| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Vascular and Interventional Radiology |
1 From the Department of Radiological Sciences, UCLA Medical Center, 10833 Le Conte Ave, B2–168, Center for the Health Sciences (CHS), Los Angeles, CA 90095-1721. Received December 18, 2002; revision requested February 27, 2003; revision received May 23; accepted July 1. Address correspondence to R.D.S. (e-mail: rsuh@mednet.ucla.edu).
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
MATERIALS AND METHODS: Twelve patients (seven men and five women; mean age, 60.6 years) with unresectable disease (because of poor lung reserve or multifocality) underwent nodule CT densitometry and CT-guided percutaneous RF ablation of 19 lung tumors (six [32%] tumors were adenocarcinoma, one (5%) was large cell carcinoma, two (10%) were bronchoalveolar carcinoma, four (21%) were colorectal carcinoma, and six (32%) were sarcoma less than 50 cm2 in area (range, 0.25–35.00 cm2). No patients had symptoms of their disease before RF ablation. Follow-up CT densitometry was scheduled for 1, 3, 6, and 12 months after RF ablation. Lesions were evaluated for change in area and contrast enhancement at follow-up CT.
RESULTS: RF ablation was well tolerated by all patients. Intraprocedural complications included 12 cases of pneumothoraces (two patients required chest tube placement, while 10 were asymptomatic and required no further treatment), two cases of pleural effusion, and two cases of moderate pain (one case during and one case both during and after the procedure). Mean follow-up was 4
months (range, 1–12 months). In the eight patients with 3-month follow-up, lesion size increased in two and remained stable in six. Mean contrast enhancement, however, decreased from 46.8 HU (range, 19–107 HU) at baseline to 9.6 HU (range, 0–32 HU) at 1–2-month follow-up. In the one patient with 12-month CT densitometry follow-up, lesion enhancement was less than 50% of that at baseline, and lesion diameter remained stable.
CONCLUSION: These preliminary results show that percutaneous RF ablation is a safe and technically feasible management option for unresectable pulmonary malignancies. CT densitometry may have potential for future use as a noninvasive method of following up tumors after RF ablation.
© RSNA, 2003
Index terms: Lung, nodule, 60.3115 • Lung neoplasms, CT, 60.12115 • Lung neoplasms, therapy • Radiofrequency (RF) ablation
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
As the leading cause of cancer death in the United States, lung cancer is a serious health care burden (19). Unfortunately, though complete recovery may be seen with early resection, approximately 15% of patients with pulmonary malignancies are surgical candidates (19–21). Most patients who are poor surgical candidates are in one of two categories: those with poor pulmonary reserve and those with widespread disease at diagnosis. In the first group, patients with lung cancer often have comorbid cardiopulmonary disease and therefore insufficient reserve to withstand lobectomy (20,22–23). Likewise, advanced disease is most often incurable surgically (20–21). While findings in studies show survival benefits after metastatectomy (24–28), surgery involves numerous risks that might be avoided with a less invasive intervention (20–21,29). Unfortunately, chemotherapy and external beam radiation have not greatly affected outcomes in patients with unresectable disease (19–20). RF ablation is a relatively new minimally invasive technique that may eventually provide these patients with a means of local control.
If RF ablation is to become widely used for treating lung tumors, a reliable imaging study for following up tumor regression is needed. Unfortunately, lesion size and morphology at conventional computed tomography (CT) may not always be useful indexes of ablation efficacy. Berber et al (30) reported difficulty in the interpretation of postablation CT scans of treated hepatic lesions because the appearance of ablated lesions surrounded by a rim of ablated normal liver tissue mimicked interval enlargement of the tumor. The use of nodule CT densitometry for following up solitary pulmonary nodules, however, has received considerable attention in the literature. This technique involves measurement of nodule enhancement after administration of intravenous contrast material and takes advantage of differences in vascularity and vasculature of benign and malignant lesions. Findings in a multicenter study by Swensen et al (31) showed 98% sensitivity in detection of malignancy if a threshold of 15-HU enhancement above baseline was used. Although the use of this technique to follow up tumors after RF ablation is less well studied, Berber et al (30) reported that successfully treated liver tumors decreased in enhancement after RF ablation. If the findings are found to be reliable, CT densitometry may eventually become a valuable index for following up lung tumors after RF ablation.
