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol 2012 Oct;57(4): Ferakis N, et al. Long-term results after computed-tomography-guided percutaneous radiofrequency ablation for small renal tumors. J Endourol 2010 Dec;24(12): *Fernando HC, et al. Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates. J Thorac Cardiovasc Surg 2005 Mar;129(3): Flanders VL, et al. Ablation of liver metastases: current status. J Vasc Interv Radiol 2010 Aug;21(8 Suppl):S *Fujimoto S, et al. Clinical pilot studies on pre-operative hyperthermic tumor ablation for advanced breast carcinoma using an 8 MHz radiofrequency heating device. Int J Hyperthermia 2003 Jan-Feb;19(1):13-22.

8 PAGE: 8 OF: 16 Fuller CW, et al. Radiofrequency ablation for treatment of benign thyroid nodules: systematic review. Laryngoscope 2014 Jan;124(1): Galen D, et al. Laparoscopic radiofrequency fibroid ablation: phase II and phase III results. J Soc Laparoendoscopic Surg 2014;18: *Galandi D, et al. Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma. Cochrane Database Syst Review 2004;(2):CD *Garbay JR, et al. Radiofrequency thermal ablation of breast cancer local recurrence: a phase II clinical trial. Ann Surg Oncol 2008 Nov;15(11): *Garrean S, et al. Radiofrequency ablation of primary and metastatic liver tumors: a critical review of the literature. Am J Surg 2008 Apr;195(4): Georgiades, et al. Renal tumor ablation. Tech Vasc Interv Radiol 2013 Dec;16(4): Germani G, et al. Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocellular carcinoma: a meta-analysis. J Hepatol 2010 Mar;52(3): *Gervais DA, et al. Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR 2005 Jul;185(1): *Gervais DA, et al. Renal cell carcinoma: clinical experience and technical success with radiofrequency ablation of 42 tumors. Radiol 2003 Feb;226(2): Gervais DA, et al. Society of International Radiology position statement on percutaneous radiofrequency ablation for the treatment of liver tumors. J Vasc Interv Radiol 2009 Jan;20(1):3-8. Girelli R, et al. Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg 2010 Feb;97(2): *Goetz MP, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 2004 Jan 15;22(2): Gontero P, et al. Ablative therapies in the treatment of small renal tumors: how far from standard of care? Urol Oncol 2010 May-Jun;28(3): Gordon-Weeks AN, et al. Systematic review of outcome of downstaging hepatocellular cancer before liver transplantation in patients outside the Milan criteria. Br J Surg 2011Sep;98(9): Graversen JA, et al. Laparoscopic ablation of renal neoplasms. J Endourol 2011 Feb;25(2): Guenette JP, et al. Radiofrequency ablation of colorectal hepatic metastases. J Surg Oncol 2010 Dec 15;102(8): Gupta A, et al. General anesthesia and contrast-enhanced computed tomography to optimize renal percutaneous radiofrequency ablation: multi-institutional intermediate-term results. J Endourol 2009 Jul;23(7): Gurusamy KS, et al. Liver resection versus other treatments for neuroendocrine tumours in patients with resectable liver metastases. Cochrane Database Syst Rev 2009 Apr 15;(2):CD Hammill CW, et al. Outcome after laparoscopic radiofrequency ablation of technically resectable colorectal liver metastases. Ann Surg Oncol 2011 Jul;18(7): *Hanje AJ, et al. Current approach to down-staging of hepatocellular carcinoma prior to liver transplantation. Curr Opin Organ Transplant 2008 Jun;13(3): *Hayashi AH, et al. Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation. Am J Surg 2003 May;185 (5):

9 PAGE: 9 OF: 16 *Heckman JT, et al. Bridging locoregional therapy for hepatocellular carcinoma prior to liver transplantation. Ann Surg Oncol 2008 Nov;15(11): *Herrera LJ, et al. Radiofrequency ablation of pulmonary malignant tumors in nonsurgical candidates. J Thorac Cardiovasc Surg 2003 Apr;125(4): *Hiraki T, et al. Repeat radiofrequency ablation for local progression of lung tumors: does it have a role in local tumor control? J Vasc Interv Radiol 2008 May;19(5): Hoffer FA, et al. A phase 1/pilot study of radiofrequency ablation for the treatment of recurrent pediatric solid tumors. Cancer 2009 Mar 15;115(6): *Hoffman Al, et al. Histologic evaluation and treatment outcome after sequential radiofrequency ablation and hepatic resection for primary and metastatic tumors. Am Surg 2002 Dec;68(12): Hoffmann RT, et al. Radiofrequency ablation in the treatment of osteoid osteoma- 5- year experience. Eur J Radiol 2010 Feb;73(2): Howington JA, et al. Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3 rd ed: American College of Chest Physicians evidenced-based clinical practice guidelines. Chest 2013 May;143(5 Suppl):e278S-313S. *Hsieh CB, et al. Comparison of transcatheter arterial chemoembolization, laparoscopic radiofrequency ablation, and conservative treatment for decompensated cirrhotic patients with hepatocellular carcinoma. World J Gastroenterol 2004 Feb 15;10(4): Huang L, et al. Is radiofrequency thermal ablation a safe and effective procedure in the treatment of pulmonary malignancies? Eur J Cardiothorac Surg 2011 Mar;39(3): Huang YZ, et al. Radiofrequency ablation versus cryosurgery ablation for hepatocellular carcinoma: a meta-analysis. Hepatogastroenterology 2013 Jan 16;60(127). Huh JY, et al. Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session prospective randomized study. Radiology 2012 Jun;263(3): *Hui GC, et al. Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol 2008 Sep;19(9): Hwang JE, et al. Combination of percutaneous radiofrequency ablation and systemic chemotherapy are effective treatment modalities for metachronous liver metastases from gastric cancer. Clin Exp Metastasis 2014 Jan;31(1): *Ikeda M, et al. Radiofrequency ablation and percutaneous ethanol injection in patients with small hepatocellular carcinoma: a comparative study. Jpn J Clin Oncol 2001 Jul;31(7): *Iannitti DA, et al. Hepatic radiofrequency ablation. Arch Surg 2002 Apr;137(4): Imoto S, et al. Feasibility study on radiofrequency ablation followed by partial mastectomy for stage I breast cancer patients. Breast 2009 Apr;18(2): *Jiang HC, et al. Clinical short-term results of radiofrequency ablation in liver cancers. World J Gastroenterol 2002 Aug;8(4): *Johnson EW, et al. The role of tumor ablation in bridging patients to liver transplantation. Arch Surg 2004 Aug; 139(8): Karam JA, et al. Radiofrequency ablation of renal tumours with clinical, radiographical and pathological results. BJU Int 2013 May;111(6): Kashima M, et al. Radiofrequency ablation for the treatment of bone metastases from hepatocellular carcinoma. AJR Am J

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