Secondary Lung Research Articles

Effect of shenfu injection on TNF、IL-6、IL-8 in patients with pulmonary contusion

Objective To Observe the levels of TNF,IL-6,IL-8 in patients with pulmonary contusion before and after treatment,explore its effect on the treatment of pulmonary contusion.Methods 110 pulmonary contusion patients were selected from wendeng central hospital thoracic surtcal ward,110 patients were randomly divided into treatment group and control group.The control group received routine treatment.tIle treatment group on the basis of conventional therapy was added Shenfu injection.The levels of TNF,IL-6,IL-8 from patients were tested.Results The two groups gcore showed no significant difference before treatment(P>0.05).Plasma TNF,IL-6,IL-8 levels in the treatnent group significantly reduced compared with control group after treatment(P<0.051.Conclusion Shenfu injection has therapeutic effect on pulmonary contusion,itcan reduce TNF,IL-6,IL-8 levels,antagonize TNF,IL-6,IL-8 of the vasoconstrictive effect,thereby reducing TNF,IL-6,IL-8 caused secondary lung injury,promote the repair of damaged tissue and lung function recovery. Key words: Pulmonary contusion; Shenfu injection; Tumor necrosis factor; Interleukin

Microwave ablation therapy for treating primary and secondary lung tumours: technical note

The purpose of our study was to retrospectively evaluate the feasibility, safety and effectiveness of microwave ablation (MWA) in nine patients with unresectable lung tumour. Ten lesions were treated in ten ablation sessions in nine patients. The treatments were performed with a microwave generator with 45 W and 915 MHz connected to a 14.5-gauge antenna for 10 min. Antenna placement was performed with computed tomography (CT) fluoroscopy guidance or XperGuide. All patients underwent CT follow-up at 1, 3 and 6 months from the procedure. Technical success was obtained in all cases; mortality at 30 days was 0%. This study shows that in selected patients, MWA is a valid alternative to other ablative techniques. Further studies are required to demonstrate the short- and long-term effects of this technique and to make a comparison with other available ablation systems, especially with radiofrequency.

NK cell lymphoma, nasal type, with massive lung involvement: a case report

Extranodal NK/T cell lymphoma, nasal type, is an Epstein-Barr virus-associated lymphoma that most commonly involves the nasal cavity and upper respiratory tract. Lung involvement by NK/T cell lymphoma is rare and seldom reported in the literature. We describe the unusual case of a 41-year-old male with NK cell lymphoma, nasal type, who presented with massive secondary lung involvement 2.5years after the detection of a retroperitoneal mass. The diagnosis was made by open lung biopsy. Despite aggressive treatment, the patient died shortly after the initiation of therapy. Lung involvement by NK/T cell lymphoma occurs most commonly as part of widely disseminated disease and carries a poor prognosis for the patient. Novel agents and innovative therapies need to be developed for this aggressive lymphoma.

The role of mucosal antiviral immunity in bacterial secondary lung infections

The role of mucosal antiviral immunity in bacterial secondary lung infections

Reconstruction of 3D lung models from 2D planning data sets for Hodgkin's lymphoma patients using combined deformable image registration and navigator channels

Late complications (cardiac toxicities, secondary lung, and breast cancer) remain a significant concern in the radiation treatment of Hodgkin's lymphoma (HL). To address this issue, predictive dose-risk models could potentially be used to estimate radiotherapy-related late toxicities. This study investigates the use of deformable image registration (DIR) and navigator channels (NCs) to reconstruct 3D lung models from 2D radiographic planning images, in order to retrospectively calculate the treatment dose exposure to HL patients treated with 2D planning, which are now experiencing late effects. Three-dimensional planning CT images of 52 current HL patients were acquired. 12 image sets were used to construct a male and a female population lung model. 23 "Reference" images were used to generate lung deformation adaptation templates, constructed by deforming the population model into each patient-specific lung geometry using a biomechanical-based DIR algorithm, MORFEUS. 17 "Test" patients were used to test the accuracy of the reconstruction technique by adapting existing templates using 2D digitally reconstructed radiographs. The adaptation process included three steps. First, a Reference patient was matched to a Test patient by thorax measurements. Second, four NCs (small regions of interest) were placed on the lung boundary to calculate 1D differences in lung edges. Third, the Reference lung model was adapted to the Test patient's lung using the 1D edge differences. The Reference-adapted Test model was then compared to the 3D lung contours of the actual Test patient by computing their percentage volume overlap (POL) and Dice coefficient. The average percentage overlapping volumes and Dice coefficient expressed as a percentage between the adapted and actual Test models were found to be 89.2 +/- 3.9% (Right lung = 88.8%; Left lung = 89.6%) and 89.3 +/- 2.7% (Right = 88.5%; Left = 90.2%), respectively. Paired T-tests demonstrated that the volumetric reconstruction method made a statistically significant improvement to the population lung model shape (p < 0.05). The error in the results were also comparable to the volume overlap difference observed between inhale and exhale lung volumes during free-breathing respiratory motion (POL: p = 0.43; Dice: p = 0.20), which implies that the accuracies of the reconstruction method are within breathing constraints and would not be the confining factor in estimating normal tissue dose exposure. The result findings show that the DIR-NC technique can achieve a high degree of reconstruction accuracy, and could be useful in approximating 3D dosimetric representations of historical 2D treatment. In turn, this could provide a better understanding of the biophysical relationship between dose-volume exposure and late term radiotherapy effects.