The purpose of our study was to assess whether percutaneous RF ablation of unresectable pulmonary malignancies is safe and technically feasible and to evaluate the usefulness of nodule CT densitometry as a tool for following up tumors after ablation.
|
MATERIALS AND METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
Ultimately, 12 patients (seven men and five women; mean age, 60.6 years; range, 44–71 years) who had no disease symptoms underwent RF ablation of 19 lung nodules. Male patients had a mean age of 62.7 years (range, 53–71 years), while female patients had a mean age of 57.6 years (range, 44–68 years). Eight of our patients had primary lung cancer, and four had metastatic disease. All 12 patients had disease that was believed to be unresectable because of poor pulmonary reserve or extent of disease. The clinical-pathologic characteristics of these patients and their tumors are summarized in Table 1. Nineteen treated lesions (those in one patient were excluded) were sampled at biopsy for tissue diagnosis before ablation: 32% (six lesions) were adenocarcinoma, 5% (one lesion) were large cell carcinoma, 10% (two lesions) were bronchoalveolar carcinoma, 32% (six lesions) were metastatic leiomyosarcoma, and 21% (four lesions) were metastatic colorectal carcinoma. Patient 4 did not undergo biopsy because the lesions were all smaller than 1 cm; however, these lesions were believed to be metastatic colorectal carcinoma on the basis of clinical findings.
|
Review of the images allowed the route for placement of the RF ablation probe to be planned. Once the patient was positioned to facilitate access of the target lesion, dispersive grounding pads were placed on the patients’ upper thighs. Patients were given aliquots of fentanyl citrate (Sublimaze; Akorn, Buffalo Grove, Ill) (50 µg intravenously) and midazolam hydrochlorate (Roche Laboratories, Nutley, NJ) (1 mg intravenously) as needed to maintain conscious sedation. Noninvasive monitoring of temperature, blood pressure, pulse, and O2 saturation was performed throughout the procedure. Continuous electrocardiographic monitoring was also performed in all patients. After the skin was prepared and draped in sterile fashion, local anesthesia was achieved with intradermal and subcutaneous 1% lidocaine (Xylocaine; AstraZeneca International, Wilmington, Del). With spiral CT guidance, a localizer 22-gauge Chiba needle was placed into the lesion. After confirmation of needle tip location, the RF ablation probe was placed into the center of the nodule by using tandem needle technique (32).
Eleven of 12 patients (17 nodules) were treated with a 6.4-F multiarray RF interstitial tissue ablation (RITA) probe (Starburst XL probe and model 1500 Electrosurgical Generator; RITA Medical Systems, Mountain View, Calif). The decision to treat patient 10 (two nodules) with a 19-gauge electrode and generator (Cool Tip; Radionics, Burlington, Mass) rather than the RITA probe was made because we believed that the proximity of this patient’s lesions to major airways and vessels (aorta, pulmonary veins, left lower lobe bronchus) would make adequate RITA tine deployment difficult. It should be noted, however, that the exclusion criterion for lesion proximity to major airways and vessels (<1 cm) was not met in any patient. Once appropriately positioned in the tumor, the RITA probe was deployed to place the tips of the tines at the periphery of the lesion. The deployment area covered by the RITA tines varied from 3 to 5 cm; for lesions larger than 5 cm, multiple overlapping RF ablations were performed. When the Cool Tip single-needle electrode was used, its tip was placed in the far center of the lesion. Care was taken to avoid placement of the tines into pulmonary vessels or other adjacent critical structures. If probe repositioning was required, the probe was not removed in its entirety; therefore, additional punctures were never required. Once the target temperature (90°C–95°C) was reached, a timer was set to monitor procedural duration. Tip cooling was not used during Cool Tip ablation because of the proximity of the patient’s tumor to major airways and vascular structures. RF ablation was terminated when the following had occurred: (a) 1-cm tumor margins were achieved, (b) ground-glass opacification was seen in the surrounding lung parenchyma at intraprocedural CT, and (c) sufficient time had elapsed, according to the probe manufacturer recommendations. As the probe was removed, the pulmonary parenchymal tract was also ablated. With regard to the RITA system, this involved complete withdrawal of the tines and use of the distal 1-cm tip for tract ablation. Figure 1 illustrates the set-up and process of RF ablation.
