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Issues in Imaging-Guided Tumor Ablation in Children Versus Adults

¹ Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115.
² Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —26-year-old man with tuberous sclerosis and mental retardation. Axial CT image shows multiple bilateral angiomyolipomas and enhancing lesion in right kidney, suspicious for renal cell carcinoma (arrow). This exophytic lesion in patient with ample intraabdominal fat was optimal lesion for radiofrequency ablation. We were asked by referring physicians to perform ablation, but patient's parents refused procedure.

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —13-year-old girl with osteoid osteoma of femur. Anteroposterior scout view shows cortical thickening along lateral cortex.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —13-year-old girl with osteoid osteoma of femur. Axial CT images show posterolateral cortical thickening and nidus with faint mineralization (arrow, B) with placement of 5-mm electrode into nidus (C). This was first case of radiofrequency ablation for osteoid osteoma performed at our institution. Seminal articles on subject at time described off-label use of 0.5-cm probe, although using different ablation parameters. Manufacturer offered to provide technical assistance only if we used 1-cm probe and different generator that, at that time, were not as well described in literature. Is this experimentation, innovation, or standard practice? What are implications for informed consent?

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —13-year-old girl with osteoid osteoma of femur. Axial CT images show posterolateral cortical thickening and nidus with faint mineralization (arrow, B) with placement of 5-mm electrode into nidus (C). This was first case of radiofrequency ablation for osteoid osteoma performed at our institution. Seminal articles on subject at time described off-label use of 0.5-cm probe, although using different ablation parameters. Manufacturer offered to provide technical assistance only if we used 1-cm probe and different generator that, at that time, were not as well described in literature. Is this experimentation, innovation, or standard practice? What are implications for informed consent?

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