Current indications and results for thoracoplasty and intrathoracic muscle transposition

Thoracoplasty has lost much of its popularity and is being supplanted by space-reduction operations using muscle flaps. Our purpose is to retrospectively study the remaining indications and the evolving modifications of this ancient technique in our current surgical practice. From 1994 to 2008, 35 patients underwent a thoracoplasty procedure in a single thoracic surgery centre for treatment of infectious complications of previous thoracic surgery. The number and length of ribs excised were dictated by the size and location of the thoracic cavity to obliterate. Muscle flaps were used to buttress bronchial fistulas and to fill out residual spaces. We reviewed the immediate and long-term results concerning infection control and procedure tolerance. The infectious complications of previous thoracic surgery were related to cancer in 25, tuberculosis in six, oesophageo-pleural fistula in two, ruptured lung abscess and pleural thickening in one each. The thoracoplasty procedure was performed for: (1) post-pneumonectomy empyema, n=20 (bronchial fistula, n=11; open window thoracostomy, n=14; mean number of resected ribs, n=7.5; associated intrathoracic muscle transposition, n=12; postoperative death, n=3); (2) post-lobectomy empyema, n=8 (bronchial fistula n=8; open window thoracostomy n=1; mean number of resected ribs n=3.6; associated intrathoracic muscle transposition n=7; no death); (3) other indications, n=7 (mean number of resected ribs n=4.8; associated intrathoracic muscle transposition n=3; no death). All patients discharged from the hospital except one were cured and did not complain of symptoms of secondary lung function and shoulder impairment. Although thoracoplasty is rarely indicated nowadays, this does not imply that the procedure should be avoided. Thoracoplasty may be associated with myoplasty, which permits achieving complete space obliteration by combining resection of a few rib segments and limited intrathoracic muscle transposition.

Mechanisms underlying acquired resistance to tyrosine kinase inhibitors in lung cancer

Aims: The response to tyrosine kinase inhibitors in lung cancer patients is variable and some responding patients eventually acquire resistance to the drugs later on. The mechanism to this phenomenon has been related to mutations in the epidermal growth factor receptor. Our study aims at establishing other factors apart from T790M mutation which lead to acquired resistance to tyrosine kinase inhibitors Erlotinib and Gefitinib, through the analysis of apoptosis regulators. We hereby report the expression variation of the Bcl2 family after exposure to drugs. Methods: Secondary lung tumor cell lines (H1299, A549 and HCC827) were used in this study. The first step involved the establishment of IC50 of each test substance through chemosensitivity testing. Viability was assessed after exposure of the cells to the drugs using MTT test. Caspace 3/7 activity was tested to evaluate apoptosis induction. Cell cycle analysis was done after propidium iodide staining. To establish the expression variation of the Bcl2 family, quantitative PCR will be carried out. Results: Chemosensitivity curves showed a concentration depended growth inhibition, with a negative correlation. HCC 827 (IC50&lt;5µM) cell line is more sensitive to Erlotinib and Gefitinib as compared to H1299 and A549 (IC50&gt;5µM) for both Erlotinib and Gefitinib. Erlotinib and Gefitinib increased the activity of caspace 3 and 7 in HCC 827 but not in A549 and H1299, there was a significant difference between the caspace activity of HCC827 when compared to the control (p=0.029), A549 (p=0.020) and H1299 (p=0.026). No significance difference in caspace actitiviy was observed between A549 and H1299 (p=0.401). Cell cycle analysis revealed subG0/G1 arrest majority of the cells however were found in the M phase. Conclusion: The sensitivity of HCC827 is due to EGFR mutation in the exon 19. A549 and H1299 are relatively resistant because they carry a wild type EGFR. HCC827 can therefore be used to induce secondary resistance so as to evaluate the changes that occur. Apart from the T790M mutation, other factors which lead to secondary resistance to TKI are likely to be established by analysis of the BCl2 family.

