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Vascular and Interventional Radiology |
1 From the Departments of Radiology (G.Y.J., G.H.C., Y.M.H., S.Y.L., C.S.K.) and Medicine (Y.C.L.), Chonbuk National University Hospital, South Korea; Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, Korea (J.M.L.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (S.N.G.). From the 2001 RSNA scientific assembly. Received July 26, 2002; revision requested September 24; final revision received April 25, 2003; accepted June 2. Address correspondence to J.M.L. (e-mail: leejm@radcom.snu.ac.kr).
PURPOSE: To assess technical feasibility, efficacy, and complications of percutaneous computed tomography (CT)-guided transthoracic radiofrequency (RF) ablation for treating inoperable non–small cell lung cancer (NSCLC) and lung metastases.
MATERIALS AND METHODS: Twenty-six patients with 27 NSCLCs and four patients with five lung metastases underwent RF ablation with cooled-tip electrodes with CT guidance. Patients were not candidates for surgery because of either advanced-stage disease (n = 20) and/or comorbid processes (n = 4) or refusal to undergo surgery (n = 6). The procedure was performed with the intent to cure in 10 (33%) patients with stage I tumors and as palliative therapy in 20 (67%) patients. Contrast material–enhanced CT was performed immediately, 1 month, and then every 3 months after RF ablation to evaluate the response to therapy. Time to death for each patient was calculated with Kaplan-Meier analysis, and the effect of tumor size and the extent of coagulation necrosis on time to death were determined.
RESULTS: Complete necrosis was attained in 12 (38%) of 32 lesions; partial (>50%) necrosis, in the remaining 20 (62%) lesions. Tumor size was a major discriminator in achieving complete necrosis. Complete necrosis was attained in all six (100%) tumors smaller than 3 cm but only in six (23%) of 26 larger tumors (P < .05). Mean survival of patients with complete necrosis (19.7 months) was significantly better than that of patients with partial necrosis (8.7 months) (P < .01). There were three (in 30 patients, 10%) major complications, which included acute respiratory distress syndrome, and two pneumothoraces that required thoracostomy.
CONCLUSION: RF ablation appears to be a safe and promising procedure for the treatment of inoperable NSCLC and metastases.
© RSNA, 2003
Index terms: Lung neoplasms, CT, 60.12111, 60.12112, 60.12115 • Lung neoplasms, metastases, 60.321, 60.33 • Radiofrequency (RF) ablation, 60.1269
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