Lung Radiofrequency Ablation Research Articles

Abstract No. 178: Complications of lung radiofrequency ablation in 892 treatments

Abstract No. 178: Complications of lung radiofrequency ablation in 892 treatments

Chest wall temperature during radiofrequency ablation in a normal rabbit lung model

The aim of this study was to examine the actual temperature during lung radiofrequency ablation (RFA) and pathological changes due to thermal damage in the pleural tissue of the chest wall in a rabbit model. The study was conducted on 14 Japanese white rabbits with normal lungs. Under computed tomography guidance, the electrode with a 2-cm expandable tip was inserted into the lower lung lobe and positioned so the tip of the needle touched the thoracic wall upon expansion. A thermometer was inserted 5 mm lateral to the point of electrode insertion. RFA was applied at 30 W (n = 7) or 15 W (n = 7) until maximum impedance (i.e., roll-off) or for 4 min at the longest. Local tissue temperature was recorded. The chest wall was dissected out immediately after RFA for histological examination. The mean (+/- SD) maximum tissue temperature at 30 W (86.7 degrees +/- 10.0 degrees C) was not significantly different from that at 15 W (82.1 degrees +/- 6.2 degrees C). The mean ablation time to increase tissue temperature to 50 degrees , 60 degrees , and 70 degrees C was faster at 30 W (13, 27, and 49 s, respectively) than at 15 W (13, 56, and 115 s, respectively) (P < 0.05). Histological examination showed pleural sloughing at the point of needle insertion and ring-shaped thermal injury in the chest wall. With rabbit lung RFA near the chest wall, ablation immediately below the pleura resulted in a rise of local tissue temperature to >80 degrees C and thermal injury.

Primary Non–Small Cell Lung Cancer: Review of Frequency, Location, and Time of Recurrence after Radiofrequency Ablation

To review the recurrence patterns in patients with primary non-small cell lung cancer (NSCLC) treated with percutaneous image-guided radiofrequency (RF) ablation. This retrospective review was institutional review board approved and HIPAA compliant. Informed consent was waived. Data from all patients with primary NSCLC who underwent lung RF ablation from January 1998 to January 2008 were reviewed. Ninety-one patients were identified. Ten patients with no posttreatment imaging results and two patients with multiple treated lung cancers were excluded. There were 79 tumors in 79 patients (mean age, 75 years). Mean tumor size was 2.5 cm (range, 1-5.5 cm). Fifteen (19%) tumors were central, and 64 (81%) tumors were peripheral. Nineteen (24%) patients underwent adjuvant external beam radiation, and nine (11%) patients underwent concomitant brachytherapy. Correlation of computed tomography and positron emission tomography imaging studies with biopsy results, tumor size, location, and stage was performed. Patterns of recurrence were classified as local, intrapulmonary, nodal, mixed (local and nodal), and distant. Forty-five (57%) patients demonstrated no evidence of recurrence at follow-up imaging (range, 1-72 months; mean, 17 months). Recurrence was seen in 34 (43%) patients (range, 2-48 months; mean, 14 months). Recurrence after RF ablation was local in 13 (38%), intrapulmonary in six (18%), nodal in six (18%), mixed in two (6%), and distant metastases in seven (21%) cases. Median disease-free survival was 23 months. Sex, tumor location, and radiation therapy were not associated with risk of recurrence. Increasing tumor size (P = .02) and stage (P = .007) were related to risk of recurrence. The most common pattern of recurrence was local, which suggests that more aggressive initial RF ablation and adjuvant radiation may offer improvement in outcomes. Continued follow-up imaging is needed because new recurrences were seen throughout the 2 years following treatment.