Thermo-ablation de cancer bronchique primitif inopérable : étude monocentrique

Radiofrequency ablation is a new interventional radiological technique for the treatment of primary or secondary lung tumors of small size (less than 3 cm) in inoperable patients or patients unsuitable for external radiotherapy. This procedure is already used in liver and renal cancers and metastases, and is now being evaluated in primary and secondary lung tumors. We have followed-up, by CT scanning, 12 consecutive patients with primary lung tumors treated by radiofrequency ablation in our institution between 2004 and 2008. Our study shows that radiofrequency ablation is well-tolerated with few minor side effects (75% pneumothorax) and no major side effects. Moreover, it gives good local control (8.3% local progression). Radiofrequency appears to be a valuable alternative to surgery for inoperable patients presenting with a small primary lung tumor.

Stereotactic Body Radiation Therapy Results in Promising Local Control in Patients with Recurrent or Secondary Lung Parenchyma Cancer after Definitive Conventional Thoracic Radiotherapy

Stereotactic Body Radiation Therapy Results in Promising Local Control in Patients with Recurrent or Secondary Lung Parenchyma Cancer after Definitive Conventional Thoracic Radiotherapy

Pneumococcal Surface Protein A Contributes to SecondaryStreptococcus pneumoniaeInfection after Influenza Virus Infection

We compared the growth of Streptococcus pneumoniae mutants with a disruption in the gene for either pneumococcal surface protein A (PspA-), neuraminidase A (NanA-), or hyaluronidase (Hyl-) to that of the parental strain D39 by means of a competitive growth model in mice with and those without prior influenza virus infection. The numbers of total bacteria recovered from mice with prior influenza virus infection were significantly greater than those recovered from mice without prior influenza virus infection. Although the Hyl- and NanA- mutants did not display attenuation in mice with or without prior influenza virus infection, the PspA- mutant exhibited attenuation both in mice with and in mice without prior influenza virus infection. This defect was severe in influenza virus-infected mice, for which growth of the PspA- mutant was 1800-fold lower than that of the parental strain D39. Furthermore, PspA immunization significantly reduced secondary bacterial lung burdens and concentrations of specific markers of lung damage in mice receiving serotypes 2, 3, and 4 pneumococci. Our findings indicate that PspA contributes to secondary S. pneumoniae infection after influenza virus infection and that PspA immunization mitigates early secondary pneumococcal lung infections.

A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia

Poor oral hygiene is associated with respiratory pathogen colonization and secondary lung infection. The impact of adding electric toothbrushing to oral care in order to reduce ventilator-associated pneumonia (VAP) incidence is unknown. The study design was a prospective, simple-blind, randomized trial of adult patients intubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomized to oral care every 8 h with 0.12% chlorhexidine digluconate (standard group) or standard oral care plus electric toothbrushing (toothbrush group). VAP was documented by quantitative respiratory cultures. Mechanical ventilation (MV) duration, hospital ICU length of stay (LOS), antibiotic use, and hospital ICU mortality were secondary end points. The study was terminated after randomizing 147 patients (74 toothbrush group) in a scheduled interim analysis. The two groups were comparable at baseline. The toothbrush group and standard group had similar rates of suspected VAP (20.3% vs 24.7%; p = 0.55). After adjustment for severity of illness and admission diagnosis, the incidence of microbiologically documented VAP was also similar in the two groups (hazard ratio, 0.84; 95% confidence interval, 0.41 to 1.73). The groups did not differ significantly in mortality, antibiotic-free days, duration of MV, or hospital ICU LOS. Our findings suggest that the addition of electric toothbrushing to standard oral care with 0.12% chlorhexidine digluconate is not effective for the prevention of VAP. ClinicalTrials.gov Identifier: NCT00842478.

