Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients

Abstract

Purpose: To retrospectively evaluate long-term survival, local tumor progression, and complication rates for all percutaneous computed tomographic (CT)-guided lung tumor radiofrequency (RF) ablations performed at a tertiary care cancer hospital in patients who refused or who were not candidates for surgery.

Materials and methods: This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Between 1998 and 2005, 153 consecutive patients (mean age, 68.5 years; range, 17-94 years) with 189 primary or metastatic medically inoperable lung cancers underwent percutaneous fluoroscopic CT-guided RF ablation. Clinical outcomes were compiled on the basis of review of medical records, imaging follow-up reports, and any biopsy-proved residual or recurrent disease (when available). Kaplan-Meier method was used to estimate overall survival and disease-free survival (progression) as a function of time since RF ablation. Comparisons between survival functions were performed by using the log-rank statistic; P < .05 was considered to indicate a significant difference.

Results: The overall 1-, 2-, 3-, 4-, and 5-year survival rates, respectively, for stage I non-small cell lung cancer were 78%, 57%, 36%, 27%, and 27%; rates for colorectal pulmonary metastasis were 87%, 78%, 57%, 57%, and 57%. The 1-, 2-, 3-, 4-, and 5-year local tumor progression-free rates, respectively, were 83%, 64%, 57%, 47%, and 47% for tumors 3 cm or smaller and 45%, 25%, 25%, 25%, and 25% for tumors larger than 3 cm. The difference between the survival curves associated with large (>3 cm) and small (< or =3 cm) tumors was significant (P < .002). The overall pneumothorax rate was 28.4% (52 of 183 ablation sessions), with a 9.8% (18 of 183 ablation sessions) chest tube insertion rate. The overall 30-day mortality rate was 3.9% (six of 153 patients), with a 2.6% (four of 153 patients) procedure-specific 30-day mortality rate.

Conclusion: Lung RF ablation appears to be safe and linked with promising long-term survival and local tumor progression outcomes, especially given the patient population treated.