|
|
|
After the needle and RF ablation probe were removed, a postprocedural limited CT scan was obtained. Patients were observed for vital signs and pain for 4–6 hours in our posttreatment unit before discharge. All patients filled out identical questionnaires regarding the severity of pain they experienced during and after the procedure (on a scale from 1 to 5, where 1 = asymptomatic and 5 = severe pain or discomfort). Patients were given acetaminophen (Tylenol; McNeil Pharmaceuticals, Fort Washington, Pa) (650 mg every 4–6 hours) for mild pain and hydrocodone bitartrate and acetaminophen (Vicodin; Abbott Laboratories, Abbott Park, Ill) (one to two tablets with 5-mg hydrocodone bitartrate and 500-mg acetaminophen every 4–6 hours) for moderate pain. No patients reported severe pain or discomfort. Postprocedural chest radiographs were obtained at 1 and 4 hours to assess for pneumothorax. All pneumothoraces that were large (>20%), expanding, or symptomatic were treated with chest tube drainage. If no complications were observed, patients were discharged with routine follow-up by the referring physician but were instructed to immediately report any shortness of breath, bloody sputum, pain, or other symptoms. Patients were also questioned about symptoms at their scheduled follow-up visits (1, 3, 6, and 12 months after RF ablation), at which time their CT scans were also reviewed for pneumothorax, pleural effusion, and other pulmonary complications.
Follow-up nodule CT densitometry scans were evaluated by the radiologist who performed the ablations (R.D.S.). Since in only a few studies has CT densitometry been used as a method of following up ablated tumors, we were uncertain about the degree of change to expect after RF ablation. Follow-up CT scans were therefore evaluated only for change in lesion enhancement.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
As of this writing, mean patient follow-up was 4.5 months (range, 1–12 months), with four patients followed up for 1–2 months, four for 3 months, two for 6 months, and two for 12 months. Of the eight patients who were followed up for at least 3 months, two had an increase in lesion size (mean increase, 54%; range, 31%–77%), and six had no significant interval change (mean change, 22%; range, 0%–40%). Of those lesions that remained stable in size on the basis of the World Health Organization criteria, four decreased, one increased, and one showed no change. These findings are summarized in Table 2. Figure 2 illustrates an example of postablation tumor change over a 12-month period.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Two cases of small pleural effusion were seen immediately after treatment, both of which resolved with observation alone. An additional small pleural effusion was noted 1 month after treatment, which also resolved spontaneously. Two patients reported pain after the procedure. One of these patients reported continued pain of moderate intensity for 1 month; the other patient reported moderate to severe pain for 3 months (pain was scored by patients as outlined in Materials and Methods). Both patients experienced adequate pain relief with hydrocodone bitartrate and acetaminophen (as needed) and did not require pain medication beyond 1 and 3 months, respectively. Table 4 summarizes complications encountered after RF ablation.
Two patients died during the course of our study. Patient 3 developed symptoms of increasing respiratory distress and dyspnea 2 months after RF ablation. A CT scan of the chest was obtained and revealed a small left-sided pleural effusion and patchy ground-glass opacification with moderate bronchial wall thickening in the left lower lobe. In light of the patient’s limited pulmonary reserve, a decision was made to aspirate the effusion with ultrasonographic guidance. Three hundred milliliters of serosanguinous fluid was aspirated, resulting in symptomatic improvement; however, the patient died 3 days later. Autopsy request was denied. Cytoanalysis of the pleural fluid revealed malignant cells consistent with metastatic adenocarcinoma from a primary lung tumor. Of note, this was the only patient in our study whose nodule demonstrated increased contrast enhancement at CT densitometry 1–2 months after RF ablation. In patient 2, who had colorectal cancer, a second primary tumor independent of the pulmonary malignancy for which RF ablation was performed was diagnosed 6 months after RF ablation. His death 1 month later was attributed to complications of a large-bowel obstruction.
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
The technical aspects of RF ablation for lung lesions still need improvement. One problem we encountered was occasional difficulty with accurate probe deployment. For patients with irregularly shaped lesions, it was often necessary to reposition the probe during the procedure. The lack of real-time CT made this particularly cumbersome, as it was necessary to stop, scan, and reposition the probe and tines several times. Even in patients with regularly shaped lesions, the traditional CT scanning methods required that the radiologist stop, leave the room for scanning, and then resume positioning of the probe. The use of CT fluoroscopy would likely facilitate accurate probe deployment, though the dose of radiation received by both the patient and radiologist might be somewhat greater (36). Another problem encountered was that of treating lesions that were small (<1 cm) or were located in proximity to critical structures. The smallest probe currently available is the 19-gauge Cool Tip probe; if smaller probes were to be developed, these lesions could be treated with greater accuracy. Fortunately, much research is underway to improve probe design (1).
