Radiofrequency Ablation of Thoracic Lesions: Part 2, Initial Clinical Experience Technical and Multidisciplinary Considerations in 30 Patients

Tuesday, January 25th, 2005.

American Journal of Roentgenology 184, no 2 (2005): 381-390. [Link]

Eric vanSonnenberg¹^,2, Sridhar Shankar¹^,2^,3, Paul R. Morrison¹, Rashmi T. Nair¹^,2, Stuart G. Silverman¹^,2, Michael T. Jaklitsch⁴^,5, Franklin Liu¹^,2^,6, Lawrence Cheung¹^,2, Kemal Tuncali¹^,2, Arthur T. Skarin⁷ and David J. Sugarbaker⁴^,5

Department of Radiology, Brigham and Women’s Hospital, Boston, MA 02115.
Department of Radiology, Dana Farber Cancer Institute, Harvard Medical School, 44 Binney St., Boston, MA 02115.
Present address: Department of Radiology, University of Massachusetts Medical Center, Worcester, MA.
Department of Surgery, Brigham and Women’s Hospital, Boston, MA 02115.
Department of Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115.
Present address: University of Washington Medical Center, Seattle, WA.
Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115.

Abstract

Objective. The purpose of our study was to report our initial experience with patients who underwent percutaneous imaging-guided radiofrequency ablation of thoracic lesions, and to emphasize technical and multidisciplinary issues and adjunctive procedures specific to thoracic tumor ablation.

Materials and Methods. Our cohort consisted of 30 patients with a spectrum of primary (n = 18) and secondary (n = 11) lung tumors, mesothelioma (n = 1), and five secondarily eroded, painful ribs who underwent ablation of 36 total lesions (one patient had two ablations). Patients either were nonsurgical candidates because of medical comorbidities or extent of disease, or had exhausted chemotherapy and radiation therapy options, or had refused surgery or undergone unsuccessful surgery. Patients were treated with radiofrequency ablation after agreement among oncologists, thoracic surgeons, and interventional radiologists. An array-style electrode under impedance control was used to treat 29 thoracic tumors and the adjacent rib metastases (n = 5). A cool-tip radiofrequency probe was used for two patients. CT guidance and general anesthetic were used for all but one patient. Sonographic guidance and IV conscious sedation were used in one patient. Pain (n = 11) and tumor cure or control (n = 19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency ablations included the creation of saline or water windows (n = 3); establishment of transosseous and transchondral routes (n = 4); use of intercostal and paravertebral nerve blocks (n = 15); and use of an intraprocedural catheter (n = 1), needle (n = 1), or sheath (n = 3) for treatment of pneumothoraces. Follow-up was from 2 to 26 months.

Results. All ablations were technically successful. No periprocedural mortality occurred. Necrosis of tumor was greater than 90% in 26 of 30 lesions based on short-term follow-up imaging (CT, PET, MRI). In the 11 patients who underwent ablation for pain, relief was complete in four and partial in the other seven. One patient developed a local skin burn, four patients had self-limited hemoptysis up to 4 days after ablation, one had transient atrial fibrillation, one developed hoarseness, and two patients were transiently reintubated after extubation. Eight pneumothoraces developed; one patient underwent placement of a chest tube. Four patients died within 1 year of ablation from extrathoracic spread of tumor.

Conclusion. Radiofrequency ablation for a variety of thoracic tumors can be performed safely and with a high degree of efficacy for pain control and tumor killing. The effect of ablation can be assessed with CT, MRI, or PET. Various technical issues differentiate thoracic tumor ablation from standard abdominal ablations. Numerous other thoracic interventional radiology procedures are beneficial to assist the radiofrequency ablation. A multidisciplinary approach offers valuable expertise for patient care.

Glossary

therapy: any of the measures taken to treat a disease. Unproven therapy is any therapy that has not been scientifically tested and approved. Use of an unproven therapy instead of standard (proven) therapy is called alternative therapy. Some alternative therapies have dangerous or even life-threatening side effects. For others, the main danger is that a patient may lose the opportunity to benefit from standard therapy. Complementary therapy, on the other hand, refers to therapies used in addition to standard therapy. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of standard cancer therapy, or improve a patient's sense of well-being. The ACS recommends that patients considering use of any alternative or complementary therapy discuss this with their health care team.
radiation therapy: treatment with radiation to destroy cancer cells. This type of treatment may be used to reduce the size of a cancer before surgery, to destroy any remaining cancer cells after surgery, or, in some cases, as the main treatment.
oncology: (on-call-o-jee) the branch of medicine concerned with the diagnosis and treatment of cancer.
mortality: a measure of the rate of death from a disease within a given population.
MRI: Stands for magnetic resonance imaging. A method of taking pictures of the inside of the body. Instead of using x-rays, MRI uses a powerful magnet and transmits radio waves through the body; the images appear on a computer screen as well as on film. Like x-rays, the procedure is physically painless, but some people find it psychologically uncomfortable to be in the small core of the MRI machine.
imaging: any method used to produce a picture of internal body structures. Some imaging methods used to detect cancer are x-rays (including mammograms and CT scans), magnetic resonance imaging (MRI), scintigraphy, and ultrasound.
chemotherapy: (key-mo-THER-uh-pee) treatment with drugs to destroy cancer cells. Chemotherapy is often used with surgery or radiation to treat cancer when the cancer has spread, when it has come back (recurred), or when there is a strong chance that it could recur.
catheter: (cath-eh-tur) a thin, flexible tube through which fluids enter or leave the body.
cancer: malignancy; a group of diseases typified by abnormal, generally out-of-control, cell growth.
tumor: an abnormal lump or mass of tissue. Tumors can be benign (not cancerous) or malignant (cancerous).
mesothelioma: a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.

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