Radiofrequency Ablation of Pulmonary Malignancies

Steven C. Rose

doi:10.1055/s-2008-1081280

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2008; 29(4): 361-383
DOI: 10.1055/s-2008-1081280

Radiofrequency Ablation of Pulmonary Malignancies

Steven C. Rose¹

¹Department of Radiology, University of California San Diego Medical Center, San Diego, California

Abstract

ABSTRACT

Several surgical, medical, irradiative, and image-guided focal ablative therapies are available for patients with primary non-small-cell lung cancer (NSCLC) or pulmonary metastases. The most appropriate therapy depends on cell type; the size, location, and number of tumors; the degree of local tumor spread and regional and distant metastases; the cardiopulmonary and functional status of the patient; symptoms; and therapeutic goals and desires of the patients and their caregivers. When potential cure or survival benefit is the goal, the most appropriate patients for radiofrequency (RF) ablation are those with stage I NSCLC or a few peripheral metastases limited to the lungs that are preferably less than 3 cm diameter, and who are not candidates for surgical resection. Because many of these patients will demonstrate local residual viable tumor or develop metastases or new primary tumors elsewhere, lifelong imaging surveillance with potential reintervention is warranted. When relief of tumor-related symptoms is the therapeutic goal, RF ablation may be applied to larger more advanced tumors with a reasonable expectation of improvement in a significant proportion of this population.

In addition to judicious case selection, precise device placement with careful attention to RF ablation technique is essential to achieve optimized outcome with respect to complete tumor necrosis and avoidance of injury to critical nontargeted structures. Awareness of potential complications, use of techniques to minimize the probability of complications, and early recognition with aggressive management of complications are paramount to maintaining a satisfactory safety profile for RF ablation.

