At the recent British Society of Interventional Radiology meeting in Brighton, Professor William Lees, The Middlesex Hospital, University College London (UCL) Hospitals, UK, presented a paper on the benefits of treating lung tumours with radiofrequency ablation (RFA). He began by stating that the majority of lung tumours are inoperable due to the advanced stage, serious coexisting health conditions or poor respiratory function in the patient. Standard treatment of inoperable tumours has been using radiotherapy, which can cause serious toxicity in a patient and chemotherapy, which is not tolerated by all patients.
However, the same consequences are not repeated with lung RFA. It is also advantageous because of potentially low costs, short hospitalisation times and good patient tolerance without mortality. Lees cited a 2004 study from Dr Cosmo Gadaleta, IRCCS Hospital of Oncology in Bari, Italy, which treated 69 tumours in 34 patients. At nine months, the study reported 58/63 complete responses. In addition, he also cited the study from
Dr Damian Dupuy, Professor of Diagnostic Imaging at Brown Medical School and Director of Ultrasound in the Office of Minimally Invasive Therapy at Rhode Island Hospital in Providence, Rhode Island, US, who treated 155 procedures in 160 patients with RFA and reported a 62% survival rate at 21 months.
In his own experience at UCL, 58 patients were treated with 170 tumours. The results revealed that there was complete necrosis in all CRC metastases (all <3cm). In addition, there was recurrence in 5/8 sarcoma metastases and 6/8 adamantinoma metastases. Despite these encouraging results, Lees noted some problems with using RFA in the lung. Notably, he said that there were difficulties in deploying umbrella probes as well puncturing the lesion. Patients also reported diaphragm and chest wall pain. Lees said there were certain requirements when performing Lung RFA, in particular, the utilisation of CT fluoroscopy and 'real time' 3D imaging. General anaesthesia can be used without increasing the pneumothorax rate.
However, Lees said that overall, with over 1,000 patients treated worldwide, RFA is safe (with only four deaths reported as a result of the procedure, conventional surgery carries a mortality rate of approximately 4%), has good results in individual lesions (90% success in complete ablation <5cm). Furthermore, the procedure is also repeatable and can treat multiple lesions in a single session.
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