Radiofrequency ablation: mechanisms and clinical applications

Radiofrequency ablation (RFA), a form of thermal ablation, employs localized heat to induce protein denaturation in tissue cells, resulting in cell death. It has emerged as a viable treatment option for patients who are ineligible for surgery in various diseases, particularly liver cancer and other tumor‐related conditions. In addition to directly eliminating tumor cells, RFA also induces alterations in the infiltrating cells within the tumor microenvironment (TME), which can significantly impact treatment outcomes. Moreover, incomplete RFA (iRFA) may lead to tumor recurrence and metastasis. The current challenge is to enhance the efficacy of RFA by elucidating its underlying mechanisms. This review discusses the clinical applications of RFA in treating various diseases and the mechanisms that contribute to the survival and invasion of tumor cells following iRFA, including the roles of heat shock proteins, hypoxia, and autophagy. Additionally, we analyze‌ the changes occurring in infiltrating cells within the TME after iRFA. Finally, we provide a comprehensive summary of clinical trials involving RFA in conjunction with other treatment modalities in the field of cancer therapy, aiming to offer novel insights and references for improving the effectiveness of RFA. Radiofrequency ablation (RFA) is a type of thermal ablation that induces coagulation necrosis of tumors by raising temperatures above 60°C. However, compared with complete RFA, because the ablation area cannot completely cover the entire tumor, insufficient RFA (iRFA) can lead to rapid local tumor progression, metastasis, and even further malignant transformation. There are three main causes of iRFA, including large or irregular tumor shape, heat sink effect, and adjacent organs/surfaces. In this review, we systematically summarize the underlying mechanisms contributing to tumor progression associated with iRFA, provide potential strategies to address the challenges posed by iRFA in order to enhance therapeutic efficacy.