Primary Non-Small Cell Lung Cancer: Review of Frequency, Location, and Time of Recurrence after Radiofrequency Ablation

Purpose To review the recurrence patterns in patients with primary non–small cell lung cancer (NSCLC) treated with percutaneous image-guided radiofrequency (RF) ablation. Materials and Methods This retrospective review was institutional review board approved and HIPAA compliant. Informed consent was waived. Data from all patients with primary NSCLC who underwent lung RF ablation from January 1998 to January 2008 were reviewed. Ninety-one patients were identified. Ten patients with no posttreatment imaging results and two patients with multiple treated lung cancers were excluded. There were 79 tumors in 79 patients (mean age, 75 years). Mean tumor size was 2.5 cm (range, 1–5.5 cm). Fifteen (19%) tumors were central, and 64 (81%) tumors were peripheral. Nineteen (24%) patients underwent adjuvant external beam radiation, and nine (11%) patients underwent concomitant brachytherapy. Correlation of computed tomography and positron emission tomography imaging studies with biopsy results, tumor size, location, and stage was performed. Patterns of recurrence were classified as local, intrapulmonary, nodal, mixed (local and nodal), and distant. Results Forty-five (57%) patients demonstrated no evidence of recurrence at follow-up imaging (range, 1–72 months; mean, 17 months). Recurrence was seen in 34 (43%) patients (range, 2–48 months; mean, 14 months). Recurrence after RF ablation was local in 13 (38%), intrapulmonary in six (18%), nodal in six (18%), mixed in two (6%), and distant metastases in seven (21%) cases. Median disease-free survival was 23 months. Sex, tumor location, and radiation therapy were not associated with risk of recurrence. Increasing tumor size (P = .02) and stage (P = .007) were related to risk of recurrence. Conclusion The most common pattern of recurrence was local, which suggests that more aggressive initial RF ablation and adjuvant radiation may offer improvement in outcomes. Continued follow-up imaging is needed because new recurrences were seen throughout the 2 years following treatment. © RSNA, 2009

Determinants of Local Progression After Computed Tomography-Guided Percutaneous Radiofrequency Ablation for Unresectable Lung Tumors: 9-Year Experience in a Single Institution

The purpose of this study was to retrospectively determine the local control rate and contributing factors to local progression after computed tomography (CT)-guided radiofrequency ablation (RFA) for unresectable lung tumor. This study included 138 lung tumors in 72 patients (56 men and 16 women; age 70.0 +/- 11.6 years (range 31-94); mean tumor size 2.1 +/- 1.2 cm [range 0.2-9]) who underwent lung RFA between June 2000 and May 2009. Mean follow-up periods for patients and tumors were 14 and 12 months, respectively. The local progression-free rate and survival rate were calculated to determine the contributing factors to local progression. During follow-up, 44 of 138 (32%) lung tumors showed local progression. The 1-, 2-, 3-, and 5-year overall local control rates were 61, 57, 57, and 38%, respectively. The risk factors for local progression were age (>or=70 years), tumor size (>or=2 cm), sex (male), and no achievement of roll-off during RFA (P < 0.05). Multivariate analysis identified tumor size >or=2 cm as the only independent factor for local progression (P = 0.003). For tumors <2 cm, 17 of 68 (25%) showed local progression, and the 1-, 2-, and 3-year overall local control rates were 77, 73, and 73%, respectively. Multivariate analysis identified that age >or=70 years was an independent determinant of local progression for tumors <2 cm in diameter (P = 0.011). The present study showed that 32% of lung tumors developed local progression after CT-guided RFA. The significant risk factor for local progression after RFA for lung tumors was tumor size >or=2 cm.

A Case Report of 20 Lung Radiofrequency Ablation Sessions for 50 Lung Metastases from Parathyroid Carcinoma Causing Hyperparathyroidism

A 47-year-old man presented with multiple lung metastases from parathyroid carcinoma that caused hyperparathyroidism and refractory hypercalcemia. Lung radiofrequency (RF) ablation was repeated to decrease the serum calcium and parathyroid hormone levels and improve general fatigue. Pulmonary resection was combined for lung hilum metastases. The patient is still alive 4 years after the initial RF session. He has received 20 RF sessions for 50 lung metastases during this period.

Intractable bronchopleural fistula caused by radiofrequency ablation: endoscopic bronchial occlusion with silicone embolic material

A 58-year-old man with primary lung cancer underwent lung radiofrequency (RF) ablation. Pneumothorax developed 12 days after lung RF ablation. Despite chest drainage for 1 month, air leakage continued through a bronchopleural fistula. Bronchial occlusion was performed with a silicone embolus, causing cessation of the air leakage.

