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J Thorac Cardiovasc Surg 2007;134:857-864
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Radiofrequency ablation for the treatment of stage I non–small cell lung cancer in high-risk patients

^a Heart, Lung, and Esophageal Surgery Institute, Pittsburgh, Pa
^b University of Pittsburgh Medical Center, and the University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, Pa
^c Boston Medical Center, Boston, Mass.

Read at the Thirty-second Annual Meeting of the Western Thoracic Surgical Association, Sun Valley, Idaho, June 21-24, 2006.

Received for publication June 27, 2006; revisions received April 1, 2007; accepted for publication April 11, 2007.

^_* Address for reprints: James D. Luketich, MD, Sampson Family Endowed Professor of Surgery, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, 200 Lothrop St, C-800, Pittsburgh PA 15213. (Email: luketichjd{at}upmc.edu).

Objective: Surgical resection is the standard of care for stage I non–small cell lung cancer. The objective of this study was to evaluate computed tomography–guided radiofrequency ablation as an alternative treatment option for high-risk patients with stage I non–small lung cancer.

Methods: Patients with medically inoperable stage I non–small lung cancer were offered radiofrequency ablation. Thoracic surgeons evaluated and performed radiofrequency ablation under computed tomographic scanning guidance. Response was assessed by means of computed tomographic and positron emission tomographic scanning. Time to progression and survival were monitored every 3 months.

Results: Nineteen patients underwent radiofrequency ablation over a 3-year period. There were 8 men and 11 women with a median age of 78 years (range, 68-88 years). Radiofrequency ablation resulted in pneumothorax requiring a pigtail catheter in 12 (63%) patients. An initial complete response was observed in 2 (10.5%) patients, a partial response in 10 (53%) patients, and stable disease in 5 (26%) patients. Early progression occurred in 2 (10.5%) patients. During follow-up, local progression occurred in 8 (42%) nodules, and the median time to progression was 27 months. There were no procedure-related mortalities, and 6 deaths occurred during follow-up. The mean follow-up in the remaining patients was 29 months (range, 9-52 months). The probability of survival at 1 year was estimated to be 95% (95% confidence interval, 0.85-1.0). The median survival was not reached.

Conclusion: Our experience indicates that radiofrequency ablation is safe in high-risk patients with stage I non–small lung cancer, with reasonable results in patients who are not fit for surgical intervention.

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