Download PDF
Semin intervent Radiol 2013; 30(02): 169-175
DOI: 10.1055/s-0033-1342958
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lung Cancer Ablation: Complications

Takao Hiraki
1   Department of Radiology, Okayama University Medical School, Okayama, Japan
,
Hideo Gobara
1   Department of Radiology, Okayama University Medical School, Okayama, Japan
,
Hiroyasu Fujiwara
1   Department of Radiology, Okayama University Medical School, Okayama, Japan
,
Hiroaki Ishii
1   Department of Radiology, Okayama University Medical School, Okayama, Japan
,
Koji Tomita
1   Department of Radiology, Okayama University Medical School, Okayama, Japan
,
Mayu Uka
1   Department of Radiology, Okayama University Medical School, Okayama, Japan
,
Satoko Makimoto
1   Department of Radiology, Okayama University Medical School, Okayama, Japan
,
Susumu Kanazawa
1   Department of Radiology, Okayama University Medical School, Okayama, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
28 May 2013 (online)

Also available at
    Permissions and Reprints

Abstract

Although radiofrequency ablation for lung cancer is generally safe (with a mortality rate <1%), it may cause various complications. Common complications include pneumothorax, pleural effusion, and parenchymal hemorrhage. Although most complications can be treated conservatively or with minimal therapy, physicians should be aware of rare but serious complications. Potentially fatal complications include massive hemorrhage, intractable pneumothorax due to bronchopleural fistula, pulmonary artery pseudoaneurysm, systemic air embolism, and pneumonitis. Other serious complications include injury to the nearby tissues (e.g., brachial nerve plexus, phrenic nerve, diaphragm, and chest wall), needle tract seeding, lung abscess, empyema, and skin burn. Although cavitation of the ablation zone is usually insignificant clinically, such a cavity occasionally ruptures, leading to pneumothorax and bleeding. Cavities may also serve as a scaffold for fungal colonization. Precautions to minimize risk should be taken whenever possible. Nevertheless, serious complications may occur, and thus physicians should be aware of the appropriate treatments for these complications. This article reviews complications associated with lung cancer ablation.