The possible roles of solar ultraviolet-B radiation and vitamin D in reducing case-fatality rates from the 1918–1919 influenza pandemic in the United States

Deaths during the 1918-1919 influenza pandemic have been linked to both the influenza virus and secondary bacterial lung infections. Case fatality rates and percentage of influenza cases complicated by pneumonia were available from survey data for twelve United States locations in the 1918-1919 pandemic. This study analyzes case fatality rates and cases complicated by pneumonia with respect to estimated summertime and wintertime solar ultraviolet-B (UVB) doses as indicators of population mean vitamin D status. Substantial correlations were found for associations of July UVB dose with case fatality rates (r = -0.72, p = 0.009) and rates of pneumonia as a complication of influenza (r = -0.77, p = 0.005). Similar results were found for wintertime UVB. Vitamin D upregulates production of human cathelicidin, LL-37, which has both antimicrobial and antiendotoxin activities. Vitamin D also reduces the production of proinflammatory cytokines, which could also explain some of the benefit of vitamin D since H1N1 infection gives rise to a cytokine storm. The potential role of vitamin D status in reducing secondary bacterial infections and loss of life in pandemic influence requires further evaluation.

Radiofrequency thermal ablation in the treatment of malignant tumors

Radiofrequency ablation (RFA) provides an effective technique for minimally invasive tissue destruction. An alternating current delivered via a needle electrode causes localized ionic agitation and frictional heating of the tissue around the needle. Image-guided, percutaneous ablation techniques have been developed in most parts of the body, but the most widely accepted applications are for the treatment of hepatocellular carcinoma (HCC) in early cirrhosis, inoperable colorectal liver metastases, inoperable renal cell carcinoma and inoperable primary or secondary lung tumors. The procedures are well tolerated and the complication rates low. Most treatments in the lung, kidney and for HCC are performed under conscious sedation with an overnight hospital stay or as a day-case. Limitations of RFA include the volume of tissue that can be ablated and most centers will treat 3–5 tumors up to 4–5 cm in diameter. Early series reporting technical success and complications are available for lung and renal ablation. Liver ablation is better established and 5-year survival figures are available from several centers. In patients with limited but inoperable colorectal metastases, the 5-year survival ranges from 26 to 30% and for HCC it is just under 50%. In summary, RFA provides the opportunity for localized tissue destruction of limited volumes of tumor; it can be offered to nonsurgical candidates and used in conjunction with systemic therapy.

Tumour characteristics and therapeutic results after percutaneous radiofrequency ablation of secondary lung neoplasms

The objective was to assess the efficacy of percutaneous radiofrequency ablation (RFA) in the treatment of secondary lung tumours and evaluation of the treatment's results by contrast-enhanced CT scan. Fifteen secondary lung neoplasms in 10 patients (mean age 64.3 years) had pulmonary radiofrequency and imaging follow-up. All the patients had absolute contraindications to the surgery. The procedure was performed under computed tomography (CT) guidance with anaesthesiologic assistance. The results were evaluated by post-procedural contrast-enhanced CT scan and CT scans 1, 3, 6, 9 and 12 months after the treatment. The median follow-up period was 26 months. A complete ablation according to the absence of enhancement after the procedure was obtained in all cases; pleural effusion was seen in 2 patients. The main adverse event was a pneumothorax, which occurred in 4 cases. A chest tube was required in two cases. A recurrence at the site of the treatment for one lesion was observed during a 12-month follow- up period. Three patients experienced systemic disease progression. In one of these 3 patients, this progression was associated with recurrence at the site of the treatment. RFA seems to be possible for "non-surgical" patients with various histologic types of secondary lung tumours. Good results in terms of local tumour control validated by contrast-enhanced CT scan were observed during short-term follow-up evaluation.

Cryosurgery Combined with Radioactive Seeds and Release-controlled Chemical Drugs Implantation for the Treatment of Lung Carcinoma.