KEYWORDS

Lung cancer - radiofrequency ablation - image-guided therapy - metastases - lung

Full Text

References

REFERENCES

1 Jemal A, Taylor M, Ward E et al.. Cancer statistics 2005. CA Cancer J Clin. 2005; 55 10-30
2 Boring C C, Squires T S, Tong T, Montgomery S. Cancer statistics, 1994. CA Cancer J Clin. 1994; 44 7-26
3 American Cancer Society .Cancer Facts and Figures 2005. Atlanta, GA; American Cancer Society 2005
4 Mountain C F. A new international staging system for lung cancer. Chest. 1986; 89(Suppl) 225S-233S
5 Mountain C F. Revisions in the International System for Staging Lung Cancer. Chest. 1997; 111 1710-1717
6 Non-Small Cell Lung Cancer (PDQ^®): Treatment. Washington, DC; National Cancer Institute, U.S. National Institutes of Health http://[www.cancer.gov/cancertopics/PDQ/treatments/non-smallcelllung/patients]
7 Lung. In: American Joint Committee on Cancer. AJCC Cancer Staging Manual. 6th ed. New York; Springer 2002: 167-181
8 Rose S C, Thistlethwaite P A, Sewell P E, Vance R B. Lung cancer and radiofrequency ablation. J Vasc Interv Radiol. 2006; 17 927-951
9 Figlin R A, Holmes E C, Turrisi III A T. Neoplasms of the lung, pleura, and mediastinum. In: Haskell CM Cancer Treatment. 4th ed. Philadelphia; WB Saunders 1995: 385-413
10 Spira A, Ettinger D S. Multidisciplinary management of lung cancer. N Engl J Med. 2004; 350 379-392
11 Burt M, Martini N, Ginsberg R J. Surgical treatment of lung carcinoma. In: Baue AE Glenn's Thoracic and Cardiovascular Surgery. 6th ed. Stamford, CT; Appleton & Lange 1996: 421-443
12 Ginsberg R J, Port J L. Surgical therapy of stage I and non-T3 NO stage II non-small cell lung cancer. In: Pass HI, Mitchell JB, Johnson DH, Turrisi AT, Minna JD Lung Cancer: Principles and Practice. 2nd ed. Philadelphia; Lippincott Williams & Wilkins 2000: 682-693
13 Ihde D C, Pass H I, Glatstein E. Small cell lung cancer. In: DeVita VT Jr, Hellman S, Rosenberg SA Cancer Principles and Practice of Oncology. 5th ed. Philadelphia; Lippincott-Raven 1997: 911-949
14 Deslauriers J. Current surgical treatment of nonsmall cell lung cancer 2001. Eur Respir J Suppl. 2002; 35 61s-70s
15 Ginsberg R J, Rubinstein L V. Randomized trial of lobectomy versus limited resection for T1 NO non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995; 60 615-623
16 Boysen P G, Block A J, Moulder P V. Relationship between preoperative pulmonary function tests and complications after thoracotomy. Surg Gynecol Obstet. 1981; 152 813-815
17 Winton T, Livingston R, Johnson D for the National Cancer Institute of Canada Clinical Trials Group and the National Cancer Institute of the United States Intergroup JBR et al.. 10 Trial Investigators. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005; 352 2589-2597
18 Johnson D H, Fehrenbacher L, Novotny W F et al.. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 2004; 22 2184-2191
19 Sandler A, Gray R, Perry M C et al.. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006; 355 2542-2550
20 Hurwitz H, Fehrenbacher L, Novotny W et al.. Bevacizumab plus irinotecan, fluorouracil, and leukovorin for metastatic colorectal cancer. N Engl J Med. 2004; 350 2335-2342
21 Shepherd F A, Pereira J R, Cinleanu T et al.. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005; 353 123-132
22 Willis R A. Secondary tumours of the lungs. In: The Spread of Tumours in the Human Body. London; Butterworth 1973: 167-174
23 Morgan-Parkes J H. Metastases: mechanisms, pathways, and cascades. AJR Am J Roentgenol. 1995; 164 1075-1082
24 Pastorino U, Buyse M, Friedel G The International Registry of Lung Metastases, Writing Committee et al.. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg. 1997; 113 37-49
25 Saito Y, Omiya H, Kohno K et al.. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg. 2002; 124 1007-1013
26 Pass H I, Donington J S. Metastatic cancer to the lung. In: DeVita VT Jr, Hellman S, Rosenberg SA Cancer. Principles and Practice of Oncology. Philadelphia; Lippincott-Raven 1997: 2536-2551
27 Chen P W, Pass H I. Indications for resection of pulmonary metastases. In: Baue AE. Glenn's Thoracic and Cardiovascular Surgery. 6th ed. Stamford, CT; Appleton & Lange 1996: 499-510
28 Landreneau R J, De Giacomo T, Mack M J et al.. Therapeutic video-assisted thoracoscopic surgical resection of colorectal pulmonary metastases. Eur J Cardiothorac Surg. 2000; 18 671-677
