Radiofrequency Ablation for Lung Carcinomas: A Retrospective Review of a High-Risk Patient Population at a Community Hospital

Purpose: The purpose of this study is to retrospectively evaluate the technical efficacy, safety, and treatment outcomes of percutaneous radiofrequency ablation (RFA) of lung tumors in patients not amenable to surgery at an urban community hospital. Materials and Methods: Informed consent and IRB approval was obtained. Eligible tumors were defined as those in patients deemed poor surgical candidates by multidisciplinary consensus or those refusing surgery. Response to treatment was assessed by computed tomography (CT) performed immediately postprocedure and regular intervals up to 36 months later. Complete response was measured as a 30% decrease in mean tumor diameter without evidence of contrast enhancement or tumor growth within the ablation zone as defined by the response evaluation in solid tumors. Patient demographics, technical success, postprocedure complications, and survival were assessed and compared with data available in literature. Results: Twenty-four patients with a total of 29 tumors underwent percutaneous CT guided RFA for biopsy-proven lung malignancies between 2010 and 2016. Complete response was achieved in 82% (14/17) of treated tumors in patients who complied with postprocedure imaging recommendations. Immediate postprocedure complications occurred following 27.6% (8/29) ablations with pneumothorax being the most common, 17.2% (6/29). Mean survival is 28.5 months (95% confidence interval: 19.7–37.3). Progressive disease was seen in 18% (3/17) patients. No immediate treatment mortality was found. No significant difference was found in survival in patients with multiple comorbidities as measured by the Charlson Comorbidity Index. Conclusions: RFA of lung tumors is a well-tolerated procedure with low incidence of minor complications, a good tumor response and survival benefit in selected patients in the community setting. This is a positive endorsement of the potential success of tumor RFA programs outside of the academic setting. In addition, patients with multiple comorbidities should still be considered candidates for RFA as no difference was seen in survival in patients with multiple medical comorbidities.

Interventional oncology - lung carcinoma - percutaneous radiofrequency ablation

Publication History

Article published online:
23 March 2021

• References

• 1 Dupuy DE. Image-guided thermal ablation of lung malignancies. Radiology 2011;260:633-55.
• 2 Abtin FG, Eradat J, Gutierrez AJ, Lee C, Fishbein MC, Suh RD, et al. Radiofrequency ablation of lung tumors: Imaging features of the postablation zone. Radiographics 2012;32:947-69.
• 3 Jahangeer S, Forde P, Soden D, Hinchion J. Review of current thermal ablation treatment for lung cancer and the potential of electrochemotherapy as a means for treatment of lung tumours. Cancer Treat Rev 2013;39:862-71.
• 4 Bargellini I, Bozzi E, Cioni R, Parentini B, Bartolozzi C. Radiofrequency ablation of lung tumours. Insights Imaging 2011;2:567-76.
• 5 Hamamoto S, Matsuoka T, Okuma T, Yamamoto A, Hamuro M, Miki Y, et al. Effective palliative radiofrequency ablation for tumors causing pain, numbness and motor function disorders: Case series. BMC Res Notes 2014;7:765.
• 6 Crabtree T, Puri V, Timmerman R, Fernando H, Bradley J, Decker PA, et al. Treatment of stage I lung cancer in high-risk and inoperable patients: Comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033). J Thorac Cardiovasc Surg 2013;145:692-9.
• 7 Simon TG, Beland MD, Machan JT, Dipetrillo T, Dupuy DE. Charlson comorbidity index predicts patient outcome, in cases of inoperable non-small cell lung cancer treated with radiofrequency ablation. Eur J Radiol 2012;81:4167-72.
• 8 Eisenhauer E. New response evaluation criteria in solid tumors: Revised RECIST guidelines (version 1.1). Eur J Cancer 2009;45:228-47.
• 9 Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14:S199-202.
• 10 de Baere T, Farouil G, Deschamps F. Lung cancer ablation: What is the evidence? Semin Intervent Radiol 2013;30:151-6.
• 11 Lencioni R, Crocetti L, Cioni R, Suh R, Glenn D, Regge D, et al. Response to radiofrequency ablation of pulmonary tumours: A prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). Lancet Oncol 2008;9:621-8.
• 12 Percutaneous radiofrequency ablation for primary or secondary lung cancers. The National Institute for Health and Clinical Excellence (NICE); December, 2010. Available from: https://www.nice.org.uk/guidance/ipg372. [Last accessed on 2018 Jan 10].
• 13 Lischalk JW, Woo SM, Kataria S, Aghdam N, Paydar I, Repka MC, et al. Long-term outcomes of stereotactic body radiation therapy (SBRT) with fiducial tracking for inoperable stage I non-small cell lung cancer (NSCLC). J Radiat Oncol 2016;5:379-87.
• 14 Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 2006;24:4833-9.
• 15 Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer. J Am Coll Surg 2010;211:68-72.