Follow-up to determine the results of ablation was challenging. Patients demonstrated variable change in lesion size after treatment, with some showing what was likely either scar tissue development or growth and others remaining stable. Because ablated tissue adjacent to a lesion can mimic interval tumor enlargement at CT (30), lesion size was not believed to be a reliable measure of ablation success. It was noted that perinodular ground-glass opacities developed during the procedure; indeed, we used this as a treatment endpoint. Goldberg et al (37) reported similar opacities after ablation in the rabbit lung that corresponded histologically to coagulative necrosis of tumor. These opacities persisted to some degree after treatment and may contribute to the apparent increase in lesion size. Although we anticipate that successfully treated lesions will ultimately shrink in size as a result of scar formation, the duration of time for this to occur has not been established.
The use of nodule CT densitometry for solitary pulmonary nodules has received considerable attention in the literature (31). Our preliminary results suggest that nodule CT densitometry may eventually become a reliable method for following up tumors after ablation. All but one lesion demonstrated a dramatic decrease in contrast enhancement after RF ablation. The marked diminution of mean contrast material uptake at the 1–2-month follow-up may in part be a result of local vessel damage caused by RF ablation. At the 3-month follow-up, there was an increase in mean contrast material uptake compared with that at the 1–2-month visit, though all uptake profiles remained lower than those seen before treatment. We postulate that the increase in contrast material uptake may be a result of recovering circulation rather than tumor growth; however, to conclusively distinguish between normal circulation and viable tumor, biopsy or long-term follow-up would be necessary. Of the two lesions followed up with CT densitometry for at least 6 months, the lesion that demonstrated increased enhancement (from a preablation baseline) had substantially increased in size since the time of ablation, while the other remained stable in size. Further, at 1-year follow-up, the lesion that was stable in size at 6 months was still stable in size and maintained a contrast material uptake profile of less than 50% of baseline enhancement. Although lesion size alone may not be a reliable indicator of treatment effectiveness, stable lesion size in the context of consistently subbaseline lesion enhancement may prove to be an indication of treatment success.
One obvious limitation in the ability of CT densitometry to accurately reflect ablation success is the issue of tumor heterogeneity. Since tumors are often heterogeneous, particularly after RF ablation, whole-lesion enhancement measurements may fail to accurately reflect activity. For instance, after RF ablation, areas of successfully treated tumor will not enhance, while areas that contain viable tumor will. Measurement of whole-tumor enhancement would combine these two types of areas and produce misleading results. We attempted to compensate for tumor heterogeneity by placing the region of interest marker on the most solid reproducible area of the lesion rather than by measuring whole-lesion enhancement. In addition, since complete necrosis of tumors is often limited by untreated portions of the rim, we were prepared to measure rim enhancement; however, no tumors in this study demonstrated peripheral enhancement. Despite our efforts to account for lesion heterogeneity, some of our CT densitometry measurements may reflect a combination of viable and necrotic tumor.
It should be emphasized that our study was one of prospective feasibility. We do not claim to have proved that RF ablation is effective in treating lung malignancies or that CT densitometry values predict treatment success; to do so would have required autopsy or surgical resection to demonstrate necrotic tissue or, alternatively, extended follow-up to demonstrate lack of clinical recurrence. Postablation biopsy would have provided a more short-term reference standard, but the possibility of sampling error would remain. Long-term studies are needed to determine ablation effectiveness.
Although our study has limited follow-up, the correlation we observed between contrast material uptake profile and lesion activity is encouraging. Berber et al (30) reported similar trends in ablated hepatic tumors; a measurable decrease in contrast material uptake was found in successfully treated lesions. Though our study was not set up to evaluate ablation effectiveness as in the study of Berber et al, the fact that lesion enhancement values were clearly altered after RF ablation suggests that densitometry may eventually be useful for following up treated tumors. The fact that RF ablation can be performed on an outpatient basis with relatively minor and easily managed sequelae is also encouraging. Patients with focal disease who are unable to tolerate surgery from a cardiopulmonary standpoint could more easily withstand the minimally invasive nature of RF ablation. Likewise, patients with multifocal disease who would otherwise undergo surgical metastatectomy may instead elect to undergo RF ablation because thoracoscopy and open thoracotomy have numerous risks.