29 Mountain C F, McMurtrey M J, Hermes K E. Surgery for pulmonary metastasis: a 20-year experience. Ann Thorac Surg. 1984; 38 323-330
30 Friedel G, Pastorino U, Ginsberg R J et al.. Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases. Eur J Cardiothorac Surg. 2002; 22 335-344
31 Nahum Goldberg S, Dupuy D E. Image-guided radiofrequency tumor ablation: challenges and opportunities–part I. J Vasc Interv Radiol. 2001; 12 1021-1032
32 McGahan J P, Browning P D, Brock J M, Tesluk H. Hepatic ablation using radiofrequency electrocautery. Invest Radiol. 1990; 25 267-270
33 McGahan J P, Brock J M, Tesluk H, Gu W Z, Schneider P, Browning P D. Hepatic ablation with use of radio-frequency electrocautery in the animal model. J Vasc Interv Radiol. 1992; 3 291-297
34 Kruskal J B, Oliver B, Huertas J C, Goldberg S N. Dynamic intrahepatic flow and cellular alterations during radiofrequency ablation of liver tissue in mice. J Vasc Interv Radiol. 2001; 12 1193-1201
35 Shirabe K, Takenaka K, Gion T et al.. Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical margin. Br J Surg. 1997; 84 1077-1080
36 Elias D, Cavalcanti A, Sabourin J C et al.. Resection of liver metastases from colorectal cancer: the real impact of the surgical margin. Eur J Surg Oncol. 1998; 24 174-179
37 Dodd III G D, Frank M S, Aribandi M, Chopra S, Chintapalli K N. Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations. AJR Am J Roentgenol. 2001; 177 777-782
38 Chen M H, Yang W, Yan K et al.. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients–mathematic model, overlapping mode, and electrode placement process. Radiology. 2004; 232 260-271
39 Grieco C A, Simon C J, Mayo-Smith W W, DiPetrillo T A, Ready N E, Dupuy D E. Percutaneous Image-Guided Thermal Ablation and Radiation Therapy: Outcomes of Combined Treatment for 41 patients with Inoperable Stage I/II Non-Small Cell Lung Cancer. J Vasc Interv Radiol. 2006; 17 1117-1124
40 Lee J M, Jin G Y, Goldberg S N et al.. Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report. Radiology. 2004; 230 125-134
41 Chin M C, Rosenqvist M, Lee M A, Griffin J C, Langberg J J. The effect of radiofrequency catheter ablation on permanent pacemakers: an experimental study. Pacing Clin Electrophysiol. 1990; 13 23-29
42 Tong N Y, Ru H J, Ling H Y, Cheung Y C, Meng L W, Chung P C. Extracardiac radiofrequency ablation interferes with pacemaker function but does not damage the device. Anesthesiology. 2004; 100 1041
43 Lencioni R, Crocetti L, Cioni R, Franchini C, Angeletti C A, Bartolozzi C. Radiofrequency ablation of lung tumors: value of multiplanar CT imaging for optimizing treatment protocol. Radiology (p). 2003; 229(suppl) 548
44 Goldberg S N, Solbiati L, Halpern E F, Gazelle G S. Variables affecting proper system grounding for radiofrequency ablation in an animal model. J Vasc Interv Radiol. 2000; 11 1069-1075
45 Friedman M, Mikityansky I, Kam A et al.. Radiofrequency ablation of cancer. Cardiovasc Intervent Radiol. 2004; 27 427-434
46 Ahmed M, Liu Z, Afzal K S et al.. Radiofrequency ablation: effect of surrounding tissue composition on coagulation necrosis in a canine tumor model. Radiology. 2004; 230 761-767
47 Gadaleta C, Mattioli V, Colucci G et al.. Radiofrequency ablation of 40 lung neoplasms: preliminary results. AJR Am J Roentgenol. 2004; 183 361-368
48 Bojarski J D, Dupuy D E, Mayo-Smith W W. CT imaging findings of pulmonary neoplasms after treatment with radiofrequency ablation: results in 32 tumors. AJR Am J Roentgenol. 2005; 185 466-471
49 Sewell Jr P E. Percutaneous radiofrequency ablation of primary and secondary pulmonary malignancies using CT guidance. Radiology. 2000; 217(Suppl P) 291
50 Yamamoto A, Nakamura K, Matsuoka T et al.. Radiofrequency ablation in a porcine lung model: correlation between ct and histopathologic findings. AJR Am J Roentgenol. 2005; 185 1299-1306
51 Sewell Jr P E, Vance R B, Wang Y D. Assessing radiofrequency ablation of non-small cell lung cancer with positron emission tomography (PET). Radiology. 2000; 217(Suppl P) 334
52 Akeboshi M, Yamakado K, Nakatsuka A et al.. Percutaneous radiofrequency ablation of lung neoplasms: initial therapeutic response. J Vasc Interv Radiol. 2004; 15 463-470
53 Goldberg S N, Gazelle G S, Compton C C, McLoud T C. Radiofrequency tissue ablation in the rabbit lung: efficacy and complications. Acad Radiol. 1995; 2 776-784