Long-term results of radiofrequency ablation in colorectal lung metastases: Single center experience

This study was undertaken to evaluate long-term results of radiofrequency (RF) ablation in patients with colorectal lung metastases and to stratify patients benefitting from lung RF ablation. Lung RF ablation was performed in 78 patients with 198 colorectal lung metastases. Safety, local tumor progression, and survival were evaluated retrospectively. The mean follow-up period after the 140 lung RF ablation sessions was 24.6+/-7.6 months. Pneumothorax and pleural effusion requiring chest tube placement occurred respectively in 18 (12.9%, 18/140) and 2 (1.4%, 2/140) sessions. The respective 1-, 3- and 5-year local tumor progression rates were 10.1% (95% CI, 2.9-17.3%), 20.6% (95% CI, 8.9-22.2%) and 20.6% (95% CI, 8.9-22.2%). The 1-, 3- and 5-year survival rates were 83.9% (95% CI, 75.2-92.7%), 56.1% (95% CI, 41.7-70.5%) and 34.9% (95% CI, 18.0-51.9%), with median survival time of 38.0 months. Univariate analysis revealed maximum tumor diameter of 3 cm or less, single-lung metastasis, lack of extrapulmonary metastasis and normal carcinoembryonic antigen (CEA) level as better prognostic factors. The latter two were significant independent prognostic factors. The 1-, 3- and 5-year survival rates were 97.7% (95% CI, 93.3-100%), 82.5% (95% CI, 68.2-96.8%) and 57.0% (95% CI, 34.7-79.2%) in 54 patients with no extrapulmonary metastases and 96.9% (95% CI, 90.8-100%), 86.1% (95% CI, 71.1-100%) and 62.5% (95% CI, 36.3-88.6%) in 33 patients with negative CEA levels. Lung RF ablation is a safe and useful therapeutic option. These identified prognostic factors will help to stratify patients who benefit from lung RF ablation.

Percutaneous radiofrequency ablation for unresectable pulmonary metastases from renal cell carcinoma

To evaluate the clinical utility of lung radiofrequency ablation (RFA) in patients with unresectable pulmonary metastasis from renal cell carcinoma (RCC). We retrospectively examined 39 patients with unresectable metastases from RCC who were treated with lung RFA. Patients with six or fewer lung metastases measuring < or =6 cm that were confined in the lung, had all lung tumours ablated (curative ablation). Patients with extrapulmonary lesions, seven or more lung tumours, or large tumours of >6 cm, had mass reduction (palliative ablation). The primary endpoints was the overall survival, secondary endpoints were safety, local tumour progression rate, and recurrence-free survival in the curative ablation group. There were significant differences in the overall survival rates between the curative and palliative groups at 1 year (100% vs 90%), 3 years (100% vs 52%) and 5 years (100% vs 52%) (P < 0.05). The maximum lung tumour diameter was also a significant prognostic factor. There was local tumour progression in 13 patients (33%) during the mean follow-up of 25 months. The recurrence-free survival rates were 92% at 1 year, 23% at 3 years and 23% at 5 years in the curative ablation group. Pneumothorax requiring chest tube placement (six of 89, 7%) and pneumonia (one of 89, 1%) were major complications. Lung RFA is a safe and effective treatment for prolonging survival in patients with unresectable RCC lung metastases.

Lung radiofrequency ablation in patients with pulmonary metastases from musculoskeletal sarcomas

The authors retrospectively evaluated the impact of lung radiofrequency (RF) ablation on survival in patients with lung metastases from musculoskeletal sarcomas. Lung RF ablation was done under the real-time computed tomography (CT) fluoroscopy. Safety, local tumor progression, and survival were evaluated in 2 institutions. Lung RF ablation was performed in 20 consecutive patients. The mean maximum tumor diameter was 14 +/- 9 mm (range, 5-40 mm) and the mean tumor number 7 +/- 6 (range, 1-18) per patient. Pneumothorax requiring chest tube placement developed in 24 of 63 RF sessions (38%). During the mean follow-up period of 18 months (range, 7 months to 54 months), 9 of 20 patients died of lung tumor progression. The 1- and 3-year survival rates from RF ablation were 58% (95% confidence interval [CI], 33.3-82.6%) and 29% (95% CI, 0-59.9%) with a median survival time of 12.9 months in all patients. Ablation of all lung tumors was the only significantly better prognostic factors in both the univariate analysis and the multivariate analyses. The 1- and 3-year survival rates were 88.9% (95% CI, 69.3%-100%) and 59.2% (95% CI, 10.2%-100%) in 11 patients with complete tumor ablation. Lung RF ablation is a safe and useful therapeutic option for selected patients. (R#1) Prognostic factors identified in our study will help to stratify those patients who may benefit from lung RF ablation.

