Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study)

Standards of Practice: Guidelines for Thermal Ablation of Primary and Secondary Lung Tumors

“…Cavitation seems to occur more frequently in patients with lung cancer near the chest wall or in patients with emphysema [49]. In a recent study, criteria for a complete response were the decrease in longest tumor diameter of at least 30% compared with the diameter assessed at 1 month, and no evidence of contrast enhancement [31]. Intratumoral contrast uptake, tumor growth at the periphery of the ablation, or a 20% increase in longest tumor diameter strongly correlated with incomplete ablation [31].…”

“…From [26] improves local disease control and survival in patients with NSCLC [32]. In pulmonary metastatic disease, RFA has been mainly performed in patients with metastases from colorectal and lung cancers, renal cell carcinoma, melanoma, hepatocellular carcinoma, and sarcoma [25,31,[33][34][35][36][37][38]. The maximum number of lung metastases that may be ablated is still not clearly defined.…”

“…The extent of the GGO surrounding the treated lesion on immediate postablation CT imaging has been shown to predict the effectiveness of thermal ablation. The tumor tissue is considered to be incorporated in the ablation zone when the GGO completely surrounded the tumor [31,43]. The GGO should encounter the treated tumor with a circumferential margin of at least 5 mm for complete tumor ablation [44].…”

“…In a recent study, criteria for a complete response were the decrease in longest tumor diameter of at least 30% compared with the diameter assessed at 1 month, and no evidence of contrast enhancement [31]. Intratumoral contrast uptake, tumor growth at the periphery of the ablation, or a 20% increase in longest tumor diameter strongly correlated with incomplete ablation [31]. At follow-up CT, the opacity will start to decrease in size as early as 4 weeks and up to 6 months [43].…”

Percutaneous ablation of malignant thoracic tumors

“…After ablation, cancer-related survival is the order of 83-93% at 1 year, 68-75% at 2 years and 59-61% at 3 years (25,47,48). Prospective controlled studies are still needed to definitely assess the role of ablation.…”