54 Morrison P R, van Sonnenberg E, Shankar S et al.. Radiofrequency ablation of thoracic lesions, I: Experiments in the normal porcine thorax. AJR Am J Roentgenol. 2005; 184 375-380
55 Nomori H, Imazu Y, Watanabe K et al.. Radiofrequency ablation of pulmonary tumors and normal lung tissue in swine and rabbits. Chest. 2005; 127 973-977
56 Goldberg S N, Gazelle G S, Compton C C, Mueller P R, McLoud T C. Radio-frequency tissue ablation of VX2 tumor nodules in the rabbit lung. Acad Radiol. 1996; 3 929-935
57 Lee J M, Jin G Y, Li C A et al.. Percutaneous radiofrequency thermal ablation of lung VX2 tumors in a rabbit model using a cooled tip-electrode: feasibility, safety, and effectiveness. Invest Radiol. 2003; 38 129-139
58 Miao Y, Ni Y, Bosmans H et al.. Radiofrequency ablation for eradication of pulmonary tumor in rabbits. J Surg Res. 2001; 99 265-271
59 Ahrar K, Price R E, Wallace M J et al.. Percutaneous radiofrequency ablation of lung tumors in a large animal model. J Vasc Interv Radiol. 2003; 14 1037-1043
60 Tominaga J, Miyachi H, Tekase K et al.. Time-related changes in computed tomographic appearance and pathologic findings after radiofrequency ablation of the rabbit lung: preliminary experimental study. J Vasc Interv Radiol. 2005; 16 1719-1726
61 Dupuy D E, Zagoria R J, Akerley W, Mayo-Smith W W, Kavanagh P V, Safran H. Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol. 2000; 174 57-59
62 Herrera L J, Fernando H C, Perry Y et al.. Radiofrequency ablation of pulmonary malignant tumors in nonsurgical candidates. J Thorac Cardiovasc Surg. 2003; 125 929-937
63 Suh R D, Wallace A B, Sheehan R E, Heinze S B, Goldin J G. Unresectable pulmonary malignancies: CT-guided percutaneous radiofrequency ablation–preliminary results. Radiology. 2003; 229 821-829
64 Steinke K, King J, Glenn D, Morris D L. Radiologic appearance and complications of percutaneous computed tomography-guided radiofrequency-ablated pulmonary metastases from colorectal carcinoma. J Comput Assist Tomogr. 2003; 27 750-757
65 Yasui K, Kanazawa S, Sano Y et al.. Thoracic tumors treated with CT-guided radiofrequency ablation: initial experience. Radiology. 2004; 231 850-857
66 Belfiore G, Moggio G, Tedeschi E et al.. CT-guided radiofrequency ablation: a potential complementary therapy for patients with unresectable primary lung cancer—a preliminary report of 33 patients. AJR Am J Roentgenol. 2004; 183 1003-1011
67 Kang S, Luo R, Liao W, Wu H, Zhang X, Meng Y. Single group study to evaluate the feasibility and complications of radiofrequency ablation and usefulness of post treatment position emission tomography in lung tumours. World J Surg Oncol. 2004; 2 30
68 Lencioni R A, Crocetti L, Glenn D W, Morris D L, Suh R D, Bartolozzi C. Radiofrequency Ablation of Pulmonary Tumors Responses Evaluation (RAPTURE) trial. Radiology. 2004; 233(suppl) 657
69 VanSonnenberg E, Shankar S, Morrison P R et al.. Radiofrequency ablation of thoracic lesions, II: Initial clinical experience—technical and multidisciplinary considerations in 30 patients. AJR Am J Roentgenol. 2005; 184 381-390
70 Fernando H C, De Hoyos A, Landreneau R J et al.. Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates. J Thorac Cardiovasc Surg. 2005; 129 639-644
71 Mack M G, Luder-Luhr T, Eichler K, Balzer J O, Lehnert T, Vogl T J. Bipolar radiofrequency ablation of lung metastases. Radiological Society of North America Annual Meeting, Radiology 2005 233(suppl): 81
72 Nguyen C L, Scott W J, Young N A, Rader T, Giles L R, Goldberg M. Radiofrequency Ablation of Primary Lung Cancer: Results from an Ablate and Resect Pilot Study. Chest. 2005; 128 3507-3511
73 Ambrogi M C, Fontanini G, Cioni R, Faviana P, Fanucchi O, Mussi A. Biologic effects of radiofrequency thermal ablation on non-small cell lung cancer: results of a pilot study. J Thorac Cardiovasc Surg. 2006; 131 1002-1006
74 Ambrogi M C, Lucchi M, Dini P et al.. Percutaneous radiofrequency ablation of lung tumours: results in the mid-term. Eur J Cardiothorac Surg. 2006; 30 177-183
75 Simon C J, Dupuy D E, Dipetrillo T A et al.. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology. 2007; 243 268-278
76 Yamakado K, Hase S, Matsuoka T et al.. Radiofrequency ablation for the treatment of unresectable lung metastases in patients with colorectal cancer: a multicenter study in Japan. J Vasc Interv Radiol. 2007; 18 393-398