Massive Hemoptysis from Pulmonary Artery Pseudoaneurysm Caused by Lung Radiofrequency Ablation: Successful Treatment by Coil Embolization

A 75-year-old man received lung radiofrequency (RF) ablation to treat lung metastases from hepatocellular carcinoma. Massive hemoptysis occurred 1 week after lung RF ablation. Emergent contrast-enhanced CT and pulmonary arteriography revealed a pulmonary artery pseudoaneurysm, which was embolized with coils. The postembolization course was uneventful. Hemoptysis did not recur for 5 months.

Percutaneous Computed Tomography–Guided Radiofrequency Ablation of Lung Tumors Complicated With Idiopathic Interstitial Pneumonia

We report 3 patients with lung cancer complicated with interstitial pneumonia who were treated by percutaneous computed tomography-guided radiofrequency ablation. Patient 1 recovered from a pneumothorax without chest drainage. Patient 2 presented with a progressive pneumothorax after discharge from the hospital and required readmission for air drainage. In patient 3, the pneumothorax did not improve by chest drainage and pleurodesis, and the patient died of acute exacerbation of interstitial pneumonia. Radiofrequency ablation of intractable lung cancer with complicating interstitial pneumonia requires careful consideration because a progressive pneumothorax may require surgical intervention or result in acute exacerbation of interstitial pneumonia.

Radiofrequency thermocoagulation of lung tumours. Where we are, where we are headed

Only 25% of all lung cancers are diagnosed in an early stage allowing surgical treatment. Primary tumours usually concerning lung metastasis are breast, colon, kidney, uterus/cervix, prostate, and head and neck tumours. During recent years many publications have confirmed the effectiveness and reliability of lung radiofrequency ablation (RFA) alone or together with other techniques (chemotherapy, radiotherapy...). Results suggest that survival increase and curative rates of lung radiofrequency are similar to those achieved by more aggressive procedures and present lower rates of complications. Pneumothorax, pleural effusion and alveolar haemorrhage are the most frequent complications. Indications for lung RFA must be individually evaluated by lung cancer committees. Percutaneous lung RFA may be useful in patients with pulmonary primary tumours and metastases, especially in those with nodules smaller than 3 cm and a peripheral location (>1 cm from the hilum). PET/CT seems to be the most accurate technique in patient follow up.

Lung RFA: Long-term results in a single-center experience

7528 Background: Radiofrequency ablation (RFA) is an advanced, minimally invasive technique used to treat several types of neoplasm. Its application in the treatment of lung tumors has received considerable interest. Long-term results on patients treated with lung RFA in a single center experience are reported. Methods: From February 2002 to December 2007, 79 patients with unresectable primary and secondary lung neoplasms underwent percutaneous CT-guided RFA. Treatment’s adequacy was assessed by CT scan detecting hypodensity of treated lesion, without contrast-enhancement, and by NMR showing an hypointense area without changes after gadolinium injection. Results: A total of 131 lung neoplasms underwent 93 sessions of RFA. In 2 cases a spiral, 19 Gauge needle, was used, and in 5 cases a bipolar 15 Gauge, cooled-tip needle, whereas in the 124 remaining nodules a monopolar, cooled-tip needle was used. With a median follow-up of 22 months (range 3–63), the rate of complete necrosis was 95%, while pneumothorax requiring pleural drainage occurred in 10.7% of sessions. Conclusions: Percutaneous lung RFA has confirmed to be a safe and feasible procedure to treat lung malignancies. CT scan and MRI with gadolinium have shown to be accurate in the response assessment. The procedure is well tolerated and could be a very attractive option in patients considered unfit for surgery. In addition, this minimally invasive ablative technique could be combined with systemic treatments. These long-term data provide meaningful results with respect to the efficacy of the technique, thus further investigation could define the optimal role of lung RFA in the multidisciplinary therapy of lung malignancies. No significant financial relationships to disclose.