An important question for future studies, in addition to whether RF ablation prolongs survival, is whether it improves patients’ quality of life. The issue of palliation was not addressed in our study because, although all of our patients had disease refractory to conventional therapy, none were symptomatic during the study. Future studies to investigate the use of RF ablation in patients with symptoms of their disease are needed to further elucidate whether the benefits of RF ablation outweigh its potential complications.
In conclusion, our preliminary results suggest that RF ablation may prove to be a safe and feasible management option for unresectable pulmonary malignancies and that CT densitometry may have potential for future use as a noninvasive method of following up ablated tumors. Though proof of ablation effectiveness and absolute correlation of CT densitometry values with tumor activity are beyond the scope of this study, future studies that follow up ablated lesions for several years after RF ablation may provide this needed information.
|
FOOTNOTES |
|---|
Author contributions: Guarantors of integrity of entire study, R.D.S., J.G.G.; study concepts and design, R.D.S., J.G.G., S.B.H.; literature research, A.B.W., R.E.S.; clinical studies, R.D.S., S.B.H., R.E.S.; data acquisition and analysis/interpretation, A.B.W., R.E.S.; statistical analysis, A.B.W., R.E.S.; manuscript preparation and definition of intellectual content, A.B.W., R.E.S.; manuscript editing, revision/review, and final version approval, all authors
|
REFERENCES |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODS RESULTSDISCUSSIONREFERENCES |
|---|
This article has been cited by other articles:
|
|
 |
|
  J. C. Zhu, T. D. Yan, D. Glenn, and D. L. Morris Radiofrequency Ablation of Lung Tumors: Feasibility and Safety Ann. Thorac. Surg., April 1, 2009; 87(4): 1023 - 1028. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Yoshimatsu, T. Yamagami, K. Terayama, T. Matsumoto, H. Miura, and T. Nishimura Delayed and Recurrent Pneumothorax After Radiofrequency Ablation of Lung Tumors Chest, April 1, 2009; 135(4): 1002 - 1009. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Zhu, T. D. Yan, and D. L. Morris A Systematic Review of Radiofrequency Ablation for Lung Tumors Ann. Surg. Oncol., June 1, 2008; 15(6): 1765 - 1774. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Pennathur, J. D. Luketich, G. Abbas, M. Chen, H. C. Fernando, W. E. Gooding, M. J. Schuchert, S. Gilbert, N. A. Christie, and R. J. Landreneau Radiofrequency ablation for the treatment of stage I non-small cell lung cancer in high-risk patients. J. Thorac. Cardiovasc. Surg., October 1, 2007; 134(4): 857 - 864. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Liapi and J.-F. H. Geschwind Transcatheter and Ablative Therapeutic Approaches for Solid Malignancies J. Clin. Oncol., March 10, 2007; 25(8): 978 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Thanos, S. Mylona, M. Pomoni, K. Athanassiadi, N. Theakos, L. Zoganas, and N. Batakis Percutaneous radiofrequency thermal ablation of primary and metastatic lung tumors Eur. J. Cardiothorac. Surg., November 1, 2006; 30(5): 797 - 800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Yan, J. King, A. Sjarif, D. Glenn, K. Steinke, and D. L. Morris Percutaneous Radiofrequency Ablation of Pulmonary Metastases from Colorectal Carcinoma: Prognostic Determinants for Survival Ann. Surg. Oncol., November 1, 2006; 13(11): 1529 - 1537. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Okuma, T. Matsuoka, T. Okamura, Y. Wada, A. Yamamoto, Y. Oyama, K. Koyama, K. Nakamura, Y. Watanabe, and Y. Inoue 18F-FDG Small-Animal PET for Monitoring the Therapeutic Effect of CT-Guided Radiofrequency Ablation on Implanted VX2 Lung Tumors in Rabbits J. Nucl. Med., August 1, 2006; 47(8): 1351 - 1358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L. Nguyen, W. J. Scott, and M. Goldberg Radiofrequency ablation of lung malignancies. Ann. Thorac. Surg., July 1, 2006; 82(1): 365 - 371. