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J Thorac Cardiovasc Surg 2009;137:160-166
© 2009 The American Association for Thoracic Surgery

Evolving Technology

Radiofrequency ablation for treatment of medically inoperable stage I non–small cell lung cancer

^a Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
^b Division of Thoracic Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass

Received for publication May 2, 2008; revisions received August 17, 2008; accepted for publication August 21, 2008.

^_* Address for reprints: Michael Lanuti, MD, Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit St, Blake 1570, Boston, MA 02114. (Email: Mlanuti{at}partners.org).

Objective: This study evaluated long-term results of radiofrequency ablation for medically inoperable early–stage lung cancer.

Methods: Thirty-one consecutive patients with biopsy-proven non–small cell lung cancer underwent 38 treatments of computed tomographically guided radiofrequency ablation in a 4.5-year period. All patients were carefully selected and deemed medically ineligible for resection by a multidisciplinary team. Radiofrequency ablation was performed with curative intent with a single or cluster cool-tip electrode. Patients were hospitalized for 23-hour observation.

Results: Treatment was complete in all cases, with no 30-day mortality. Local recurrence was confirmed radiographically by computed tomography, positron emission tomography, or both after 31.5% of treatments (12/38). Two patients were successfully retreated for technical failures related to pneumothorax; 3 underwent radiotherapy with stable disease. Mean maximal diameter of 38 tumors treated was 2.0 ± 1.0 cm (range 0.8–4.4 cm). After median follow-up of 17 ± 11 months, 74% of patients (23/31) were alive. Three patients died of metastatic disease; 5 died of pneumonia remote from treatment. The 2- and 4-year survivals were 78% and 47%, respectively. Median overall survival was 30 months. Pneumothorax (13%), pneumonia (16%), and pleural effusion (21%), were the most common complications.

Conclusions: Radiofrequency ablation of medically inoperable early–stage lung cancer in carefully selected patients yields encouraging midterm results without significant loss of pulmonary function. Local tumor progression appears related to lung tumors larger than 3 cm. Computed tomography and positron emission tomography need further validation for the early identification of local tumor progression following radiofrequency ablation.