It is very difficult for cryosurgery to ablate all tumors because of its large volume and irregular shape. It is a complementary method for chemo-radioactive concurrent therapy to treat tumor remains. The aim of this study is to evaluate the application, security and effectiveness of Argon-Helium cryosurgery combined with radioactive seeds/release-controlled drugs implantation for percutaneous treatment of pulmonary neoplasma by CT guidance. Lung cryosurgery and radioactive seeds and release-controlled drugs implantation were sequentially performed in 20 cases with 16 primary lung cancer and 4 secondary lung cancer. Side effects were observed during cryosurgery and seeds implantation. (3.4+/-0.2) cryoprobes were inserted into a nodule which is average (5.8+/-0.5) cm in diameter in 20 cases with 21 tumors. 85.6%+/-2.4% of tumor size had been ablated for each procedure. Haemoptysis occurred in 80% patients after cryosurgery, and disappeared in a week. Pneumothroax happened in 15% patients and recovered in a short time without special treatment. Absorption fever occurred in 20% patients and returned to normal in a week. (23.4+/-1.4) radioactive seeds and (8.3+/-1.2) drug-released drugs were percutaneously inserted into the 21 remaining tumors in a week after cryosurgery and 4 tumors (<2 cm in diameter) without cryosurgery. There were no severe side effects directly related to the procedures except 3 had slight nausea. The medium survive time was 16 months and average survive time was (14.0+/-2.6) months. More than 60% of patients survived more than 1 year. Cryosurgery is a rapid modality for the debulking of pulmoanry tumor and concurrent therapy of radioactive seeds and release-controlled drugs implantation could effectively treat the remaining tumor. It is a rapid and effective method for the treatment of advanced stage lung cancer.

Evaluating cancer patient satisfaction before and after daily multidisciplinary care for thoracic surgery inpatients

9605 Background: Significant subpopulations of cancer inpatients in the SUPPORT trial were dissatisfied with their pain control. (Desbiens, Wu et al. 1996) The hospitalized thoracic surgical patient is a person at risk for uncontrolled symptoms and burdens due to advanced cancer at time of presentation. Methods: This is a retrospective, observational, study of 1188 thoracic surgery patients undergoing elective surgical procedures for lung cancer at an NCI-approved cancer hospital over a 3-year period. Patients with primary and secondary lung cancer, undergoing elective thoracic surgery procedures were evaluated before (n=660, “Period 1”) and after (n=528, “Period 2”) an 8-month, daily, collaborative multidisciplinary Intervention Period to improve pain control and to facilitate transition for discharge. The collaborative process also identified thoracic surgical patients who needed more complex symptom management and additional support for advanced disease. Patient satisfaction with pain therapy and referrals to hospice were analyzed before and after the intervention period. Results: Pain satisfaction scores improved from baseline in each sequential period (Period 1 = 9.0 SD 1.71, Intervention Period = 9.4 SD 1.37, and Period 2 = 9.5 SD 1.03, p&lt;0.0001). The percentage of patients referred to hospice increased from 0.15% to 1.7% (p&lt;0.0001). Conclusions: Innovative collaboration between thoracic surgery specialists and a palliative medicine service improved patients’ satisfaction with pain control. The collaborative relationship resulted in an increase in referrals to hospice for patients with advanced cancer. These improvements were sustained by the thoracic surgery service after a daily collaborative intervention period ceased. No significant financial relationships to disclose.

Testicular non-seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Testicular non-seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Evaluation of outcomes in patients with head and neck squamous cell carcinoma diagnosed with a secondary primary lung cancer: a retrospective study

Background and Objectives: Secondary primary lung cancer (SPLC) is one of the leading causes of mortality in head and neck patients. We retrospectively studied clinical-pathological data and outcome of our patients who developed SPLC.

Intraoperative Radiofrequency Ablation of Lung Metastases and Histologic Evaluation

Radiofrequency ablation (RFA) has received high interest in the treatment of primary and secondary lung neoplasms. Clinical experience continues to accumulate; however, the biologic effects after ablation remain poorly understood. This study evaluated the safety and feasibility of RFA in an open thoracotomy setting and investigated the early histopathologic changes after RFA. The study enrolled 18 subjects with multiple pulmonary metastases from a solid primary tumor. RFA was performed at an open thoracotomy setting, followed by wedge resection of the ablated tumor. No intraoperative complications during the RFA procedure occurred. Immunostaining revealed a complete ablation in 7 patients (39%). The grade of ablation was greater than 90% in 9 patients (50%), and less than 90% in 2 (11%). No correlation was found between the grade of ablation and the applied energy and the diameter of the lesion. Intraoperative RFA in an open thoracotomy setting appears to be a safe and feasible technique. Tumor devitalization sufficient for local control was achieved in 89% in our series. Ablation was incomplete in 11%, subject to the methods used in this study. This result appears to be inferior to metastasectomy by surgical resection.