Lung Radiofrequency Ablation: In Vivo Experimental Study with Low-Perfusion-Rate Multitined Electrodes

The purpose of this study was to investigate the feasibility and safety of lung radiofrequency (RF) ablation by using low-perfusion-rate, expandable, multitined electrodes in an in vivo animal model. Ten New Zealand White rabbits underwent RF ablation using low-perfusion-rate, expandable, multitined electrodes (Starburst Talon; RITA Medical Systems, Mountain View, CA) and a 200-W RF generator. The electrode was positioned under fluoroscopy guidance and a single percutaneous RF ablation was performed. Saline perfusate was doped with nonionic iodinated contrast agent to render it visible on computed tomography (CT). The pump infused the saline doped with contrast agent into the lateral tines at a rate of 0.1 ml/min. The planned ablation was of 3 min, with the hooks deployed to 2 cm at a target temperature of 105 degrees C. An immediate posttreatment CT scan documented the distribution of the doped saline and the presence of immediate complications. The animals were monitored for delayed complications and sacrificed within 72 h (n = 4), 2 weeks (n = 3), or 4 weeks (n = 3). Assessment of ablation zone and adjacent structures was done at autopsy. Major complications consisted of pneumothorax requiring drainage (n = 2) and skin burn (n = 1). Immediately after the procedure the area of ablation was depicted at CT as a round, well-demarcated area, homogeneously opacified by iodinated contrast medium (mean size, 2.3 +/- 0.8 cm). The presence of a sharply demarcated area of coagulation necrosis (mean size, 2.1 +/- 0.4 cm) without severe damage to adjacent structures was confirmed at autopsy. In one case, euthanized at 4 weeks, in whom pneumothorax and pleural effusion were depicted, pleural fibrinous adhesions were demonstrated at autopsy. In conclusion, lung RF ablation performed in an in vivo animal model using low-perfusion-rate, expandable, multitined electrodes is feasible and safe. No severe damage to adjacent structures was demonstrated.

Extending Indications for Radiofrequency Ablation of Lung Tumors Through an Intraoperative Approach

Radiofrequency ablation (RFA) is a means of local destruction of lung tumors. The role of this technique in regards to improved survival or quality of life has yet to be well defined. RFA can be performed through an intraoperative or percutaneous route. Percutaneous RFA can be performed without single-lung ventilation under local anesthesia with sedation and is often the preferred route of ablation. We detail instances of RFA in patients who were either not candidates for percutaneous RFA or in whom the tumor was found to be unresectable at operation. Ten patients with either primary or secondary lung tumors who underwent operation with consideration of intraoperative RFA were reviewed. Patients were followed up with chest computed tomography scans at least every 6 months. Preoperative characteristics, intraoperative techniques, complications, and tumor response were noted. The median patient age was 60 years (range, 40 to 85 years). Six patients had lung cancer, 4 had cancer metastatic to the lung, and 5 patients had hilar lesions. Combined lung resection and RFA was done in 4 patients; 6 underwent RFA only. The average size of the ablated lesion was 3.0 cm (range, 1.0 to 5.8 cm). No serious intraoperative or perioperative complications were noted. No immediate or delayed hemorrhage or hemoptysis has been noted. Of patients at least 6 months out from ablation, 4 had no growth of the ablated tumor at an average of 13.5 months (range, 8 to 23 months) after ablation, and 5 have had growth of the tumor first noted at an average of 12.8 months (range, 9 to 14) after ablation. Intraoperative RFA is useful (1) when the lesion is near vital structures such as the great vessels, hilum, or heart, (2) if resectability can only be determined at the time of operation, and (3) when used in patients with secondary tumors of the lung combined with limited resection to preserve lung parenchyma.

