Radiofrequency Ablation: Treatment of Primary Lung Cancer

Abstract

t Recent 2010 American Cancer Society estimates suggest that of new cancer diagnoses, primary lung cancer remains the second most commonly diagnosed and the leading cause of death in both men and women.1 Primary lung caners are broadly divided into 2 types: nonsmall cell lung ancer (NSCLC), which account for 85%-90% of diagnoses, nd small cell lung cancer (SCLC), which account for the ther 10%-15% of cases. SCLC is generally a more aggressive isease, often diagnosed at advanced stages and with lower ssociated survival rates compared with NSCLC. Systemic herapies remain the mainstay for patients with SCLC, with nly a small subset qualifying for local salvage therapies. omparatively, NSCLC is more often diagnosed at early tages, allowing for therapy with curative intent. Surgical resection with curative intent remains the current tandard of treatment for patients with early stage lung caner. Controversy over the optimal surgical resection strategy lobectomy vs sublobar resection) for early-stage lung cancer as been a hotly debated topic since the feasibility of sublobar esection was suggested.2 In 1995, researchers from a prospective, multiinstitutional randomized trial by the Lung Cancer Study Group compared lobectomy and sublobar resection in T1N0 disease and found a significant survival advantage and lower local recurrence rate with lobectomy versus sublobar resection.3 This study, along with others in the ate 1990s, resulted in a shift towards limiting sublobar reection to patients with inadequate pulmonary reserve to ndergo lobectomy.4 The broader implications of this paradigm would seem to suggest that compared with lobectomy, all local therapies—sublobar resection, radiofrequency (RF) ablation, or radiotherapy—would be inferior and should be reserved for patients unable to undergo lobectomy. Current advances in both surgical techniques as well as diagnostic imaging have spawned a resurgence in interest of sublobar resection and other local therapies instead of lobectomy in patients who are candidates for anatomic lobectomy.