Pulmonary Radiofrequency Ablation in Patients with a Single Lung: Feasibility, Efficacy, and Tolerance

Abstract

To evaluate the feasibility, efficacy, and tolerance of pulmonary radiofrequency (RF) ablation for the treatment of lung tumors in patients with a single lung. This was a retrospective study from four institutions, with waiver of institutional review board approval and of informed consent. From July 2003 to March 2009, 15 single-lung patients (nine men and six women; mean age, 64 years; age range, 42-82 years) with one to three lung tumors underwent 16 sessions of RF ablation. One patient underwent two sessions due to occurrence of new tumors. Eleven patients had primary lung cancer and four patients had metastases. The previous pneumonectomy was performed for the treatment of primary or secondary lung tumors. Twenty-one tumors measuring 4-37 mm (mean, 15.5 mm ± 8 [standard deviation]) were treated. All procedures were performed by using general anesthesia with intubation. Electrodes were expandable in 13 procedures and straight in three. The efficacy was evaluated with computed tomography (CT) or positron emission tomography (PET)/CT, performed 3, 6, 12, and 18 months and 2 years after treatment. The median follow-up was 17.6 months, with seven patients being followed at 1 year and three being followed at 2 years. Treatment tolerance was evaluated from results of clinical examination, follow-up CT, and CT performed immediately after completion of RF ablation. No procedural deaths occurred. Procedural complications observed at CT during RF ablation were mild parenchymal hemorrhages (n = 5; 31%). All pneumothoraces (n = 6; 37%) resolved after chest tube placement. Postprocedural complications included one case of pulmonary infection and two cases of limited hemoptysis. Complete tumor ablation was obtained in all RF sessions but one (15 of 16; 95%). Overall survival rate was 71.4% (95% confidence interval [CI]: 36%, 92%) at 2 years; cancer-specific survival was 100% at 2 years. The tumor-free survival was 58.7% (95% CI: 32%, 81%) at 1 year and 19.6% (95% CI: 4%, 58%) at 2 years. RF ablation appears to be a reasonable and safe option in patients with a single lung.