PURPOSE: To evaluate the long term results of radiofrequency ablation as primary treatment of medically inoperable lung cancer.
METHODS: Sixteen consecutive patients with biopsy proven non small cell lung cancer (NSCLC) underwent 19 treatments of CT-guided radiofrequency ablation (RFA) over a period of 30 months. All patients underwent careful re-evaluation by a thoracic surgeon and were deemed medically inoperable. Patients were clinically staged with CT-PET and/or mediastinoscopy to rule out metastatic disease. RFA was performed with curative intent using a single or cluster cool-tip F electrode (Radionics, Burlington, MA). Procedures were done predominantly under conscious sedation and patients were hospitalized for 23 hour observation. CT-PET was implemented in the follow-up at various intervals.
RESULTS: Treatment was successfully completed in all patients with no 30-day mortality. Local recurrence was demonstrated radiographically in 2/18 (11.1%) patients. One patient was retreated successfully and the other underwent external beam radiotherapy. The mean maximal diameter of the 19 tumors was 1.8 ± 1 cm (range 0.8-4.4cm). Among 16 patients treated for cure, 13/16 (81%) were alive after a mean follow up of 9.2 ± 7.8 months. One patient died of extrathoracic disease progression and two patients died due to unrelated disease. Complications included pneumothorax (5/19), fever (2/19), pneumonia (2/19), mild hemoptysis (6/19), small pleural effusion (4/19), and hematoma (1/19). Two patients with upper lobe lesions developed transient nerve palsies involving the recurrent laryngeal nerve and ulnar nerve, respectively.
CONCLUSION: Radiofrequency ablation of lung cancer in carefully selected patients yields encouraging mid to long term results. The incidence of major complications remains low. CT-PET should be further evaluated in the early detection of local failure of RFA-treated lung cancer.
CLINICAL IMPLICATIONS: RFA treatment of lung cancer in patients who are deemed nonsurgical candidates can be safely performed and appears to provide excellent local control in tumors less than 3cm. Additional studies are needed to identify the size limit of current RFA technology. Ultimately, RFA treatment of lung cancer should be compared to conventional radiotherapy as primary treatment.
DISCLOSURE: Michael Lanuti, None.