Complications after lung radiofrequency ablation: risk factors for lung inflammation

This retrospective study was conducted to review the complications of lung radiofrequency (RF) ablation and to clarify the effects of inflammation after lung RF ablation on mortality and morbidity. Complications were evaluated by reviewing medical records on an RF session basis. The C-reactive protein (CRP) value was used as an indicator of inflammation and was measured before and every 1-2 days during the hospital stay after RF ablation. The relationships between CRP values and patient baselines were evaluated to identify factors affecting lung inflammation. 130 patients who underwent 327 lung RF ablation sessions were enrolled in this study. The major complication rate was 18.3% (60/327). Inflammation-related complications such as interstitial pneumonia (n = 2) and aseptic pleuritis (n = 2) developed in four sessions (1.2%). Death occurred in two patients with interstitial pneumonia (0.6%). The mean CRP value increased significantly from 1.3+/-2.6 mg dl(-1) to 3.4+/-5.6 mg dl(-1) (p<0.01) after RF ablation. Large tumour size (>or=2 cm) and previous external-beam radiotherapy were significant factors associated with an increased CRP value in both univariate and multivariate analyses. In conclusion, although the incidence rate is low, fatal lung inflammation may develop after lung RF ablation. Large tumour size and previous external-beam radiotherapy are risk factors for severe lung inflammation.

MTP8-01: Percutaneous radiofrequency ablation of malignant thoracic tumors

MTP8-01: Percutaneous radiofrequency ablation of malignant thoracic tumors

CT18P RADIOFREQUENCY ABLATION OF LUNG TUMOURS: A SYSTEMATIC REVIEW

Purpose This systematic review aims to assess the safety and efficacy of radiofrequency ablation(RFA) for pulmonary malignancies.Methodology Searches for relevant literature on RFA for lung tumours prior to Nov 2006 were performed in six electronic databases. Application of predetermined inclusion and exclusion criteria, quality assessment and data extraction were independently performed for all retrieved studies. Results were synthesized through tabulation and combined with a narrative review.Results Sixteen relevant studies on lung RFA with more than 10 patients that reported rates of morbidity, mortality, complete tumour ablation, local recurrence or survival were identified for this review. All included studies were level 4 evidence case series with median follow‐up periods ranging from 9–24 months. The overall post‐procedural morbidity rates ranged from 15–76% and mortality rates ranged from 0–5%. The most common complications were pneumothoraces occurring at 9–61 % of procedures. The rates of complete tumour necrosis achieved by RFA ranged from 38–98% while the rates of local recurrence from previously ablated lesions ranged from 2–38%. The overall median progression free interval ranged from 13 to 26 months. The overall median survival from the time of lung RFA, ranged from 8.6–33 months, with 1, 2 and 3 year survival of 71–85%, 55–65% and 38–46%, respectively.Conclusion The available evidence for radiofrequency ablation of primary and metastatic lung tumours is very limited. Surgical resection should remain the standard of care when feasible. Radiofrequency ablation, however, is safe and appears to have a promising role in the treatment of unresectable lung tumours.

Hepatectomy and lung radiofrequency ablation for hepatic and subsequent pulmonary metastases from colorectal carcinoma

Lung radiofrequency ablation (RFA) is a relatively safe procedure and may have a useful role in the management of non-surgical candidates with colorectal pulmonary metastases. This study consisted of 30 patients, who had previously undergone hepatectomy for colorectal liver metastases and subsequently developed pulmonary metastases, which were then treated with lung RFA. Lung RFA was performed percutaneously under local anesthesia and conscious sedation. The primary aim of this article was to demonstrate the survival outcome in this particular patient population after lung RFA. The secondary aim was to assess the prognostic indicators for survival after lung RFA. The median survival after lung RFA was 32 months, with 3-year survival rate of 45%. The following four factors were found to significantly influence survival in univariate analysis: size of the largest pulmonary metastasis (P = 0.032), proximity of metastases to major pulmonary vessels (P = 0.003), pre-lung RFA CEA levels (P = 0.013) and post-lung RFA CEA levels (P = 0.022). Lung RFA may have a useful role in the management of non-surgical candidates with colorectal pulmonary metastases.