Researchers ponder lung RFA’s next stage

Radio-frequency ablation of lung malignancies has been proven technically feasible and safe. More studies are needed, however, to understand exactly where the technique applies in various patient populations, stages of disease, and tumor types.

A formal trial that may illuminate RFA's ultimate role in the clinical management of patients with lung cancer is under way, said Dr. Robert Suh, director of thoracic interventional services at the David Geffen School of Medicine at the University of California, Los Angeles.

The multicenter study will be conducted under the auspices of the American College of Radiology Imaging Network and the American College of Surgeons Oncology Group. The pilot study, already approved by the National Cancer Institute's Cancer Therapy Evaluation Program, may enroll about 50 patients and should begin sometime this year.

Researchers agree that, at this point, RFA cannot go head-to-head with surgery for small early-stage lung malignancies. Interventionalists normally ablate this type of tumor only in patients who have been deemed nonoperable due to high comorbidities, which often kill them before their tumors do.

Either for palliation or disease control, physicians may resort to RFA with discretion until more definitive data become available, said Dr. Riccardo Lencioni, an interventional radiologist at the University of Pisa in Italy.

Several studies reported at the RSNA meeting indicate the current status of RFA. Brown University researchers found that 60% of 126 inoperable patients who underwent RFA for tumor control are still alive, while 28% have died from causes unrelated to RFA. They also observed that, among complications, the pneumothorax rate was higher in cases in which expandable needles with multiple hooks had been deployed.

Lencioni and colleagues reported on 14 patients with stage IA non-small cell lung cancer who were unfit for surgery or radical radiotherapy. After one-year follow-up, his group recorded an overall survival rate of 81% and a cause-specific survival rate of 100%.

Boston researchers led by Dr. Eric vanSonnenberg, formerly an interventional radiologist at Brigham and Women's Hospital, found a one-year survival rate of 86% in 30 patients. The group used several procedures to assist RFA, including saline solution instillation, intercostal and paravertebral nerve blocks, and intraprocedural pneumothorax drainages.

Dr. Amanda Wallace, a resident at the Geffen School of Medicine, and colleagues found that long-term disease continued in half of 16 patients - at the RFA site in two cases and within the same lobe in one. An Italian team led by Dr. Giuseppe Belfiore from San Sebastiano Hospital in Caserta reported similarly negative results. Of 40 patients with primary lung cancer, 25 showed clinical improvement at six months, and 11 at one year.

For more information from the Diagnostic Imaging archives:

RF ablation of lung tumors wins support

Insurance companies line up to reimburse for liver RFA

RF tumor ablation breaks through in clinical practice

Brachytherapy boosts RFA for lung cancer