Keywords

radiofrequency ablation - lung cancer - complication - interventional radiology
 

  • References

  • 1 Dupuy DE, Zagoria RJ, Akerley W, Mayo-Smith WW, Kavanagh PV, Safran H. Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol 2000; 174 (1) 57-59
    CrossrefPubMedGoogle Scholar
  • 2 Steinke K, Sewell PE, Dupuy D , et al. Pulmonary radiofrequency ablation—an international study survey. Anticancer Res 2004; 24 (1) 339-343
    PubMedGoogle Scholar
  • 3 Hiraki T, Tajiri N, Mimura H , et al. Pneumothorax, pleural effusion, and chest tube placement after radiofrequency ablation of lung tumors: incidence and risk factors. Radiology 2006; 241 (1) 275-283
    CrossrefPubMedGoogle Scholar
  • 4 Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, Nishimura T. Pneumothorax as a complication of percutaneous radiofrequency ablation for lung neoplasms. J Vasc Interv Radiol 2006; 17 (10) 1625-1629
    CrossrefPubMedGoogle Scholar
  • 5 Okuma T, Matsuoka T, Yamamoto A , et al. Frequency and risk factors of various complications after computed tomography-guided radiofrequency ablation of lung tumors. Cardiovasc Intervent Radiol 2008; 31 (1) 122-130
    CrossrefPubMedGoogle Scholar
  • 6 Nour-Eldin NE, Naguib NN, Saeed AS , et al. Risk factors involved in the development of pneumothorax during radiofrequency ablation of lung neoplasms. AJR Am J Roentgenol 2009; 193 (1) W43-8
    CrossrefPubMedGoogle Scholar
  • 7 Yoshimatsu R, Yamagami T, Terayama K, Matsumoto T, Miura H, Nishimura T. Delayed and recurrent pneumothorax after radiofrequency ablation of lung tumors. Chest 2009; 135 (4) 1002-1009
    CrossrefPubMedGoogle Scholar
  • 8 Clasen S, Kettenbach J, Kosan B , et al. Delayed development of pneumothorax after pulmonary radiofrequency ablation. Cardiovasc Intervent Radiol 2009; 32 (3) 484-490
    CrossrefPubMedGoogle Scholar
  • 9 Sakurai J, Hiraki T, Mukai T , et al. Intractable pneumothorax due to bronchopleural fistula after radiofrequency ablation of lung tumors. J Vasc Interv Radiol 2007; 18 (1 Pt 1) 141-145
    CrossrefPubMedGoogle Scholar
  • 10 Kodama H, Yamakado K, Murashima S , et al. Intractable bronchopleural fistula caused by radiofrequency ablation: endoscopic bronchial occlusion with silicone embolic material. Br J Radiol 2009; 82 (983) e225-e227
    CrossrefPubMedGoogle Scholar
  • 11 Cannella M, Cornelis F, Descat E , et al. Bronchopleural fistula after radiofrequency ablation of lung tumours. Cardiovasc Intervent Radiol 2011; 34 (Suppl. 02) S171-S174
    CrossrefPubMedGoogle Scholar
  • 12 Nomura M, Yamakado K, Nomoto Y , et al. Complications after lung radiofrequency ablation: risk factors for lung inflammation. Br J Radiol 2008; 81 (963) 244-249
    CrossrefPubMedGoogle Scholar
  • 13 Tajiri N, Hiraki T, Mimura H , et al. Measurement of pleural temperature during radiofrequency ablation of lung tumors to investigate its relationship to occurrence of pneumothorax or pleural effusion. Cardiovasc Intervent Radiol 2008; 31 (3) 581-586
    CrossrefPubMedGoogle Scholar
  • 14 Lee JM, Jin GY, Goldberg SN , et al. Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report. Radiology 2004; 230 (1) 125-134
    CrossrefPubMedGoogle Scholar
  • 15 Sano Y, Kanazawa S, Gobara H , et al. Feasibility of percutaneous radiofrequency ablation for intrathoracic malignancies: a large single-center experience. Cancer 2007; 109 (7) 1397-1405
    CrossrefPubMedGoogle Scholar
  • 16 Steinke K, King J, Glenn D, Morris DL. Pulmonary hemorrhage during percutaneous radiofrequency ablation: a more frequent complication than assumed?. Interact Cardiovasc Thorac Surg 2003; 2 (4) 462-465
    CrossrefPubMedGoogle Scholar
  • 17 Nour-Eldin NE, Naguib NN, Mack M, Abskharon JE, Vogl TJ. Pulmonary hemorrhage complicating radiofrequency ablation, from mild hemoptysis to life-threatening pattern. Eur Radiol 2011; 21 (1) 197-204
    CrossrefPubMedGoogle Scholar
  • 18 Vaughn C, Mychaskiw II G, Sewell P. Massive hemorrhage during radiofrequency ablation of a pulmonary neoplasm. Anesth Analg 2002; 94 (5) 1149-1151
    CrossrefPubMedGoogle Scholar
  • 19 Dupuy DE, Mayo-Smith WW, Abbott GF, DiPetrillo T. Clinical applications of radio-frequency tumor ablation in the thorax. Radiographics 2002; 22 (Spec No) S259-S269
    CrossrefPubMedGoogle Scholar
  • 20 Herrera LJ, Fernando HC, Perry Y , et al. Radiofrequency ablation of pulmonary malignant tumors in nonsurgical candidates. J Thorac Cardiovasc Surg 2003; 125 (4) 929-937
    CrossrefPubMedGoogle Scholar