77 Therasse P, Arbuck S G, Eisenhauer E A et al.. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000; 92 205-216
78 Solbiati L, Goldberg S N, Ierace T, Dellanoce M, Livraghi T, Gazelle G S. Radio-frequency ablation of hepatic metastases: postprocedural assessment with a US microbubble contrast agent–early experience. Radiology. 1999; 211 643-649
79 Raman S S, Lu D S, Vodopich D J, Sayre J, Lassman C. Creation of radiofrequency lesions in a porcine model: correlation with sonography, CT, and histopathology. AJR Am J Roentgenol. 2000; 175 1253-1258
80 Choi D, Lim H K, Kim S H et al.. Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: usefulness of power Doppler US with a microbubble contrast agent in evaluating therapeutic response-preliminary results. Radiology. 2000; 217 558-563
81 Chopra S, Dodd III G D, Chintapalli K N, Leyendecker J R, Karahan O I, Rhim H. Tumor recurrence after radiofrequency thermal ablation of hepatic tumors: spectrum of findings on dual-phase contrast-enhanced CT. AJR Am J Roentgenol. 2001; 177 381-387
82 Cioni D, Lencioni R, Rossi S et al.. Radiofrequency thermal ablation of hepatocellular carcinoma: using contrast-enhanced harmonic power Doppler sonography to assess treatment outcome. AJR Am J Roentgenol. 2001; 177 783-788
83 Meloni M F, Goldberg S N, Livraghi T et al.. Hepatocellular carcinoma treated with radiofrequency ablation: comparison of pulse inversion contrast-enhanced harmonic sonography, contrast-enhanced power Doppler sonography, and helical CT. AJR Am J Roentgenol. 2001; 177 375-380
84 Kim S K, Lim H K, Kim Y H et al.. Hepatocellular carcinoma treated with radio-frequency ablation: spectrum of imaging findings. Radiographics. 2003; 23 107-121
85 Morimoto M, Nozawa A, Numata K et al.. Evaluation using contrast-enhanced harmonic gray scale sonography after radio frequency ablation of small hepatocellular carcinoma: sonographic-histopathologic correlation. J Ultrasound Med. 2005; 24 273-283
86 Sacks D, McClenny T E, Cardella J F, Lewis C A. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003; 14(9 Pt 2) S199-S202
87 Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, Nishimura T. Pneumothorax as a complication of percutaneous radiofrequency ablation for lung neoplasms. J Vasc Interv Radiol. 2006; 17 1625-1629
88 Hiraki T, Tajiri N, Mimura H et al.. Pneumothorax, pleural effusion, and chest tube placement after radiofrequency ablation of lung tumors; incidence and risk factors. Radiology. 2006; 241 275-283
89 Jin G Y, Lee J M, Lee Y C, Han Y M. Acute cerebral infarction after radiofrequency ablation of an atypical carcinoid pulmonary tumor. AJR Am J Roentgenol. 2004; 182 990-992
90 Yamakado K, Akeboshi M, Nakatsuka A et al.. Tumor seeding following lung radiofrequency ablation: a case report. Cardiovasc Intervent Radiol. 2005; 28 530-532
91 Steinke K, King J, Glenn D W, Morris D L. Percutaneous radiofrequency ablation of lung tumors with expandable needle electrodes: tips from preliminary experience. AJR Am J Roentgenol. 2004; 183 605-611
92 Kinney T B, Chen H T, Rose S C, Valji K, Roberts A C. Complications of thoracic intervention: evaluation of contributory factors. J Vasc Interv Radiol. 2003; 14(Suppl) S89
93 Okuma T, Matsuoka T, Yamamoto A et al.. Factors contributing to cavitation after CT-guided percutaneous radiofrequency ablation for lung tumors. J Vasc Interv Radiol. 2007; 18 399-404
94 Hiraki T, Yasui K, Mimura H et al.. Radiofrequency ablation of metastatic mediastinal lymph nodes during cooling and temperature monitoring of the tracheal mucosa to prevent thermal tracheal damage: initial experience. Radiology. 2005; 237 1068-1074
95 Rose S C, Fotoohi M, Levin D L, Harrell J H. Cerebral microembolization during radiofrequency ablation of lung malignancies. J Vasc Interv Radiol. 2002; 13 1051-1054
96 Yamamoto A, Matsuoka T, Toyoshima M et al.. Assessment of cerebral microembolism during percutaneous radiofrequency ablation of lung tumors using diffusion-weighted imaging. AJR Am J Roentgenol. 2004; 183 1785-1789
97 Ahrar K, Stafford R J, Tinkey P T et al.. Evaluation of cerebral microemboli during radiofrequency ablation of lung tumors in a canine model with use of impedance-controlled devices. J Vasc Interv Radiol. 2007; 18 929-935

Steven C RoseM.D.

Department of Radiology 8756, University of California San Diego Medical Center

200 West Arbor Dr., San Diego, CA 92103-8756

Email: scrose@ucsd.edu