Thermal Ablation of Malignant Lung Tumors

Abstract

SUMMARYBackground: About 50 000 new cases of non-small-cell carcinoma of the lung are diagnosed in Germany each year. More than 20% of the affected patients cannot be offered radical resection because of comorbidity alone. The lung is also the second most common site of distant metastases of extrathoracic tumors; it is the only site of such metastases in 20% of cases. In recent years, image-guided thermoablation has been used with increasing frequency in patients who are unable to undergo surgery for medical reasons.

Pulmonary radiofrequency ablation (Part 1): Current state

“…7,12,24,37,47 Today there is not enough evidence to develop differentiating indications between thermal ablation and the SRT. 17 Although more controversial that in the NSCLC, in selected patients with single pulmonary metastasis and oligometastasis the SLR (metastasectomy) can be the treatment of choice. Survival has increased according to retrospective studies 6,40 (Fig.…”

“…10,17 Patients treated through RFA usually have more comorbilities than the rest 45 which falsely increases the mortality attributed to radiofrequency. It translates into a lower overall survival---that does not distinguish among causes of mortality than other therapies but with cancerspecific, disease-free and median survivals apparently similar to that of SLR 26 and SRT (e-table 2) (Fig.…”

“…Compared to the lobectomy+review/sample of mediastinal ganglia (treatment of choice): More local relapses with the SLR (22%) than with the lobectomy (5%) butthey improve with the antomic SLR, the review of ganglia and the use of brachitherapy (17) Better local control and greater Sv in lobectomies. In tumors <2cm N0M0 there are no differences between the SLR and the lobectomy in the overall Sv at 5 years (14,31) the disease free Sv (1) or the rates of local relapse (14).…”

“…22 Radiofrequency is at present the most widely used ablative procedure for the management of malignant lung neoplasms. 17,26 Although the FDA approved it for soft-tissue tumors it is more and more used for lung tumors. 27 It uses a high-frequency alternating current (400---500 kHz) and 100---250 W of power produced by a generator 25 and it is released into the tissue through the tip of a needle that is the active electrode (''active tip'').…”

“…27 It uses a high-frequency alternating current (400---500 kHz) and 100---250 W of power produced by a generator 25 and it is released into the tissue through the tip of a needle that is the active electrode (''active tip''). From there it travels to the pads (dispersing electrodes) located on the patient's legs or back that dissipate the current in a monopolar circuit 17 or to a second electrode near the first one, in a bipolar circuit. 19,25 The needle is introduced in the tumor percutaneously.…”