  • 21 Sakurai J, Mimura H, Gobara H, Hiraki T, Kanazawa S. Pulmonary artery pseudoaneurysm related to radiofrequency ablation of lung tumor. Cardiovasc Intervent Radiol 2010; 33 (2) 413-416
    CrossrefPubMedGoogle Scholar
  • 22 Yamakado K, Takaki H, Takao M , et al. Massive hemoptysis from pulmonary artery pseudoaneurysm caused by lung radiofrequency ablation: successful treatment by coil embolization. Cardiovasc Intervent Radiol 2010; 33 (2) 410-412
    CrossrefPubMedGoogle Scholar
  • 23 Soh J, Toyooka S, Gobara H , et al. A case of delayed massive hemothorax caused by the rupture of a pulmonary artery pseudoaneurysm after radiofrequency ablation of lung tumors. Jpn J Clin Oncol 2012; 42 (7) 646-649
    CrossrefPubMedGoogle Scholar
  • 24 Hiraki T, Mimura H, Gobara H , et al. Two cases of needle-tract seeding after percutaneous radiofrequency ablation for lung cancer. J Vasc Interv Radiol 2009; 20 (3) 415-418
    CrossrefPubMedGoogle Scholar
  • 25 Yamakado K, Akeboshi M, Nakatsuka A , et al. Tumor seeding following lung radiofrequency ablation: a case report. Cardiovasc Intervent Radiol 2005; 28 (4) 530-532
    CrossrefPubMedGoogle Scholar
  • 26 Hiraki T, Gobara H, Mimura H , et al. Brachial nerve injury caused by percutaneous radiofrequency ablation of apical lung cancer: a report of four cases. J Vasc Interv Radiol 2010; 21 (7) 1129-1133
    CrossrefPubMedGoogle Scholar
  • 27 Matsui Y, Hiraki T, Gobara H , et al. Phrenic nerve injury after radiofrequency ablation of lung tumors: retrospective evaluation of the incidence and risk factors. J Vasc Interv Radiol 2012; 23 (6) 780-785
    CrossrefPubMedGoogle Scholar
  • 28 Le TX, Andrews RT. Thermal osteonecrosis of the rib after radiofrequency ablation in the thorax. J Vasc Interv Radiol 2008; 19 (6) 940-944
    CrossrefPubMedGoogle Scholar
  • 29 Hiraki T, Gobara H, Shibamoto K , et al. Technique for creation of artificial pneumothorax for pain relief during radiofrequency ablation of peripheral lung tumors: report of seven cases. J Vasc Interv Radiol 2011; 22 (4) 503-506
    CrossrefPubMedGoogle Scholar
  • 30 Hiraki T, Gobara H, Masaoka Y, Toyooka S, Kanazawa S. Diaphragmatic hernia after percutaneous radiofrequency ablation of lung tumor. J Vasc Interv Radiol 2011; 22 (12) 1777-1778
    CrossrefPubMedGoogle Scholar
  • 31 Hiraki T, Gobara H, Kato K, Toyooka S, Mimura H, Kanazawa S. Bronchiolitis obliterans organizing pneumonia after radiofrequency ablation of lung cancer: report of three cases. J Vasc Interv Radiol 2012; 23 (1) 126-130
    CrossrefPubMedGoogle Scholar
  • 32 Okuma T, Matsuoka T, Hamamoto S, Nakamura K, Inoue Y. Percutaneous computed tomography-guided radiofrequency ablation of lung tumors complicated with idiopathic interstitial pneumonia. Ann Thorac Surg 2009; 87 (3) 948-950
    CrossrefPubMedGoogle Scholar
  • 33 Okuma T, Matsuoka T, Tutumi S, Nakmura K, Inoue Y. Air embolism during needle placement for CT-guided radiofrequency ablation of an unresectable metastatic lung lesion. J Vasc Interv Radiol 2007; 18 (12) 1592-1594
    CrossrefPubMedGoogle Scholar
  • 34 Ghaye B, Bruyère PJ, Dondelinger RF. Nonfatal systemic air embolism during percutaneous radiofrequency ablation of a pulmonary metastasis. AJR Am J Roentgenol 2006; 187 (3) 327-328
    CrossrefPubMedGoogle Scholar
  • 35 Jin GY, Lee JM, Lee YC, Han YM. Acute cerebral infarction after radiofrequency ablation of an atypical carcinoid pulmonary tumor. AJR Am J Roentgenol 2004; 182 (4) 990-992
    CrossrefPubMedGoogle Scholar
  • 36 Yamamoto A, Matsuoka T, Toyoshima M , et al. Assessment of cerebral microembolism during percutaneous radiofrequency ablation of lung tumors using diffusion-weighted imaging. AJR Am J Roentgenol 2004; 183 (6) 1785-1789
    CrossrefPubMedGoogle Scholar
  • 37 Okuma T, Matsuoka T, Yamamoto A , et al. Factors contributing to cavitation after CT-guided percutaneous radiofrequency ablation for lung tumors. J Vasc Interv Radiol 2007; 18 (3) 399-404
    CrossrefPubMedGoogle Scholar
  • 38 Hiraki T, Gobara H, Mimura H , et al. Aspergilloma in a cavity formed after percutaneous radiofrequency ablation for lung cancer. J Vasc Interv Radiol 2009; 20 (11) 1499-1500
    CrossrefPubMedGoogle Scholar
  • 39 Chua TC, Sarkar A, Saxena A, Glenn D, Zhao J, Morris DL. Long-term outcome of image-guided percutaneous radiofrequency ablation of lung metastases: an open-labeled prospective trial of 148 patients. Ann Oncol 2010; 21 (10) 2017-2022
    CrossrefPubMedGoogle Scholar