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Hiran C. Fernando
Rodney J. Landreneau
Percival O. Buenaventura
Neil A. Christie
James D. Luketich
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J Thorac Cardiovasc Surg 2005;129:639-644
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Radiofrequency ablation for the treatment of non–small cell lung cancer in marginal surgical candidates

Hiran C. Fernando, MDa, Alberto De Hoyos, MDa, Rodney J. Landreneau, MDa, Sebastian Gilbert, MDa, William E. Gooding, MSb, Percival O. Buenaventura, MDa, Neil A. Christie, MDa, Chandra Belani, MDc, James D. Luketich, MDa,*

a Department of Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center,
b Department of Biostatistics, University Pittsburgh Cancer Institute,
c Division of Hematology and Oncology, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, Pa

Read at the Thirtieth Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 23-26, 2004.

Received for publication June 18, 2004; revisions received September 21, 2004; accepted for publication October 8, 2004.

* Address for reprints: James D. Luketich, MD, Professor of Surgery, Chief, Division of Thoracic and Foregut Surgery, UPMC Presbyterian, 200 Lothrop St, Suite C-800, Pittsburgh, PA 15213 (E-mail: luketichjd{at}upmc.edu).

OBJECTIVE: Treatment options for patients with non–small cell lung cancer who are not surgical candidates or who refuse operation are limited. Radiofrequency ablation represents a potential less invasive option for these patients. Our initial experience with radiofrequency ablation for peripheral, primary non–small cell lung cancer is reported.

METHODS: We treated 21 tumors in 18 patients. Median age was 75 (range 58-86) years. Cancer stages were I (n = 9), II (n = 2), III (n = 3), and IV (n = 4). Patients with stage IV disease included 3 with recurrence after previous lobectomies and 1 with a synchronous liver metastasis also treated with radiofrequency ablation. Median tumor diameter was 2.8 cm (range 1.2-4.5 cm). Radiofrequency ablation was delivered by minithoracotomy in 2 cases and by a computed tomography–guided percutaneous approach in 16 patients. Computed tomographic and positron emission tomographic scans were used to evaluate recurrence and radiographic response in ablated nodules.

RESULTS: One postoperative death occurred from pneumonia after open radiofrequency ablation. Median hospital stay was 2.5 days. A chest tube or pigtail catheter was required in 7 patients (38.9%) for procedure-related pneumothoraces. At a median follow-up of 14 months, 15 patients (83.3%) were alive. Local progression occurred in 8 nodules (38.1%). Mean and median progression-free intervals were 16.8 and 18 months, respectively. For stage I cancers, mean progression-free interval was 17.6 months. Median progression-free interval was not reached.

CONCLUSION: This study demonstrates the feasibility of radiofrequency ablation for small, peripheral non–small cell lung cancer tumors. Local control is comparable to, if not better than, that provided by radiotherapy. Radiofrequency ablation should continue to be evaluated by thoracic surgeons as a noninvasive therapy for the high-risk patient with non–small cell lung cancer.




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