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Pulmonary Radiofrequency Ablation: Long-term Safety and Efficacy in 153 Patients¹

¹ From the Departments of Diagnostic Imaging (C.J.S., D.E.D., C.A.G., W.W.M.), Radiation Oncology (T.A.D.), Medical Oncology (H.P.S.), and Thoracic Surgery (T.N.), Brown Medical School/Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. Received January 16, 2006; revision requested March 21; revision received May 18; accepted June 8; final version accepted August 3. Address correspondence to D.E.D. (e-mail: ddupuy{at}lifespan.org).

Purpose: To retrospectively evaluate long-term survival, local tumor progression, and complication rates for all percutaneous computed tomographic (CT)-guided lung tumor radiofrequency (RF) ablations performed at a tertiary care cancer hospital in patients who refused or who were not candidates for surgery.

Materials and Methods: This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Between 1998 and 2005, 153 consecutive patients (mean age, 68.5 years; range, 17–94 years) with 189 primary or metastatic medically inoperable lung cancers underwent percutaneous fluoroscopic CT-guided RF ablation. Clinical outcomes were compiled on the basis of review of medical records, imaging follow-up reports, and any biopsy-proved residual or recurrent disease (when available). Kaplan-Meier method was used to estimate overall survival and disease-free survival (progression) as a function of time since RF ablation. Comparisons between survival functions were performed by using the log-rank statistic; P < .05 was considered to indicate a significant difference.

Results: The overall 1-, 2-, 3-, 4-, and 5-year survival rates, respectively, for stage I non–small cell lung cancer were 78%, 57%, 36%, 27%, and 27%; rates for colorectal pulmonary metastasis were 87%, 78%, 57%, 57%, and 57%. The 1-, 2-, 3-, 4-, and 5-year local tumor progression–free rates, respectively, were 83%, 64%, 57%, 47%, and 47% for tumors 3 cm or smaller and 45%, 25%, 25%, 25%, and 25% for tumors larger than 3 cm. The difference between the survival curves associated with large (>3 cm) and small (3 cm) tumors was significant (P < .002). The overall pneumothorax rate was 28.4% (52 of 183 ablation sessions), with a 9.8% (18 of 183 ablation sessions) chest tube insertion rate. The overall 30-day mortality rate was 3.9% (six of 153 patients), with a 2.6% (four of 153 patients) procedure-specific 30-day mortality rate.

Conclusion: Lung RF ablation appears to be safe and linked with promising long-term survival and local tumor progression outcomes, especially given the patient population treated.

© RSNA, 2007

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