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This retrospective study was conducted to review the complications of lung radiofrequency (RF) ablation and to clarify the effects of inflammation after lung RF ablation on mortality and morbidity. Complications were evaluated by reviewing medical records on an RF session basis. The C-reactive protein (CRP) value was used as an indicator of inflammation and was measured before and every 1-2 days during the hospital stay after RF ablation. The relationships between CRP values and patient baselines were evaluated to identify factors affecting lung inflammation. 130 patients who underwent 327 lung RF ablation sessions were enrolled in this study. The major complication rate was 18.3% (60/327). Inflammation-related complications such as interstitial pneumonia (n = 2) and aseptic pleuritis (n = 2) developed in four sessions (1.2%). Death occurred in two patients with interstitial pneumonia (0.6%). The mean CRP value increased significantly from 1.3+/-2.6 mg dl(-1) to 3.4+/-5.6 mg dl(-1) (p<0.01) after RF ablation. Large tumour size (>or=2 cm) and previous external-beam radiotherapy were significant factors associated with an increased CRP value in both univariate and multivariate analyses. In conclusion, although the incidence rate is low, fatal lung inflammation may develop after lung RF ablation. Large tumour size and previous external-beam radiotherapy are risk factors for severe lung inflammation.

ancreatic cancer is the fourth leading cause of cancerrelated mortality in the United States. In 2018, an estimated 55 440 people were diagnosed with pancreatic cancer, and 44 330 people died of it (1). Neoadjuvant chemotherapy and radiation therapy (CRT) is increasingly used to treat potentially resectable pancreatic ductal adenocarcinoma (PDA), especially for borderline resectable disease, as an alternative to surgery. CRT improves the rates of negativemargin resections and possibly treats early micrometastatic disease. However, neoadjuvant CRT is not entirely safe and is sometimes associated with toxicity and disease progression. Consequently, it is important to identify patients likely to respond to CRT to avoid unnecessary drug toxicity while maximizing the chances of tumor regression.In PDA, conventional multiphasic CT is the most widely used imaging modality to evaluate response to therapy by using the Response Evaluation Criteria in Solid Tumors (RECIST). However, it is becoming evident that conventional CT imaging-through assessment of serial tumor size changes-is insufficient for reliable response evaluation after neoadjuvant CRT because of poor correlation with histologic grading of response (2-4). This poor performance can be explained by the abundant fibrous stroma of PDA, which cannot be differentiated from posttherapy fibrous scarring.Obtaining negative pathologic margins (R0) after surgery is an important marker of therapy in PDA. Patients with PDA with R0 have significantly longer survival than patients with positive margins (5,6). Recently, the rate of R0 resection is increasing with the use of neoadjuvant CRT. In a study by Chatterjee et al ( 7), R0 resection was achieved in approximately 90% of patients with PDA