Radiofrequency ablation of pulmonary malignant tumors in nonsurgical candidates

Objective: Radiofrequency ablation applies thermal energy with a catheter delivery system, resulting in coagulation necrosis. Radiofrequency ablation is frequently used for hepatic malignant tumors, but few reports exist regarding its use for lung tumors. We report our experience with radiofrequency ablation for the treatment of pulmonary malignant tumors. Methods: We evaluated the results of lung radiofrequency ablation for patients not considered surgical candidates. Indications for radiofrequency ablation were pulmonary malignant tumors in patients with medical comorbidities, pulmonary compromise, or refusal of surgery. Results: Thirty-three lung tumors in 18 patients (12 male, 6 female) were treated with radiofrequency ablation. Tumors included metastatic carcinoma (n = 8), sarcoma (n = 5), and lung cancer (n = 5). Mean age was 60 years (range 27-95 years). Thoracic surgeons performed radiofrequency ablation by minithoracotomy (n = 5) or computed tomography-guided percutaneous methods (n = 13) with patients under general anesthesia in the operating room. Mean length of stay was 3 days (range 1-7 days). Complications included procedure-related pneumothorax in 7 of 13 percutaneous procedures (53.8%), delayed pneumothorax (1/18), pneumonitis/pneumonia (4/18), small pleural effusion (9/18) and transient renal failure (1/18). One death occurred as a result of hemoptysis 19 days after radiofrequency ablation of a central nodule. This patient had also received recent brachytherapy. After a mean follow-up of 6 months (range 1-14 months), radiofrequency ablation had achieved a radiographically determined response in 8 of 12 patients with treated tumors smaller than 5 cm (66.6%). Death with progressive metastatic disease occurred in 7 of 18 patients (38%) during follow-up. Conclusion: This pilot study demonstrates the feasibility of radiofrequency ablation for small peripheral lung tumors. Larger tumors responded poorly. Additional trials are needed to determine safety and efficacy.