Invited Commentary

Radiofrequency ablation (RFA) for the treatment of either primary or metastatic lung cancer has been used as an alternative, particularly for patients who have limited pulmonary reserve or who are otherwise considered to be “medically inoperable.” Although this emerging technology is the focus of an ongoing cooperative group pilot trial (American College of Surgeons Oncology Group Z4033) for patients with early stage nonsmall cell lung carcinoma, few studies have validated this technique biologically. Schneider and colleagues [1Schneider T. Warth A. Herpel E. et al.Intraoperative radiofrequency ablation of lung metastases and histologic evaluation.Ann Thorac Surg. 2009; 87: 379-384Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar] present their study of intraoperative RFA with an “ablate and resect” approach for the treatment of pulmonary metastases. The purpose of their study was to evaluate the histologic changes in metastatic tumors after intraoperative RFA, with attention to assessing cellular viability at the ablation zone margins. Cellular viability at the tumor margins was determined by two methods: (1) determination of mitochondrial staining by mitochondrial-specific antibody and (2) assessment of nicotinamide adenine dinucleotide (NAD+) reduction by vital staining. Of 24 patients enrolled in the study, 6 were excluded, including 2 patients in whom the ablation probe placement was not within the center of the targeted lesion. With tumors ranging in size from 7 mm to 25 mm among the patients consenting to this study, only 39% (7 patients) were found to have complete tumor ablation with neither detection of mitochondrial staining nor NAD+-reducing activity noted. Near complete ablation (>90%) occurred in an additional 50% (9 patients) of centrally-treated tumors, with incomplete ablation occurring in 2 of the 18 patients studied. Had the 2 patients who were excluded because of tangential probe placement been included in histologic analysis, then incomplete ablation would have occurred in 4 of 20 patients. However, this study was not a trial of RFA efficacy, but rather a study of histopathologic correlation. The authors' approach of determining cell viability by mitochondrial staining and NAD+ activity provides potentially more accurate assessment of tumor viability than standard histologic techniques. Furthermore, because tumors were resected immediately after ablation, continued cell death still might have occurred in situ, as discussed by the authors. Other measures discussed by Schneider and colleagues [1Schneider T. Warth A. Herpel E. et al.Intraoperative radiofrequency ablation of lung metastases and histologic evaluation.Ann Thorac Surg. 2009; 87: 379-384Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar], particularly terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) staining, have been evaluated. Most recently, for example, Clasen and colleagues [2Clasen S. Krober S.M. Kosan B. et al.Pathomorphologic evaluation of pulmonary radiofrequency ablation.Cancer. 2008; 113: 3121-3129Crossref PubMed Scopus (42) Google Scholar] evaluated percutaneous RFA followed by scheduled resection 3 days post-ablation. Of 11 tumors treated in 9 patients, 10 had evidence of tumor necrosis by TUNEL staining and electron microscopy, even though hematoxylin and eosin staining indicated preserved tissue architecture. In addition, there was only minimal to no margin of tissue damage around 2 ablated tumors. Both of these reports demonstrate that validation of nonsurgical ablative technology should include not only standard histologic studies but also evaluation of cellular viability and/or pathomorphology. Ultimately the efficacy of RFA will depend on long-term oncologic outcomes. The authors adopt an appropriate cautionary tone regarding RFA for pulmonary metastasectomy. Their findings demonstrate that ablative techniques, such as RFA, even when properly targeted, still can result in incomplete ablation. Therefore, such an approach should be reserved only for patients considered “medically inoperable.” Surgical metastasectomy, when oncologically and medically feasible, remains the preferred approach. Intraoperative Radiofrequency Ablation of Lung Metastases and Histologic EvaluationThe Annals of Thoracic SurgeryVol. 87Issue 2PreviewRadiofrequency ablation (RFA) has received high interest in the treatment of primary and secondary lung neoplasms. Clinical experience continues to accumulate; however, the biologic effects after ablation remain poorly understood. This study evaluated the safety and feasibility of RFA in an open thoracotomy setting and investigated the early histopathologic changes after RFA. Full-Text PDF