Percutaneous radiofrequency ablation of primary NSCLC

Reviewer: James M. Metz, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: July 11, 2005

Presenter: M. Ambrogi
Presenter's Affiliation: Cardiac and Thoracic Department, Pisa, Italy
Type of Session: Plenary

Background

Radiofrequency ablation (RFA) causes local destruction of tumors after insertion of electrodes attached to an RF generator into the mass under CT guidance. RFA works through localized tissue heating causing necrosis of the tumor. This technique has been used extensively for the treatment of primary and secondary liver tumors. This study reports the experience of a single institution on the early use of RFA in the treatment of primary NSCLC.

Materials and Methods

23 patients with primary NSCLC received treatment with RFA over the past 4 years. This included 35 RFA’s of 25 lesions.
20 males and 3 females with a mean age of 74.5 years
Clinical staging included 16 pts with stage I, 2 stage II, and 5 stage IV NSCLC
Selection criteria included the following: not a surgical candidate, lesions smaller then 3.5 cm, at least 1 cm from great vessels or bronchi
All patients were treated under local anesthesia and conscious sedation with percutaneous CT guidance of the RFA
A 14 guage needle with 9 electrodes are attached to a 200 W RF generator
Target temperature is 90 degrees C to a 1 cm margin around the target and maintained for 15-27 min depending on the size of the tumor
Follow up included CT scans at 1, 3, and every 6 months

Results

Toxicity consisted of 4 cases of partial pnuemothorax (17%) and no mortalities
7 patients with a local recurrence or an additional lesion were retreated (range 1-5 retreatments)
Median overall survival is 28.5 months
Progression free survival is 14 months

Author's Conclusions

RFA of lung tumors seems feasible and safe
RFA may be an alternative local therapy when surgery is not an option
The determination of efficacy and indications requires a greater number of patients and longer follow-up

Clinical/Scientific Implications

This is an interesting preliminary study of RFA for the treatment of NSCLC. The study has relatively short follow-up and a small and selected patient population. Responses were seen and this appears safe in this small series. It is not clear if PET was used in this study to assess response. Significant care must be used in excluding conventional options such as surgery, radiation therapy, and chemotherapy before considering this experimental technique. It is currently unclear how this treatment will complement conventional treatments in the future. Further study of this technique in clinical trials is warranted.