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Ambrogi, M. Lucchi, P. Dini, F. Melfi, G. Fontanini, P. Faviana, O. Fanucchi, and A. Mussi Percutaneous radiofrequency ablation of lung tumours: results in the mid-term. Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 177 - 183. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Rossi, R. Dore, A. Cascina, V. Vespro, F. Garbagnati, L. Rosa, V. Ravetta, A. Azzaretti, P. Di Tolla, G. Orlandoni, et al. Percutaneous computed tomography-guided radiofrequency thermal ablation of small unresectable lung tumours. Eur. Respir. J., March 1, 2006; 27(3): 556 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L. Nguyen, W. J. Scott, N. A. Young, T. Rader, L. R. Giles, and M. Goldberg Radiofrequency Ablation of Primary Lung Cancer: Results From an Ablate and Resect Pilot Study Chest, November 1, 2005; 128(5): 3507 - 3511. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Yamamoto, K. Nakamura, T. Matsuoka, M. Toyoshima, T. Okuma, Y. Oyama, Y. Ikura, M. Ueda, and Y. Inoue Radiofrequency Ablation in a Porcine Lung Model: Correlation Between CT and Histopathologic Findings Am. J. Roentgenol., November 1, 2005; 185(5): 1299 - 1306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Bojarski, D. E. Dupuy, and W. W. Mayo-Smith CT Imaging Findings of Pulmonary Neoplasms After Treatment with Radiofrequency Ablation: Results in 32 Tumors Am. J. Roentgenol., August 1, 2005; 185(2): 466 - 471. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Aberle, C. Chiles, C. Gatsonis, B. J. Hillman, C. D. Johnson, B. L. McClennan, D. G. Mitchell, E. D. Pisano, M. D. Schnall, and A. G. Sorensen Imaging and Cancer: Research Strategy of the American College of Radiology Imaging Network Radiology, June 1, 2005; 235(3): 741 - 751. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Horkan, K. Dalal, J. A. Coderre, J. L. Kiger, D. E. Dupuy, S. Signoretti, E. F. Halpern, and S. N. Goldberg Reduced Tumor Growth with Combined Radiofrequency Ablation and Radiation Therapy in a Rat Breast Tumor Model Radiology, April 1, 2005; 235(1): 81 - 88. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Fernando, A. D. Hoyos, R. J. Landreneau, S. Gilbert, W. E. Gooding, P. O. Buenaventura, N. A. Christie, C. Belani, and J. D. Luketich Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 639 - 644. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. vanSonnenberg, S. Shankar, P. R. Morrison, R. T. Nair, S. G. Silverman, M. T. Jaklitsch, F. Liu, L. Cheung, K. Tuncali, A. T. Skarin, et al. Radiofrequency Ablation of Thoracic Lesions: Part 2, Initial Clinical Experience--Technical and Multidisciplinary Considerations in 30 Patients Am. J. Roentgenol., February 1, 2005; 184(2): 381 - 390. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Belfiore, G. Moggio, E. Tedeschi, M. Greco, R. Cioffi, F. Cincotti, and R. Rossi CT-Guided Radiofrequency Ablation: A Potential Complementary Therapy for Patients with Unresectable Primary Lung Cancer--A Preliminary Report of 33 Patients Am. J. Roentgenol., October 1, 2004; 183(4): 1003 - 1011. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Y. Jin, J. M. Lee, Y. C. Lee, Y. M. Han, and Y. S. Lim Primary and Secondary Lung Malignancies Treated with Percutaneous Radiofrequency Ablation: Evaluation with Follow-Up Helical CT Am. J. Roentgenol., October 1, 2004; 183(4): 1013 - 1020. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Louie, J. P. McGahan, E. H. Moore, J. Goodnight, and J. Brock Radio Frequency Ablation of Lung Metastasis Using Sonographic Guidance J. Ultrasound Med., September 1, 2004; 23(9): 1241 - 1244. [Full Text] [PDF]
|
|
|
|
|
|
P. N. Cascade, J. Min Lee, and S. Nahum Goldberg Percutaneous Radiofrequency Ablation of Pulmonary Malignancies: Giving Credit for Previous Work * Drs Lee and Goldberg respond: Radiology, September 1, 2004; 232(3): 931 - 932. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| RADIOLOGY | RADIOGRAPHICS | RSNA JOURNALS ONLINE |
= patient 7 enhancement, 
= patient 7 size, 
= patient 5 enhancement, 
= patient 5 size.